Arch Gynecol Obstet (2010) 282:115–116 DOI 10.1007/s00404-009-1343-2
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Primary peritoneal carcinoma: a diagnostic dilemma Rachna Agarwal · Sonal Sharma · Kiran Guleria · Gita Radhakrishnan · A. G. Radhika
Received: 12 October 2009 / Accepted: 15 December 2009 / Published online: 31 December 2009 © Springer-Verlag 2009
Dear Sir, We read with deep interest the report by Bhuyan et al. [1] detailing diagnosis and management aspects of extra ovarian primary peritoneal carcinoma (EOPPC). Indeed the clinician is intrigued by the presentation of EOPPC and equally challenging is the management because of limited guidance available in literature with these tumours. We recently diagnosed EOPPC in a 62-year-old lady and would like to share the atypical presentation of the carcinoma. This patient had received six cycles of chemotherapy (paclitexal and cisplatin) for papillary adenocarcinoma. At prior exploratory laparotomy, there was an inoperable mass adherent to transverse colon serosa with liver metastasis. As no primary site of tumour was discernable, biopsies from peritoneum and peritoneal washings were taken revealing papillary adenocarcinoma. Post chemotherapy, computed tomography scan showed resolution of ascitis, normal-sized bilateral adnexa and uterus; however, omental thickening and liver metastasis still persisted. Serum CA125 level decreased from 200 to 17.5 IU/ml. At subsequent debulking laparotomy, there was no free Xuid in abdomen but a large desmoplastic transverse colon [2] was seen. The
uterus with bilateral adnexa was normal in size and shape; however, multiple hard peritoneal deposits ranging 1–10 cm in size were present in the mesentery, inWltrating up to the wall of transverse colon. Panhysterectomy and resection of transverse colon mass was done. The second laparotomy again could not reveal the primary site of tumour. Repeated histopathology of colonic segment showed serous papillary adenocarcinoma with numerous psammoma bodies inWltrating serosa and reaching up to muscularis propria. Both ovaries showed superWcial cortical involvement by the same tumour (Figs. 1, 2). Serosal aspect of both fallopian tubes, mesentery and parametrium were also studded with the same tumour. Since the gynaecologic oncology group criteria were fulWlled in our case, a diagnosis of EOPPC was rendered [3]. In our case, positive immunostaining for pan-cytokeratin (CK) and estrogen receptor, and negative staining for calretinin further supported the
R. Agarwal (&) · K. Guleria · G. Radhakrishnan · A. G. Radhika Department of Obstetrics and Gynaecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, 4/103 East End Apartments, Mayur Vihar Ph-I Extension, Shahdara, Delhi 110096, India e-mail:
[email protected] S. Sharma Department of Pathology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
Fig. 1 Sections from solid area showing inWltrative glands with focal papillary fronds and numerous psammoma bodies (H & E £200)
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Arch Gynecol Obstet (2010) 282:115–116
EOPPC thus presents with subtle clinical signs, and the diagnosis can be missed easily if not suspected and speciWcally looked for. A varied presentation such as a desmoplastic colon awaits surgeon and patient morbidity is increased due to failure to diagnose the case at primary laparotomy. To conclude, EOPPC should always be kept in diVerential diagnosis in elderly females investigated for advanced ovarian carcinoma. ConXict of interest statement
None.
References
Fig. 2 Section from ovary showing hyperplastic ovarian stroma with tumour cells only at periphery in serosa in form of numerous psammoma bodies and small atypical glands (H & E £40)
diagnosis of papillary carcinoma. The patient was followed up in oncology department for further chemotherapy.
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1. Bhuyan P, Mahapatra S, Mahapatra S, Sethy S, Parida P, Satpathy S (2009) Extraovarian primary peritoneal papillary serous carcinoma. Arch Gynecol Obstet. doi:10.1007/s00404-009-1201-2 2. Krestin GP, Beyer D, Lorenz R (1985) Secondary involvement of the transverse colon by tumors of the pelvis: spread of malignancies along the greater omentum. Gastrointest Radiol 10:283–288 3. Eltabbakh GH, Piver MS (1998) Extraovarian primary peritoneal carcinoma. Oncology 129:813–825
