levoleucovorin and Hernia--Inguinal

Pseudomyxoma peritonei is a disease that results from a perforated mucinous neoplasm of the appendix so that mucinous ascites and mucin-producing tumor cells are widely disseminated in a characteristic pattern throughout the abdomen and pelvis. The intraabdominal mucus can accumulate in the inguinal canal and by physical examination be indistinguishable from the usual inguinal hernia.. A database of patients with pseudomyxoma peritonei was used to identify patients who had an inguinal hernia prior to or at the time of cytoreductive surgery (CRS) and perioperative hyperthermic chemotherapy (HIPEC). At the time of CRS, care was taken in all patients to remove the peritoneal lining of the inguinal canal. Patients who had the inguinal hernia repaired prior to definitive treatment with CRS and HIPEC had all tissue and mesh associated with prior herniorrhaphy resected.. In 178 pseudomyxoma peritonei patients, 17 had a new onset or previously repaired inguinal hernia that required extraction of mucus and mucinous tumor from the hernia site. No repair of the open inguinal canal was attempted at the time of CRS. No recurrent inguinal hernias were recorded and no patients required an inguinal incision at a later time to resect progressive disease within the inguinal canal.. Inguinal hernias caused by mucinous ascites and tumor were definitively treated by cytoreductive surgery plus HIPEC. Extraction of tumor and peritoneum from the inguinal canal facilitates fibrous closure of the hernia defect so that hernia recurrence was not observed.

Topics: Adenocarcinoma, Mucinous; Adult; Aged; Antineoplastic Combined Chemotherapy Protocols; Appendiceal Neoplasms; Ascites; Cytoreduction Surgical Procedures; Doxorubicin; Female; Fluorouracil; Hernia, Inguinal; Humans; Hyperthermia, Induced; Infusions, Parenteral; Inguinal Canal; Leucovorin; Male; Middle Aged; Mitomycin; Mucus; Peritoneal Neoplasms; Pseudomyxoma Peritonei; Retrospective Studies; Tomography, X-Ray Computed

We report a case of aggressive resection of synchronous and asynchronous peritoneal dissemination of colon cancer, including metastasis to the inguinal hernia sac. A 68-year-old man who was examined for anemia was diagnosed with ascending colon cancer. He underwent right hemicolectomy and resection of the disseminated tumors at the omentum and peritoneum near the Treitz ligament (moderately differentiated tubular adenocarcinoma, pT4a [SE] N0M1P2H0, stageⅣ). After 1 year 6 months, he was readmitted for intestinal obstruction due to the recurrence of peritoneal dissemination, and underwent partial resection of the ileum, liver, and right kidney. In the CT scan examination before surgery, right inguinal hernia and tumor were identified, and hernioplasty with resection of the inguinal tumor was subsequently performed after intestinal obstruction resolution. All tumors were identified as peritoneal dissemination of the colon cancer tumors by pathological examination. After surgery, he was treated with mFOLFOX6 for 6 months and survived without signs of recurrences despite the absence of treatment. Even in cases of peritoneal recurrence of colon cancer, aggressive resection may improve the prognosis in some cases.

Topics: Adenocarcinoma; Aged; Antineoplastic Combined Chemotherapy Protocols; Colectomy; Colonic Neoplasms; Fluorouracil; Hernia, Inguinal; Humans; Leucovorin; Male; Organoplatinum Compounds; Peritoneal Neoplasms; Recurrence

Effective systemic therapy for advanced pseudomyxoma peritonei (PMP) is the focus of investigation. We describe a case of PMP arising from an adenoma of the appendix in a 58-year-old man. First, the patient underwent explorative laparotomy with ileocoecal resection, but without possibility of major tumor debulking due to adhesive gross tumor masses. Subsequently, six cycles of Folfox IV chemotherapy were administered, without response, but with severe side effects. Upon progressive disease, a combination of bevacizumab and capecitabine led to a long term stabilization of disease and obvious improvement of performance status. Our case suggests that modulation of tumor microenvironment and angiogenesis by bevacizumab, potentially augmented by moochemotherapy, may be beneficial in borderline tumors such as PMP.

Topics: Adenoma, Villous; Angiogenesis Inhibitors; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Appendiceal Neoplasms; Bevacizumab; Capecitabine; Combined Modality Therapy; Deoxycytidine; Disease Progression; Fluorouracil; Hernia, Inguinal; Humans; Ileocecal Valve; Leucovorin; Male; Middle Aged; Organoplatinum Compounds; Peritoneal Neoplasms; Pseudomyxoma Peritonei; Treatment Outcome