Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2018; 24(19): 2130-2136
Published online May 21, 2018. doi: 10.3748/wjg.v24.i19.2130
Pressurized intraperitoneal aerosol chemotheprapy after misdiagnosed gastric cancer: Case report and review of the literature
Maciej Nowacki, Dariusz Grzanka, Wojciech Zegarski
Maciej Nowacki, Wojciech Zegarski, Department of Surgical Oncology, Ludwik Rydygier’s Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital in Bydgoszcz, Bydgoszcz 85-796, Poland
Dariusz Grzanka, Department of Clinical Pathomorphology, Ludwik Rydygier’s Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz 85-094, Poland
Author contributions: Nowacki M designed the report and wrote the paper; Nowacki M and Zegarski W collected the patient’s clinical data, analyzed the data; Zegarski W reviewed the article; Grzanka D performed the histopatological analyses.
Informed consent statement: Written informed consent from patient involved in this study was received prior to study inclusion. All details that might disclose the identity of the subjects under study were omitted or anonymized.
Conflict-of-interest statement: Authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Maciej Nowacki, MD, MSc, PhD, Doctor, Lecturer, Research Scientist, Surgical Oncologist, Department of Surgical Oncology, Ludwik Rydygier’s Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Oncology Centre-Prof. Franciszek Łukaszczyk Memorial Hospital in Bydgoszcz, ul. Romanowskiej 2, Bydgoszcz 85-796, Poland. maciej.nowacki@cm.umk.pl
Telephone: +48-52-3743420 Fax: +48-52-3743412
Received: January 30, 2018
Peer-review started: January 31, 2018
First decision: February 24, 2018
Revised: March 22, 2018
Accepted: March 31, 2018
Article in press: March 31, 2018
Published online: May 21, 2018
ARTICLE HIGHLIGHTS
Case characteristics

A 49-year-old female patient with reduced general condition and nutritional status (low BMI and weight loss in the nutritional anamnesis) was admitted after bilateral hysterectomy with a diagnosis of diffuse peritoneal carcinomatosis and several co-morbidities.

Clinical diagnosis

The final clinical diagnosis was made by upper gastrointestinal (GI) endoscopy combined with a pathological assay that showed a mucin-positive, poorly differentiated adenocarcinoma located in the gastric antral mucosa.

Differential diagnosis

The differential diagnosis included severe peritoneal carcinomatosis and primary origin cancer with a particular emphasis on ovarian cancer.

Laboratory diagnosis

Despite the patient’s reduced general condition and nutritional status, all of the performed laboratory tests were within normal limits.

Imaging diagnosis

The CT scan performed during hospitalization in our department showed an additional superficially located metastasis in liver segment 5.

Pathological diagnosis

In this case, staining revealed CK7(+), CK20(-), CDX2(+) and CA125(-) status, suggesting a primary tumor originating from the upper GI- tract. A postoperative upper GI endoscopy showed a mucin-positive, poorly differentiated adenocarcinoma located in the gastric antral mucosa.

Treatment

The PIPAC procedure was based on the administration of a solution of low-dose cisplatin (7.5 mg/m2 BSA) and doxorubicin (1.5 mg/m2) BSA diluted in 200 mL of saline solution aerosolized at a pressure of 12 mmHg and a temperature of 37 °C into the abdomen using a CE-certified nebulizer as neoadjuvant therapy before palliative D2 gastrectomy combined with liver metastasectomy.

Related reports

Very few cases of spontaneous regression of an intra-abdominal inflammatory myofibroblastic tumor have been reported in the literature. The clinical and pathological characteristics of inflammatory myofibroblastic tumors remain unclear, and the treatment is controversial.

Term explanation

The acronym PIPAC describes pressurized intraperitoneal aerosol chemotherapy (PIPAC).

Experiences and lessons

This case might contribute to future confirmation of the usefulness of PIPAC as a rescue or neoadjuvant, supportive form of therapy in a very select group of patients. This clinical development might be particularly important for patients with a KT presentation of gastric cancer who have been recently qualified to undergo classic chemotherapy or standard oncologic surgical procedures.