Characteristics of ascitic fluid in ovarian carcinomatosis
Sánchez-Lombraña, J.L.; De la Vega, J.; Fernández, E.; Pérez, R.; Linares, A.; Rodríguez, M.; Rodrígo, L.
Revista Espanola de Enfermedades Digestivas Organo Oficial de la Sociedad Espanola de Patologia Digestiva 87(2): 127-138
1995
ISSN/ISBN: 1130-0108 PMID: 7748705 Document Number: 453454
Objectives: To study the characteristics of ascitic fluid in cases of malignant ascites secondary to ovarian carcinoma. To determine the diagnostic value of several ascitic fluid parameters in differentiating ovarian carcinomatosis from malignant ascites secondary to other malignancies, tuberculous peritonitis and sterile cirrhotic ascites. Design: Fifty two patients with malignant ascites, tuberculous peritonitis and sterile cirrhotic ascites were studied. The values of total protein, cell count, pH, lactate, lactic dehydrogenase, leucinaminopeptidase, amylase and glucose were determined in ascitic fluid and in serum. Their blood-ascites gradients were calculated. Patients: Patients were divided in four groups: 15 patients with malignant ascites secondary to ovarian carcinoma (group I), were compared with 7 patients with ascites secondary to other malignancies (group II), 10 with tuberculous peritonitis (group III), and 20 with cirrhotic ascites (group IV). In the groups, I, II and III, the diagnosis was confirmed by histologic examination of peritoneal tissue obtained during laparoscopy. Results: Increased levels of ascitic fluid total protein (p lt 0.001), lactic dehydrogenase (p lt 0.05), leucinaminopeptidase (p lt 0.05) and amylase (p lt 0.05), and lactic dehydrogenase ascites/serum ratio gt 0.6 (p lt 0.001) were found in group I when compared with group IV. A decreased ascitic fluid pH (p lt 0.001) and an increase in its blood-ascitic gradient (p lt 0.01) were also observed in the group I in comparison with group IV. No significant differences were found between group I when compared with groups II and III. Ascitic fluid cytology revealed malignant cells in 53.3% of patients with ovarian carcinoma and in 85.7% of non-ovarian origin tumours. Conclusions: On the basis of ascitic fluid biochemical tests, ovarian carcinomatosis is clearly different from cirrhotic ascites, however is indistinguishable from other malignant ascites and is very similar to tuberculous peritonitis. When cytology in the ascitic fluid is negative, laparoscopy and peritoneal biopsy seems mandatory for establishing a definite diagnosis.