The emergence of malignant ascites (MA) indicates poor prognoses in patients with ovarian, gastrointestinal, breast, and pancreatic cancer. Interleukin-10 (IL-10) is a pleiotropic cytokine with immunoregulatory effects in tumor microenvironment. The level of IL-10 in MA varied across cancer types and patients, influencing cancer progression and outcomes. Originating from various immune and cancer cells, IL-10 contributes to complex signaling pathways in MA. Systemic IL-10 administration, although the evidence of its efficacy on MA is limited, still emerges as a promising therapeutic strategy because it can increase CD8+ T cells cytotoxicity and invigorate exhausted CD8+ tumor infiltration lymphocytes (TILs) directly. IL-10 signaling blockade also demonstrates great potential when combined with other immunotherapies in MA treatment. We reviewed the levels, origins, and functions of IL-10 in malignant ascites and overviewed the current IL-10 signaling targeting therapies, aiming to provide insights for MA treatment. 

The complex role of IL-10 in malignant ascites: a review

A pleural effusion is a common pulmonary manifestation of systemic lupus erythematosus (SLE), and differential diagnosis is needed to perform targeted treatments. An SLE patient with refractory chylothorax is presented. Chylothorax rarely occurs in SLE patients and occasionally follows a refractory clinical course despite intensive treatment with immunosuppressive therapies, resulting in a poor prognosis with malnutrition caused by frequent thoracenteses. In such cases, pleuro-peritoneal and peritoneal-venous shunts along with cell-free and concentrated ascites re-infusion therapy might be effective to improve the dyspnea while maintaining nutrition. 

Refractory bilateral chylothorax and chylous ascites in a patient with systemic lupus erythematosus treated by pleuro-peritoneal and peritoneal-venous shunts along with cell-free and concentrated ascites re-infusion therapy

For cirrhotic refractory ascites, diuretics combined with albumin and vasoactive drugs are the first-line choice for ascites management. However, their therapeutic effects are limited, and most refractory ascites do not respond to medication treatment, necessitating consideration of drainage or surgical interventions. Consequently, numerous drainage methods for cirrhotic ascites have emerged, including large-volume paracentesis, transjugular intrahepatic portosystemic shunt, peritoneovenous shunt, automated low-flow ascites pump, cell-free and concentrated ascites reinfusion therapy, and peritoneal catheter drainage. This review introduces the advantages and disadvantages of these methods in different aspects, as well as indications and contraindications for this disease. 

Drainage of ascites in cirrhosis

Abstract Background Cardiac ascites is a classical finding of right-sided heart failure, mainly caused by tricuspid valve disease and constrictive pericarditis. Refractory cardiac ascites, defined as ascites that is uncontrollable with any medication, including conventional diuretics and selective vasopressin V2 receptor antagonists, is a rare but challenging entity. Although cell-free and concentrated ascites reinfusion therapy (CART) is a therapeutic option for refractory ascites in patients with liver cirrhosis and malignancy, its efficacy in cardiac ascites has never been reported. We herein report a case of CART for refractory cardiac ascites in a patient with complex adult congenital heart disease (ACHD). Case summary A 43-year-old Japanese female with a history of ACHD involving single ventricle haemodynamics presented with refractory massive cardiac ascites due to progressive heart failure. Because conventional therapy using diuretics could not control her cardiac ascites, abdominal paracentesis was frequently required, resulting in hypoproteinaemia. Therefore, CART was initiated once per month in addition to conventional therapies, which enabled the prevention of hypoproteinaemia and further hospitalizations except to undergo CART. In addition, it helped improve her quality of life without any complications for 6 years until she died from cardiogenic cerebral infarction at the age of 49 years. Discussion This case demonstrated that CART can be safely performed in patients with complex ACHD and refractory cardiac ascites due to advanced heart failure. Thus, CART may improve refractory cardiac ascites as effectively as massive ascites caused by liver cirrhosis and malignancy and lead to an improvement in the patients’ quality of life.

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Cell-free and concentrated ascites reinfusion therapy for refractory massive cardiac ascites in an adult with single ventricle haemodynamics: a case report

Background: Ascites, the accumulation of fluid in the peritoneal cavity, poses significant diagnostic challenges, particularly in differentiating between malignancy-related ascites (MRA) and non-malignant ascites (NMA). This differentiation is critical for appropriate clinical management.
Objective: The study aimed to evaluate the diagnostic value of ascitic fluid cholesterol levels in distinguishing MRA from NMA.
Methods: This cross-sectional study enrolled 48 patients with ascites, divided equally into Group A (MRA) and Group B (NMA). Diagnostic paracentesis was performed, and 20 ml of ascitic fluid was collected for analysis. Cholesterol levels were measured using the Zaks method. Demographic data were recorded, and statistical analysis was conducted using the Mann-Whitney U-test, with a p-value of 0.05 set for statistical significance.
Results: Both groups had an equal gender distribution (12 males and 12 females in each), and the mean ages were 60.3 ± 19.1 years for Group A and 60.8 ± 17.9 years for Group B. The mean cholesterol level in ascitic fluid was significantly higher in Group B (189.9 ± 29.9 mg%) compared to Group A (167.73 ± 26.87 mg%), with mean standard deviations of 91.8 ± 12.4 and 20.4 ± 9.1, respectively. The p-values for gender distribution and age differences were <0.001.
Conclusion: The study demonstrated that cholesterol levels in ascitic fluid are a reliable biomarker for differentiating between MRA and NMA. Higher cholesterol levels were associated with non-malignant cases, offering a non-invasive, cost-effective diagnostic tool in clinical settings.

Diagnostic Value of Ascitic Fluid Cholesterol Level in Differentiating Malignant Ascites from Non-Malignant Ascites

Background: Malignancy-related ascites (MRA) is one of the symptoms causing discomfort in advanced cancer patients. Cell-free and concentrated ascites reinfusion therapy (CART) is one of the palliative treatments widely conducted in Japan only. Methods: A systematic review following a meta-analysis of CART was performed. The efficiency and adverse events were evaluated. Results: A total of 2567 patients and 6013 procedures of CART were identified in this study. The mean volume of MRA collected was 4.29 (95% confidence interval (CI) 3.47–5.11) L, and the volume reinfused after concentrating was 0.49 (95% CI 0.39–0.60) L. A total of 86.1 (95% CI 77.1–95.2) g protein and 42.9 (95% CI 36.0–50.0) g albumin was reinfused. The mean time to the next paracentesis was 20.7 (95% CI 15.6–25.8) days. The body weight was reduced by 3.38 (95% CI 1.90–4.86; p < 0.01) kg, and abdominal circumference was reduced by 7.86 (95% CI 6.58–9.14; p < 0.001) cm. Serum albumin increased an average of 0.14 (95% CI −0.01–0.28; p = 0.07) mg/dL the day after CART. Abdominal distension, dyspnea, and fatigue were alleviated by 6.0 (95% CI 5.59–6.51), 2.66 (95% CI 2.05–3.28), and 2.64 (95% CI 1.86–3.42) points using a numerical rating scale system ranging from 0 to 10. Overall, 17% (95% CI 0.03–0.31%) of patients had improved performance status after CART. Significant body temperature elevation was observed, at an average of 0.4 °C (95% CI 0.18–0.62 °C). Conclusions: CART might be a safe and effective palliative therapy in MRA and further clinical trials are necessary.

Effectiveness of Cell-Free and Concentrated Ascites Reinfusion Therapy in the Treatment of Malignancy-Related Ascites: A Systematic Review and Meta-Analysis

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Effectiveness of Cell-Free and Concentrated Ascites Reinfusion Therapy in the Treatment of Malignancy-Related Ascites: A Systematic Review and Meta-Analysis