Spontaneous Regression Of Ovarian Carcinoma After Septic Peritonitis; A Unique Case Report
Roelofsen, T., Wefers, C., Gorris, M. A. J., Textor, J. C., Massuger, L. F. A. G., de Vries, I. J. M., & van Altena, A. M. (2018). Spontaneous Regression of Ovarian Carcinoma After Septic Peritonitis; A Unique Case Report. Frontiers in oncology, 8, 562. https://doi.org/10.3389/fonc.2018.00562
View Original Source →Abstract
Despite advances in therapy, ovarian cancer remains the most lethal gynecological malignancy and prognosis has not substantially improved over the past 3 decades. Immunotherapy is a promising new treatment option. However, the immunosuppressive cancer microenvironment must be overcome for immunotherapy to be successful. Here, we present a unique case of spontaneous regression of ovarian carcinoma after septic peritonitis. A 79-year-old woman was diagnosed with stage IIIc ovarian cancer. The omental cake biopsy was complicated by sepsis. Although the patient recovered, her physical condition did not allow further treatment for her ovarian cancer. After 6 months, spontaneous regression of the tumor was observed during surgery. Analysis of the immune infiltrate in the tissues showed a shift from a pro-tumorigenic to an anti-tumorigenic immune response after sepsis. Strong activation of the immune system during sepsis overruled the immunosuppressive tumor microenvironment and allowed for a potent anti-tumor immune response. More understanding of immunological responses in cases with cancer and septic peritonitis might be crucial to identify potential new targets for immunotherapy.
Case Details
Disease Location
Ovaries
Personal Characteristics
79-year-old woman
Clinical Characteristics
Increasingly distended abdomen, fatigue and dyspnoea. CT-scan, an enlarged ovary and extensive ascites with omental cake were demonstrated. Ca-125 tumor marker was elevated. Histopathological results of an omental biopsy and prior aspiration of ascitic fluid the diagnosis of stage iiic epithelial ovarian cancer was established. She was discharged from the hospital with palliative comfort care. Biopsy was complicated by a septic peritonitis
Remission Characteristics
Six months later, she was referred for a second opinion. During physical examination she did not show signs of lymphadenopathy, ascites or an abdominal mass. The serum marker ca-125 was normal. CT-scan: both ovaries were slightly enlarged. There were no signs of free fluid, ascites, omental cake, peritonitis carcinomatosis, or other abnormalities. Biopsy showed a high-grade serous carcinoma was noted within the left ovary. There were no tumor deposits detected in the right ovary, the omentum or in any of the other biopsies.
Treatment & Mechanisms
Proposed Remission Mechanisms
Sepsis is able to overrule the immunosuppressive tumor microenvironment, inducing a long- lasting anti-tumor immune response
Clinical Treatment
None reported