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1.  Analysis of computed tomography and pathological observations of non-Hodgkin lymphomas with peritoneal, omental and mesenteric involvement 
The aim of the present study was to evaluate the association between computed tomography (CT) images and the pathological observations of non-Hodgkin lymphoma (NHL) patients with peritoneal, omental and mesenteric involvement. In total, 26 patients suffering from an NHL with peritoneal, omental or mesenteric involvement were reviewed retrospectively, and the observed CT scan characteristics were analyzed. In addition, associations among the CT scan characteristics and the NHL subtypes, including diffuse large B-cell, mantle cell, follicular cell and T-cell lymphoma, were evaluated. The CT scan characteristics of the NHLs with peritoneal, omental and mesenteric involvement included peritoneal cord-like thickening, peritoneal omental nodular and swelling thickening, omental cake-like thickening and mesenteric mass. The probability of peritoneal linear, omental nodular and swelling thickening was found to be higher in diffuse large B-cell lymphoma cases compared with cases of other NHL subtypes (P<0.05). However, the probability of omental cake-like thickening and mesenteric mass was not found to be significantly different among the NHL subtypes (P>0.05). Signs of peritoneal, omental and mesenteric involvement were observed in the CT scans of all the NHL subtypes, particularly in diffuse large B-cell lymphoma cases. Therefore, linear, omental nodular and swelling thickening were characteristic of diffuse large B-cell lymphoma, while omental cake-like thickening and mesenteric mass were observed in all NHL subtypes.
doi:10.3892/etm.2015.2210
PMCID: PMC4316982  PMID: 25667648
abdomen; non-Hodgkin lymphoma; X-ray; computed tomography
2.  Omental cakes: unusual aetiologies and CT appearances 
Insights into Imaging  2011;2(4):399-408.
Background
Omental cakes typically are associated with ovarian carcinoma, as this is the most common malignant aetiology. Nonetheless, numerous other neoplasms, as well as infectious and benign processes, can produce omental cakes.
Methods
A broader knowledge of the various causes of omental cakes is valuable diagnostically and to direct appropriate clinical management.
Results
We present a spectrum of both common and unusual aetiologies that demonstrate the variable computed tomographic appearances of omental cakes.
Conclusion
The anatomy and embryology are discussed, as well as the importance of biopsy when the aetiology of omental cakes is uncertain.
doi:10.1007/s13244-011-0105-4
PMCID: PMC3259316  PMID: 22347961
Gastrointestinal; Malignancy; Infection; CT; Biopsy
3.  Omental cakes: unusual aetiologies and CT appearances 
Insights into Imaging  2011;2(4):399-408.
Background
Omental cakes typically are associated with ovarian carcinoma, as this is the most common malignant aetiology. Nonetheless, numerous other neoplasms, as well as infectious and benign processes, can produce omental cakes.
Methods
A broader knowledge of the various causes of omental cakes is valuable diagnostically and to direct appropriate clinical management.
Results
We present a spectrum of both common and unusual aetiologies that demonstrate the variable computed tomographic appearances of omental cakes.
Conclusion
The anatomy and embryology are discussed, as well as the importance of biopsy when the aetiology of omental cakes is uncertain.
doi:10.1007/s13244-011-0105-4
PMCID: PMC3259316  PMID: 22347961
Gastrointestinal; Malignancy; Infection; CT; Biopsy
4.  Misleading menorrhagia in a peri-menopausal woman with underlying bowel cancer: a case report 
Cases Journal  2008;1:36.
A peri-menopausal woman presented with symptoms and signs suggestive of fibroids. She was fit and healthy with no significant past medical history. She consented to having a hysterectomy but her surgery was performed prior to any diagnostic imaging being done.
At surgery there was an unexpected finding of disseminated carcinoma, diffusely infiltrating the uterus, fallopian tubes and ovaries. There was an omental cake that was biopsied. Frozen section showed signet ring cells, suggesting bowel carcinoma. Further intra-operative examination revealed a caecal tumour. After surgery she was investigated further and eventually referred for palliation, due to her advanced disease.
doi:10.1186/1757-1626-1-36
PMCID: PMC2488321  PMID: 18627620
5.  T-Cell lymphoproliferative disorder of hand-mirror cell morphology presenting in an eosinophilic loculated peritoneal effusion, with omental "caking" 
CytoJournal  2006;3:13.
Background
Cells with "hand mirror" morphology have not, to the best of our knowledge, been described in a primary effusion sample. This paper describes a case of T-cell lymphoma with eosinophilia in a patient with suspected peritoneal carcinomatosis. Rarely, a T-cell lymphoproliferative process may mimic primary peritoneal carcinomatosis, clinically suggested by a presentation in CT imaging of omental caking with bilateral massive loculated effusions in a patient without lymphadenopathy or splenomegaly.
Methods
A 60 year old caucasian male presented with vague abdominal discomfort and increasing abdominal girth. Computed tomography showed a two centimeter thick omental cake and a small loculated effusion. The clinical presentation and imaging findings were most consistent with peritoneal carcinomatosis. Cytologic evaluation of the effusion was undertaken for diagnostic study.
Results
Rapid intraprocedural interpretation of the effusion sample showed a monomorphic population of cells with "hand-mirror" cell morphology exhibiting cytoplasmic extensions (uropodia) with 3–5 course dark cytoplasmic granules and a rim of vacuolated cytoplasm capping the opposing "mirror head" side. These cells were seen within a background of mature eosinophils. Flow cytometric evaluation of the ascites fluid demonstrated an atypical T-cell population with the following immunophenotype: CD2-, CD3+, CD4-, CD5-, CD7-, CD8+, CD56+. T-cell receptor (TCR) gene rearrangement was positive for clonal TCR-gamma gene rearrangement, supporting the diagnosis of a T-lymphoprolifereative disorder.
Conclusion
A T-cell lymphoproliferative process may present with "hand mirror" morphology in an effusion sample. These cells may show polar cytoplasmic vacuolization and 3–5 course granules within the "handle" of these unique cells. Cytoplasm shows peripheral constriction around the nucleus.
doi:10.1186/1742-6413-3-13
PMCID: PMC1524978  PMID: 16681858
6.  The use of CT findings to predict extent of tumor at primary surgery for ovarian cancer 
Gynecologic oncology  2013;130(2):280-283.
Background
High tumor dissemination (HTD) is a major risk factor for serious morbidity after primary ovarian cancer (OC) surgery, particularly in medically compromised patients. We performed a pilot study of whether CT findings could predict extent of disease and surgical complexity necessary in advanced OC.
Methods
Preoperative CT images for patients with advanced OC from 1997–2003 were evaluated for rigorously defined disease-related findings and compared to both the findings at exploration and the required surgical procedures. Associations were assessed by the chi-square test.
Results
Forty-six cases met inclusion criteria. Mean age was 66.4 y, and 76% had residual disease (RD) 1cm or less. CT and surgical findings correlated (sensitivity/specificity) as follows: diaphragm disease (48%/100%); surface liver (100%/93%); omental cake (72%/65%); any sigmoid involvement (54%/100%); ascites (44%/100%); extra-pelvic large bowel involvement (29%/91%). When diaphragm disease and omental cake were present, HTD was found in all cases (positive predictive value and specificity=100%, sensitivity 48%). For CT findings of liver, large bowel and spleen involvement there was a strong trend toward resection (p=0.001, p=0.06 and p=0.06, respectively).
Conclusions
The findings of diaphragm disease and omental cake on CT scan are highly predictive for high tumor dissemination (HTD) and thus likelihood of extensive surgery required to achieve low residual disease. In addition, multiple CT findings correlate strongly with the need for higher surgical complexity which should facilitate preoperative planning and/or triage to specialized centers. These preliminary data suggest specific CT findings can be used to optimize treatment planning.
doi:10.1016/j.ygyno.2013.05.007
PMCID: PMC3753038  PMID: 23672930
Ovarian Neoplasms; Outcome Assessment; Radiologic Imaging; Cytoreduction
7.  Role of CT scan-based and clinical evaluation in the preoperative prediction of optimal cytoreduction in advanced ovarian cancer: a prospective trial 
British Journal of Cancer  2009;101(7):1066-1073.
Background:
In advanced ovarian cancer, maximal efforts have to be attemptedto achieve optimal cytoreduction, as this represents the keystone in the therapeutic management. This large, prospective study aims at investigating the role of computed tomography (CT) scan in predicting the feasibility of optimal cytoreduction in ovarian cancer.
Methods:
A total of 195 consecutive patients with clinical/radiographic suspicion of advanced ovarian/peritoneal cancer were enrolled at the Gynecologic Oncology Unit, Catholic University of Rome and Campobasso, Italy. Preoperative CT scans were performed with a high-speed scanner (CT Hi Speed Nx/i Pro; 2-slice; GE Medical System). All patients underwent standard laparotomy, and maximal surgical effort was attempted. The following CT parameters were used: peritoneal thickening, peritoneal implants >2 cm, bowel mesentery involvement, omental cake, pelvic sidewall involvement and/or hydroureter, suprarenal aortic lymph nodes >1 cm, infrarenal aortic lymph nodes >2 cm, superficial liver metastases >2 cm and/or intraparenchimal liver metastases any size, large volume ascites (>500 ml). Clinical data included were age, Ca125 serum levels, and ECOG-PS. Radiographic and clinical features exhibiting a specificity >75%, a positive and negative predictive value >50%, an accuracy >60% in predicting surgical outcome were assigned a point value of 2. With this scoring system, a predictive index (PI) was calculated for each patient.
Results:
The PI scores ranged from 0 to 6, and from 0 to 8, in Model 1 (including only radiographic parameters) and in Model 2 (including radiographic and clinical data). The AUC was 0.78+0.035 in Model 1, and 0.81+0.031 in Model 2. Therefore, the addition of ECOG-PS data led to the improvement of the diagnostic performances (z=2.41, P-value <0.05).
Conclusions:
Computed scan still represents a valid tool to predict ovarian cancer optimal cytoreduction; the predictive ability of a CT scan-based model is improved by integrating ECOG-PS data.
doi:10.1038/sj.bjc.6605292
PMCID: PMC2768100  PMID: 19738608
prospective trial; ovarian cancer; cytoreduction; predictive models; CT scan
8.  Laparoscopic omentectomy for preoperative diagnosis of torsion of the greater omentum 
Introduction
Torsion of the greater omentum is unusual. In most cases, the preoperative diagnosis was difficult due to the non-specific clinical presentation.
Presentation of case
We present a case of greater omental torsion in a 28-year-old man with an untreated right inguinal hernia since childhood. Computed tomography (CT) revealed characteristic signs of omental torsion, which was important in making correct diagnosis. We made correct preoperative diagnosis and performed laparoscopic omentecomy. The greater omentum distal to the twisted part was dark red and showed necrotic change. This case was secondary omental torsion associated with a right inguinal hernia.
Discussion
Omental torsion should always be included in the differential diagnosis of acute abdomen.
Conclusion
CT multi-planar reconstruction (MPR) imaging played a particularly important role in making a precise diagnosis. Laparoscopic approach could be useful in both diagnostic and therapeutic intervention. A successful laparoscopic omentectomy was performed in the present case.
doi:10.1016/j.ijscr.2011.11.004
PMCID: PMC3267276  PMID: 22288058
Omental torsion; Laparoscopic omentectomy; Omentum infarction
9.  Giant neoplastic omental cyst masquerading as ascites: a case report 
Cases Journal  2009;2:6482.
Introduction
Cystic lesion of the omentum and mesentery are rare. The incidence of both cyst types has been variously reported to vary from 1/27,000-100,000 hospital admission. Omental cysts occur three to ten times less frequently than mesenteric cyst. Preoperative diagnosis is infrequently made because of lack of characteristic symptoms and signs.
Case presentation
We present our diagnostic and management challenges in a 43-year-old man with an unusually giant omental cyst confirmed as fibrosarcoma at histology. The cyst gave the abdomen an anteroposterior diameter of about 74 cm that could not be penetrated sufficiently by X-ray photons to produce diagnostic image even at maximum attainable output. Patient benefited from surgical excision. The removed cyst contained about 35 litres of fluid.
Conclusion
Neglected omental cysts as in this case may grow to enormous size, undergo malignant transformation and poses serious diagnostic and surgical challenges.
doi:10.4076/1757-1626-2-6482
PMCID: PMC2769296  PMID: 19918526
10.  Experimental study of cake formation on heat treated and membrane coated needle felts in a pilot scale pulse jet bag filter using optical in-situ cake height measurement 
Powder Technology  2011;214(3-3):388-399.
Pulse-jet bag filters are frequently employed for particle removal from off gases. Separated solids form a layer on the permeable filter media called filter cake. The cake is responsible for increasing pressure drop. Therefore, the cake has to be detached at a predefined upper pressure drop limit or at predefined time intervals. Thus the process is intrinsically semi-continuous. The cake formation and cake detachment are interdependent and may influence the performance of the filter. Therefore, understanding formation and detachment of filter cake is important. In this regard, the filter media is the key component in the system. Needle felts are the most commonly used media in bag filters. Cake formation studies with heat treated and membrane coated needle felts in pilot scale pulse jet bag filter were carried out. The data is processed according to the procedures that were published already [Powder Technology, Volume 173, Issue 2, 19 April 2007, Pages 93–106]. Pressure drop evolution, cake height distribution evolution, cake patches area distribution and their characterization using fractal analysis on different needle felts are presented here. It is observed that concavity of pressure drop curve for membrane coated needle felt is principally caused by presence of inhomogeneous cake area load whereas it is inherent for heat treated media. Presence of residual cake enhances the concavity of pressure drop at the start of filtration cycle. Patchy cleaning is observed only when jet pulse pressure is too low and unable to provide the necessary force to detach the cake. The border line is very sharp. Based on experiments with limestone dust and three types of needle felts, for the jet pulse pressure above 4 bar and filtration velocity below 50 mm/s, cake is detached completely except a thin residual layer (100–200 μm). Uniformity and smoothness of residual cake depends on the surface characteristics of the filter media. Cake height distribution of residual cake and newly formed cake during filtration prevails. The patch size analysis and fractal analysis reveal that residual cake grow in size (latterly) following regeneration initially on the base with edges smearing out, however, the cake heights are not leveled off. Fractal dimension of cake patches boundary falls in the range of 1–1.4 and depends on vertical position as well as time of filtration. Cake height measurements with Polyimide (PI) needle felts were hampered on account of its photosensitive nature.
Graphical abstract
Cake formation studies with heat treated and membrane laminated needle felts has been carried out. Pressure drop evolution, cake patches area distribution and their fractal analyses are investigated. Results reveal that filter media may affect cake formation. A strong influence of the distribution of filter cake is also observed.
Highlights
► It is revealed that filter media has an influence on the evolution of pressure drop. ► Filter cakes of different heights exist on the needle felts. ► Cake formation is two dimensional (lateral and vertical) after regeneration contrary to one dimensional only (vertical).
doi:10.1016/j.powtec.2011.08.037
PMCID: PMC3886367  PMID: 24415801
Cake formation; Needle felts; Bag filter; In-situ; Cake height measurements
11.  Lipolytic signaling in response to acute exercise is altered in female mice following ovariectomy 
Journal of cellular biochemistry  2011;112(12):3675-3684.
Impaired ovarian function alters lipid metabolism, ultimately resulting in increased visceral fat mass. Currently, we have a poor understanding of alterations in signaling events regulating lipolysis after ovarian function declines. The purpose of this study was to determine if cellular mechanisms regulating lipolysis are altered in mice after ovariectomy (OVX) and if OVX mice exhibit impaired lipolytic signaling when stimulated by acute exercise. SHAM and OVX mice were divided into two groups: control (SHAM cont; OVX cont) or acute treadmill exercise (SHAM ex; OVX ex). The omental/mesenteric (O/M) fat mass of all OVX mice was significantly greater than the SHAM mice. Serum glycerol and blood glucose levels were significantly elevated in OVX cont compared to SHAM cont. Treadmill exercise increased serum glycerol levels only in SHAM mice, with no exercise-induced change detected in OVX mice. NEFA levels were significantly elevated by acute exercise in the SHAM and OVX groups. In O/M fat from both OVX groups there were significant increases in cytosolic ATGL and PLIN2 in the fat cake fraction with concurrent reductions in PLIN1 in the fat cake compared to SHAM. Further, exercise induced significant increases in HSL Ser660 phosphorylation in SHAM mice, but not OVX mice. This suggests that reduced ovarian function has significant effects on critical lipolytic cell signaling mechanisms in O/M adipose tissue.
doi:10.1002/jcb.23302
PMCID: PMC3202083  PMID: 21815195
Lipid; Adipose; Adipose Triglyceride Lipase; Lipolysis; PLIN; Female sex steroids
12.  Desmoplastic small round cell tumour in a 74 year old man: an uncommon cause of ascites (case report) 
Diagnostic Pathology  2011;6:55.
A rare case is provided of a 74 year old man who presented with ascites of unknown etiology. CT scan of the abdomen revealed extensive omental caking, and omental biopsy cytogenetics showed findings in keeping with a diagnosis of desmoplastic small round cell tumour (DSRCT). This case is unique in that it involves a significantly older patient, negative WT1 immunohistochemical staining, and negative cytology. Despite repeated paracenteses and fluid management, the patient died in hospital secondary to renal complications.
doi:10.1186/1746-1596-6-55
PMCID: PMC3132325  PMID: 21696639
13.  Omental torsion 
Omental torsion is a rare cause of acute abdominal pain, and clinically mimics acute appendicitis. A 11-year-old boy presented with symptoms and signs suggestive of appendicitis. A computed tomography of abdomen revealed findings suggestive of omental torsion. Diagnostic laparoscopy confirmed the diagnosis of torsion of a segment of the greater omentum.
doi:10.4103/0971-9261.44770
PMCID: PMC2788468  PMID: 20011502
Acute abdomen; appendicitis; omental torsion
14.  Idiopathic Omental Infarction, Diagnosed and Managed Laparoscopically: A Case Report 
Case Reports in Surgery  2013;2013:193546.
Idiopathic omental infarction is a rare cause of acute abdomen in adults, and the clinical finding can mimic acute appendicitis. Although idiopathic omental infarction is uncommon, the incidence of its detection has become more frequent as a result of advances in radiological technologies. We reported on a 21-year-old man who presented with sudden onset of intermittent right lower quadrant abdominal pain for seven days. The pain became more localized at the right iliac fossa (RIF) at day 2 before admission. A physical examination revealed a fever (38.2°C), severe RIF tenderness, mass-like fullness, and positive rebound tenderness. A CT of the abdomen showed inflammatory changes and increased fat density mass in the right upper quadrant measuring 5 × 4 cm representing focal panniculitis. However, the appendix was visualized normally and the findings were not in favor of acute appendicitis. Diagnosis was carried on laparoscopically. Serosanguinous free fluid was found in all abdominal quadrants. A 6 × 4 cm gangrenous omental mass was noted. The omental mass was excised and an appendectomy was performed. In summary, omental infarction should be considered as a deferential diagnosis for acute right-sided abdominal pain, especially if the clinical finding does not correspond to appendicitis.
doi:10.1155/2013/193546
PMCID: PMC3770034  PMID: 24062963
15.  Omental infarction in an obese 10-year-old boy 
Pediatric Reports  2011;3(3):e22.
Primary omental infarction (POI) has a low incidence worldwide, with most cases occurring in adults. This condition is rarely considered in the differential diagnosis of acute abdominal pain in childhood. Herein, we present a case of omental infarction in an obese 10-year-old boy who presented with acute abdominal pain in the right lower abdomen. The ultrasound (US) examination did not reveal the appendix but showed secondary signs suggesting acute appendicitis. The child was thus operated on under the preoperative diagnosis of acute appendicitis but the intra-operative finding was omental infarct. Since the omental infarct as etiology of acute abdominal pain is uncommon, we highlight some of the possible etiologies and emphasize the importance of accurate diagnosis and appropriate treatment of omental infarction.
doi:10.4081/pr.2011.e22
PMCID: PMC3207310  PMID: 22053266
abdominal pain; children; omental infarction.
16.  JcTI-I: a novel trypsin inhibitor from Jatropha curcas seed cake with potential for bacterial infection treatment 
Jatropha curcas seed cake is a low-value by-product resulting from biodiesel production. The seed cake is highly toxic, but it has great potential for biotechnology applications as it is a repository of biomolecules that could be important in agriculture, medicine, and industry. To explore this potential, a novel trypsin inhibitor called JcTI-I was purified by fractionation of the crude extract with trichloroacetic acid (2.5%, v/v) followed by affinity chromatography (Trypsin-Sepharose 4B) and molecular exclusion (Sephacryl S-200). Non-reducing sodium dodecyl sulfate-polyacrylamide gel electrophoresis and gel filtration showed that JcTI-I has approximately 20.0~kDa. Mass spectrometry analysis revealed that the intact molecular mass of JcTI-I is 10.252~kDa. Moreover, JcTI-I is a glycoprotein with 6.4% (m/m) carbohydrates, pI of 6.6, N-terminal sequence similarity around 60% to plant albumins and high stability to heat, pH, and salinity. JcTI-I presented antibacterial activity against the human pathogenic bacteria Salmonella enterica subspecies enterica serovar choleraesuis and Staphylococcus aureus, with minimum inhibitory concentration less than 5~μg/mL. Furthermore, JcTI-I did have inhibitory activity against the serine proteases from the tested bacteria. Otherwise, no hemolytic activity of human erythrocytes and signs of acute toxicity to mice were observed for JcTI-I. The results demonstrate the benefits of J. curcas seed cake as a source of trypsin inhibitor with potential for biotechnological application as a new antimicrobial agent against human pathogenic bacteria.
doi:10.3389/fmicb.2014.00005
PMCID: PMC3906595  PMID: 24523715
Jatropha curcas; seed cake; serine proteinase inhibitor; trypsin inhibitor; bacterial infections, antimicrobial agent
17.  Secondary Omental Infarction Related to Open and Laparoscopic-Assisted Distal Gastrectomy: Report of Two Cases 
Korean Journal of Radiology  2011;12(6):757-760.
Omental infarction occurring after open and laparoscopic-assisted distal gastrectomy with partial omentectomy for gastric cancer was a very rare disease in the past, but its incidence has increased as more partial omentectomies are now being performed. But there are few case reports or radiologic studies on its increasing incidence. It is necessary to differentiate omental infarction from carcinomatosis peritonei, since both have similar imaging findings. In this report, we describe two cases of omental infarction; each occurred after open and laparoscopic-assisted distal gastrectomy in early gastric cancer patients. Partial omentectomy was performed in both cases. Omental infarction following distal gastrectomy with partial omentectomy can be discriminated from carcinomatosis peritonei by comparing with different initial and follow up CT findings.
doi:10.3348/kjr.2011.12.6.757
PMCID: PMC3194783  PMID: 22043161
Omental infarction; Gastrectomy; CT; Carcinomatosis peritonei
18.  An unusual cause of abdominal pain 
BMJ Case Reports  2011;2011:bcr0920103370.
A 26-year-old man presented to the Emergency Department with abdominal pain, diarrhoea, anorexia and haematemesis. The patient was previously diagnosed with latent tuberculosis (TB). On examination, his abdomen was diffusely tender, with localised guarding in the right iliac fossa. CT imaging of his abdomen and pelvis demonstrated a low volume of ascites, diffuse studding of the peritoneum, omental caking and several bulky low-density lymph nodes in the retroperitoneum. A laparoscopy was performed to obtain a peritoneal biopsy. Histology demonstrated fragments of peritoneum with necrotising granulomatous inflammatory infiltrate in keeping with an infectious process, favouring TB. He was commenced on rifampicin, isoniazid, pyrazinamide, ethambutol and pyridoxine under the direct observed therapy by the infectious diseases team. In view of his extensive peritoneal involvement, he was empirically started on high-dose prednisolone for symptomatic control and to reduce complications related to peritoneal adhesions.
doi:10.1136/bcr.09.2010.3370
PMCID: PMC3062369  PMID: 22715270
19.  Florid diffuse peritoneal deciduosis mimicking carcinomatosis in a primigravida patient: a case report and review of the literature 
A case of a 27 year old G1P0 female with a dichorionic, diamniotic twin pregnancy presenting with premature rupture of membranes found to have omental caking and diffuse yellow-tan peritoneal nodules, clinically suspicious for carcinomatosis. The case work-up showed this to be an example of florid-diffuse peritoneal deciduosis mimicking carcinomatosis which has since resolved 4 months postpartum.
PMCID: PMC3816836  PMID: 24228129
Deciduosis; peritoneal; carcinomatosis; decidua; pregnancy
20.  Peritoneal Tuberculosis Mimicking Peritoneal Carcinomatosis 
Case Reports in Medicine  2014;2014:436568.
A 67-year-old male presented with fatigue, abdominal pain , and 30-pound weight loss over 3 months. Computerized tomography (CT) abdomen displayed ascites with thickening and enhancement of the peritoneum and mottled nodular appearing as soft tissue consistent with omental caking worrisome for peritoneal carcinomatosis. A paracentesis revealed white blood cell count of 2,500 with 98% lymphocytes and serum ascites albumin gradient of 0.9 g/L. No acid-fast bacilli were seen by microscopic exam and culture was negative. Purified protein derivative skin test (PPD) was negative and CXR did not reveal any infiltrates. Esophagogastroduodenoscopy (EGD) and colonoscopy were unrevealing. The patient underwent exploratory laparotomy with round ligament and peritoneal biopsies that revealed numerous necrotizing granulomas. Acid-fast bacteria Ziehl-Neelsen stain (AFB) of the biopsy specimen revealed single acid-fast bacilli. Treatment for M. tuberculosis was initiated and final culture revealed that mycobacterium tuberculosis was sensitive to Isoniazid, Rifampin, Ethambutol, and Pyrazinamide. After 6 months of treatment, the ascites and peritoneal carcinomatosis resolved.
doi:10.1155/2014/436568
PMCID: PMC3970461  PMID: 24715911
21.  A gastrointestinal stromal tumor with mesenteric and retroperitoneal invasion 
Background
Gastrointestinal stromal tumors are rare visceral sarcomas arising in the gastrointestinal tract wall. In this report we present a case of gastrointestinal stromal tumors with mesenteric and retroperitoneal invasion, describe and discuss its computed tomography findings.
Case presentation
A 57-years-old male patient has been complaining of abdominal distention, weight lose, and hematuria. During physical examination, significant distention and multiple palpable tumor masses were identified on the abdomen. Abdominal computed tomography showed multiple, well-defined, soft tissue masses with homogenous and heterogeneous pattern, in the mesenteric and retroperitoneal areas. Unlike specific features of gastrointestinal stromal tumor, renal obstruction and atypical central calcification without chemotherapy that has not been yet described were seen in this case. Computed tomography did not reveal liver metastases and/or the lymph nodes with pathological size. Ultrasonography-guided true-cut® biopsy was made, histopathologic and immunohistochemical analyses demonstrated stromal tumor which, C-KIT (+). The patient underwent left ureterectomy, left nephrectomy and total colectomy. Postoperative histopathological analyses revealed lower grade malignant GISTs. As of 17 months after the surgery, he is alive and free of recurrence.
Conclusion
When intraabdominal, multiple, large (>5 cm), well-circumscribed, homogenous or heterogeneous mass lesions without ascites, omental caking and lymph nodes metasteses were seen, gastrointestinal stromal tumors should be considered in the differential diagnosis.
doi:10.1186/1477-7819-5-121
PMCID: PMC2164961  PMID: 17958889
22.  A Case of KIT-Negative Extra-Gastrointestinal Stromal Tumor of the Lesser Omentum 
Case Reports in Gastroenterology  2012;6(2):375-380.
We report the unique case of a 69-year-old man with an extra-gastrointestinal stromal tumor (EGIST) in the lesser omentum. Based on the location of the tumor and the radiological findings, we made a provisional diagnosis of hepatic cavernous hemangioma in the lateral segment. However, after 5 years of follow-up, tumor growth was noted and the patient underwent a laparotomy. The tumor was located in the lesser omentum and resected en bloc with its fused lesser omentum and an adherent portion of the liver. The pathology results indicated an EGIST with microscopic proliferation of epithelioid cells in the lesser omentum; the tumor was immunohistochemically negative for KIT staining and positive for CD34 and PKC theta. Because of the rarity of mitotic figures and the low Ki-67 labeling, the tumor was diagnosed as a KIT-negative EGIST with a low malignant potential. The patient was followed up without receiving imatinib mesylate treatment and has remained free of any signs of recurrence for 26 months. The present case report describes a very rare lesser omental KIT-negative EGIST.
doi:10.1159/000337908
PMCID: PMC3398081  PMID: 22855655
Extra-gastrointestinal stromal tumor; KIT-negative; Lesser omentum
23.  Early Rupture of an Ultralow Duodenal Stump after Extended Surgery for Gastric Cancer with Duodenal Invasion Managed by Tube Duodenostomy and Cholangiostomy 
Case Reports in Surgery  2013;2013:430295.
When dealing with gastric cancer with duodenal invasion, gastrectomy with distal resection of the duodenum is necessary to achieve negative distal margin. However, rupture of an ultralow duodenal stump necessitates advanced surgical skills and close postoperative observation. The present study reports a case of an early duodenal stump rupture after subtotal gastrectomy with resection of the whole first part of the duodenum, complete omentectomy, bursectomy, and D2+ lymphadenectomy performed for a pT3pN2pM1 (+ number 13 lymph nodes) adenocarcinoma of the antrum. Duodenal stump rupture was managed successfully by end tube duodenostomy, without omental patching, and tube cholangiostomy. Close assessment of clinical, physical, and radiological signs, output volume, and enzyme concentration of the tube duodenostomy, T-tube, and closed suction drain, which was placed near the tube duodenostomy site to drain the leak around the catheter, dictated postoperative management of the external duodenal fistula.
doi:10.1155/2013/430295
PMCID: PMC3789440  PMID: 24159410
24.  Primary omental Gastrointestinal stromal tumor (GIST) 
Background
We report herein a rare case of primary omental gastrointestinal stromal tumor (GIST).
Case presentation
A 65 year-old man was referred to our hospital with a huge abdominal mass occupying the entire left upper abdomen as shown by sonography. On computed tomography (CT), this appeared as a heterogeneous low-density mass with faint enhancement. Abdominal angiography revealed that the right gastroepiploic artery supplied the tumor. With such an indication of gastric GIST, liposarcoma, leiomyosarcoma or mesothelioma laparotomy was performed and revealed that this large mass measured 20 × 17 × 6 cm, arising from the greater omentum. It was completely resected. Histopathologically, it was composed of proliferating spindle and epithelioid cells with an interlacing bundle pattern. Immunohistochemically, the tumor was positive for myeloid stem cell antigen (CD34), weakly positive for c-KIT (CD117) and slightly positive for neuron-specific enolase (NSE), but negative for cytokeratin (CK), alpha-smooth muscle actin (SMA) and S-100 protein. A mutation was identified in the platelet-derived growth factor alpha (PDGFRA) juxtamembrane domain (exon 12, codon561) and the tumor was diagnosed as an omental GIST. The postoperative course was uneventful. The patient is treated by Glevec® and is alive well with no sign of relapse.
Conclusion
Our case demonstrated a weak immunohistochemical expression of c-kit (CD117) and a point mutation in PDGFRA exon 12 resulting in an Asp for Val561 substitution. Imatinib therapy as an adjuvant to complete resection has been carried out safely. Because of the rarity of primary omental GISTs, it is inevitable to analyze accumulating data from case reports for a better and more detailed understanding of primary omental GISTs.
doi:10.1186/1477-7819-5-66
PMCID: PMC1924523  PMID: 17565683
25.  Genetically Modified Flax Expressing NAP-SsGT1 Transgene: Examination of Anti-Inflammatory Action 
The aim of the work was to define the influence of dietary supplementation with GM (genetically modified) GT#4 flaxseed cake enriched in polyphenols on inflammation development in mice liver. Mice were given ad libitum isoprotein diets: (1) standard diet; (2) high-fat diet rich in lard, high-fat diet enriched with 30% of (3) isogenic flax Linola seed cake; and (4) GM GT#4 flaxseed cake; for 96 days. Administration of transgenic and isogenic seed cake lowered body weight gain, of transgenic to the standard diet level. Serum total antioxidant status was statistically significantly improved in GT#4 flaxseed cake group and did not differ from Linola. Serum thiobarbituric acid reactive substances, lipid profile and the liver concentration of pro-inflammatory cytokine tumor necrosis factor-α were ameliorated by GM and isogenic flaxseed cake consumption. The level of pro-inflammatory cytokine interferon-γ did not differ between mice obtaining GM GT#4 and non-GM flaxseed cakes. The C-reactive protein concentration was reduced in animals fed GT#4 flaxseed cake and did not differ from those fed non-GM flaxseed cake-based diet. Similarly, the liver structure of mice consuming diets enriched in flaxseed cake was improved. Dietetic enrichment with GM GT#4 and non-GM flaxseed cakes may be a promising solution for health problems resulting from improper diet.
doi:10.3390/ijms150916741
PMCID: PMC4200857  PMID: 25247574
genetically modified flax; seed cake; flavonoid glycosides; inflammation; food safety; mouse

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