Lege Artis Medicinae

[DIAGNOSTIC PROCEDURES AND SUCCESSFUL TREATMENT OF A RARE INTRAABDOMINAL NEOPLASM IN AN UNCOMMON LOCALISATION]

KIS János Tibor, PÁLHEGYI Erika

OCTOBER 20, 2003

Lege Artis Medicinae - 2003;13(07)

[INTRODUCTION - Primary neoplasms of the grater omentum are rarely revealed. The primitive neuroectodermal tumor of the grater omentum is extremely rare, only one case has been reported in the English literature. CASE REPORT - We report a case of an omental tumour occurring in a 50-year-old man with HBV-positive liver cirrhosis (Child C). The patient had regular check-ups in our outpatient clinic. One of the regular ultrasound scans revealed an epigastrial space-occupying lesion, which was not seen previously. The symptoms and the laboratory tests did not suggest an intraabdominal malignancy. Abdominal CT scan did not raise the suspicion of a neoplastic lesion either. Some weeks later a sudden increase in the amount of ascites has developed. A repeated abdominal ultrasound scan detected the tumour again. The reassessment of the CT scan provided some suspicion of the presence of an abdominal neoplasm. After draining the ascitic fluid by paracentesis an apple-sized nodule was palpable. Abdominal US-guided biopsy was performed. On histopathological examination the diagnosis of a primary peritoneal neuroectodermal tumour was made. Laparotomy proved the precise location but the tumorous conglomeration could not be removed as a whole. Following surgery the patient was treated in the oncology department and a significant improvement could be achieved. CONCLUSION - This case highlights the importance of the correlation of the clinical data and imaging techniques and the necessity of regular patient follow-up.]

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[Interferon-α proved to be the most effective therapy of chronic hepatitis C. Its combination with ribavirin enhances the antiviral activity and this modality has become the therapeutic standard recommended worldwide during the past few years. Metaanalysis of the international studies revealed that only 12-19% of the patients became virus-free following a 48-week long course of α interferon monotherapy. The combination treatment with ribavirin for 48 weeks increased the proportion of sustained responders to 35-45%. The introduction of pegylated interferons resulted in significantly higher response rates. The new therapeutic possibilities are due to the modified pharmacokinetic characteristics of the drug by changing the size and the structure of the molecules. Multicentre studies investigating the clinical effectiveness of the 40 kD sized pegylated interferon α-2a as well as the 12 kD sized pegylated interferon α-2b in combination with ribavirin reported 56% and 54% response rate, respectively. However, there is significant heterogeneity in the results according to the type of drug administered and to the genotype of the hepatitis C virus, as well as in the basal viral level and the stage of hepatic fibrosis, respectively. The message and the conclusion of the viral kinetic studies are worth remembering: if the result of the HCV nucleic acid test is still positive at week 12 or 24, therapy should be ceased due to the patient non-responder status. Since pegylated interferons are also available in Hungary the authors felt useful to give an overview of the current knowledge, summarizing the results of the relevant studies and provide a suggested state-of-the-art therapeutic protocol based on international consensus.]

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