Diagnostic Dilemma: A Case Report on Primary Peritoneal Carcinoma in a Patient with Suspected Ovarian Malignancy

@#INTRODUCTION: Primary peritoneal carcinoma (PPC) is an uncommon malignancy and is often misdiagnosed as peritoneal carcinomatosis from metastatic gastrointestinal carcinoma and more frequently from ovarian carcinomas due to a common embryonic origin of the ovary and the peritoneum. Its diagnosis is a challenge for clinicians. Herein, we report a rare case of PPC in a 72-year-old woman who was initially suspected with metastatic ovarian malignancy, and emphasizes points that help differentiate PPC from primary ovarian cancer. CASE: This a case of a 72-year-old female with abdominal discomfort and distension, initially diagnosed with ovarian carcinoma, with abdominal CT scan revealing thickening of the omentum multiple enhancing nodules in the left adnexa, within the pouch of Douglas and subdiaphragmatic region compatible with malignancy such as metastases from carcinoma. Cancer antigen (CA) 125 (3476 u/mL) and CA 15-3 (45.94 u/mL) were elevated. The patient underwent dilation and curettage and diagnostic laparoscopy and biopsy with frozen section, which revealed metastatic clear cell adenocarcinoma, favoring primary ovarian carcinoma. The patient then underwent exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy with bilateral lymph node dissection, and omentectomy. Further histopathological findings later confirmed that the patient had carcinoma primarily from the peritoneum instead of from the ovary. The patient was discharged, improved and underwent chemotherapy post-operation. CONCLUSION: This report emphasizes how to distinguish primary malignancy from the peritoneum from that in the ovary, preventing misdiagnosis. The emphasis in considering primary peritoneal cancer as a differential diagnosis in patients with abdominal symptoms suspected due to malignancy should be noted.

An Unusual Cause of Fever, Rash, and Joint Pain: A Case Report of Adult Onset Still’s Disease

@#BACKGROUND: Adult-Onset Still's Disease is a rare inflammatory disorder with an estimated incidence of 1 in 1,000,000 that presents with a rash, fever, and arthritis. Furthermore, there have only been three reported cases in the Philippines. Its presentation is similar to other more commonly encountered inflammatory disorders; however, it is the negative immunologic and serologic workup that typically distinguishes this rare specific inflammatory disorder along with the fulfillment of diagnostic criteria set by Yamaguchi and Cush. CASE: This is a case of an 18-year-old female who presented with recurrent fever, rash, and polyarthritis. The patient underwent extensive workup, but immunologic studies were negative. A consideration of Adult-Onset Stills Disease was made and along with the fulfillment of the classification criteria set by Yamaguchi and Cush, the diagnosis was clinched and the patient was started on glucocorticoid therapy where improvement of the patient's condition was noted with the resolution of the fever, rash and minimal complaints of joint pain. CONCLUSION: Adult-Onset Still’s Disease is an uncommon inflammatory disorder that confers high morbidity and disability. It commonly presents with shared clinical features among other inflammatory disorders; thus, recognition of the existence of this disease entity could pose a diagnostic dilemma. A high clinical suspicion along with negative studies and fulfillment of the diagnostic criteria avoids unnecessary workup and inappropriate management.