American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
Open Access
Journal Browser
Go
American Journal of Medical Case Reports. 2015, 3(8), 239-243
DOI: 10.12691/ajmcr-3-8-5
Open AccessCase Report

Primary Peritoneal Carcinoma: A Case Report of Primary Peritoneal Papilary Serous Adenocarcinoma in a 59 Year Old Postmenopausal Woman

Solomon Gumanga1, , Edwin Mwintiereh Ta-ang Yenli1 and Saeed Jibreel1

1Tamale Teaching Hospital, Ghana

Pub. Date: July 01, 2015

Cite this paper:
Solomon Gumanga, Edwin Mwintiereh Ta-ang Yenli and Saeed Jibreel. Primary Peritoneal Carcinoma: A Case Report of Primary Peritoneal Papilary Serous Adenocarcinoma in a 59 Year Old Postmenopausal Woman. American Journal of Medical Case Reports. 2015; 3(8):239-243. doi: 10.12691/ajmcr-3-8-5

Abstract

Primary peritoneal carcinoma is rare and may present with symptoms similar to epithelial ovarian carcinoma which has some histological similarities. This is a case report of a 59 year old woman Para 2 who presented with massive ascites, abdominal pain, difficulty in breathing, abdominal mass and weight loss of three months duration. No conclusive diagnosis could be made after an ultrasound scan and CT-scan investigations showed the ovaries were of normal size but serum CA125 level was markedly elevated. No organ including the ovaries was identified as primary source of the tumour at an initial laparatomy. Specimens were however taken from multiple areas including the peritoneum and the omentum for histopathology. Reports of cytology and histology specimens indicated papillary serous adenocarcinoma with likely primary source being the ovary. Two cycles of neo-adjuvant chemotherapy was administered followed by re-laparatomy where total abdominal hysterectomy plus bilateral salpingoophorectomy, omectomy and surgical reduction of tumour seedlings. Final histopathology ruled out papillary serous adenocarcinoma of the ovary which has similar histological features with papillary serous adenocarcinoma of the peritoneum. Four cycles of adjuvant platinum plus paclitaxel based chemotherapy was then administered and serum CA 125 declined from 214u/ml to 49.5u/ml with no clinical signs of residual disease on completion of chemotherapy. The patient is now on followed-up. Conclusion: Primary peritoneal carcinoma though rare, should be suspected if the peritoneum is involved in a malignancy of an unknown primary source. Management of primary peritoneal carcinoma should involve surgical debulking and appropriate chemotherapy as in ovarian carcinoma.

Keywords:
primary peritoneal carcinoma carcinoma of unknown primary origin peritoneal serous papilary adenocarcinoma primary peritoneal malignancies

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Herbst AL. Neoplastic Diseases of the ovary. In: Stenchever MA, Droegenmueller W, Herbst AL, Mishell DR, editors. Comprehensive Gynecology. St. Louis: Mosby; 2001; 955-998.
 
[2]  Cormio G, Di Vagno G, Di Gesu G, Mastroianni M, Melilli GA, Vimercati A, et al. Primary peritoneal carcinoma: a report of twelve cases and a review of the literature. Gynecol Obstet Invest. 2000; 50(3):203-6.
 
[3]  Popovska S, Veselinova T, Gorchev G, Tomov S, Elenchev L. [Primary peritoneal carcinoma: a report of two cases and a review of the literature]. Akush Ginekol (Sofiia). 2005; 44(1): 8-10.
 
[4]  Stenchever MA, Fertilisation and Embryogenesis. In: Stenchever MA, Droegenmueller W, Herbst AL, Mishell DR, editors. Comprehensive Gynecology. St. Louis: Mosby; 2001; 3-21.
 
[5]  Nam JH, Kim YM, Jung MH, Kim KR, Yoo HJ, Kim DY, et al. Primary peritoneal carcinoma: experience with cytoreductive surgery and combination chemotherapy. Int J Gynecol Cancer. 2006;16(1):23-8.
 
[6]  Zhang C; Cui H; Zhao Y; Liang XD; Wang CH; Li XP; Shen DH; Wang SJ; Wei LH. Clinical management and prognostic analysis of primary peritoneal neoplasms. Zhonghua Fu Chan Ke Za Zhi 2005; 40(7):464-8.
 
[7]  Jaaback KS, Ludeman L, Clayton NL, Hirschowitz L. Primary peritoneal carcinoma in a UK cancer center: comparison with advanced ovarian carcinoma over a 5-year period. Int J Gynecol Cancer. Jan-Feb 2006;16 :1:123-8.
 
[8]  Stafford-Johnson DB, Bree RL, Francis IR, Korobkin M. CT appearance of primary papillary serous carcinoma of the peritoneum. AJR Am J Roentgenol. 1998; 171(3):687-9.
 
[9]  Moccia F, Cimmino M, Ciancia G, Rossetti G, Pascotto B, Morra I, D'Armiento M, Fei L. A case of extraovarian primary peritoneal carcinoma in an oophorectomized-hysterectomised patient: a diagnostic dilemma. G Chir, 2013;34(3):82-5.
 
[10]  Vergote I, Amart F, Kristensen G, Ehler T, Reed NS, Casado A. Primary surgery or neoadjuvant chemotherapy followed by interval debulking surgery in advanced ovarian cancer. Eur J Cancer. 2011; 47(supp 3):s88-92.
 
[11]  Colombo PE, Labaki M, Fabbro M, Bertrad M, Mourregot A et al. Impact of neoadjuvant chemotherapy cycles prior to interval surgery in patients with advanced epithelial ovarian cancer. Gynecol oncol 2014; 135(4):2 23-30.
 
[12]  McCluggage WG, Lyness RW, Atkinson RJ, Dobbs SP, Harley I,McClelland HR,Price JH. Morphological effects of chemotherapy on ovarian carcinoma. J Clin Pathol 2002; 55: 27-31.
 
[13]  Pavlidis N, Briasoulis E, Hainsworth J, Greco FA. Diagnostic and therapeutic management of cancer of an unknown primary. Eur J Cancer. 2003; 39(14): 1990-2005.
 
[14]  Pentheroudakis G, Pavlidis N. Serous papillary peritoneal carcinoma: Unknown primary tumour, ovarian cancer counterpart or a distinct entity? A systematic review. Crit Rev OncolHematol. (6) 2009.