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.

Primary Peritoneal Carcinoma with long term survival: A case report / Philippine Journal of Obstetrics and Gynecology

@#Primary peritoneal carcinoma is rare, presents with non-specific abdominal symptoms, is usually diagnosed late and is associated with a poor prognosis. A 51-year-old female with Primary Peritoneal Carcinoma Stage III-C, was initially treated with cytoreductive surgery and intravenous paclitaxel and carboplatin. After 28 months in remission, she developed tumor recurrence. She underwent tumor excision followed by combined intravenous paclitaxel and intraperitoneal carboplatin. The patient is alive and disease-free 5 years after the initial operation. This case was reported to inform our clinicians that the peritoneum can be the primary site of a rare malignancy. Prognosis may be poor but long-term survival can be achieved in younger patients with good performance status. Having a tumor that is sensitive to platinum-based chemotherapy can contribute to a longer survival even if the tumor was sub-optimally reduced.

Tuberculous Peritonitis Mimicking Primary Peritoneal Carcinoma

Tuberculous peritonitis is one of the most common extrapulmonary tuberculosis. The presenting signs and symptoms, together with the carbohydrate antigen (CA) 125 status and imaging findings may resemble the primary peritoneal carcinoma or ovarian carcinoma. We herein report a case on a 71-year-old woman who is presented with abdominal distension, abdominal pain, nausea, anorexia. Abdomino-pelvic computed tomography scans reveal large amounts of ascites and mottled omentum with diffuse nodular masses, and the serum CA 125 level is elevated. The initial clinical diagnosis is the primary peritoneal carcinoma, but the final histological diagnosis confirms the tuberculous peritonitis. Thus, we discuss the differential diagnosis of tuberculous peritonitis from primary peritoneal carcinoma and also the problems especially found in old aged patients. In conclusion, although the elderly patients are suspected with malignancy, we should keep in mind the possibility of curable diseases and perform laparoscopic biopsy during the early stage aggressively.

Clinicopathologic characteristics and prognostic factors of primary peritoneal carcinoma / 대한산부인과학회지

OBJECTIVE: The objective of this study was to examine the clinicopathologic characteristics and prognostic factors of primary peritoneal carcinoma (PPC). METHODS: Clinicopathologic variables were obtained by examining the medical records of patients with PPC who were diagnosed and treated at our institute, between January 1996 and December 2005. To find prognostic factors, the association of clinicopathologic variables with survival was evaluated by univariate and multivariate analysis. RESULTS: All patients had advanced-stage tumors. Residual tumor was smaller than 1 cm in 12 patients and was equal or larger than 1 cm in nine patients. The response rate to adjuvant chemotherapy was 47.6%. The median progression-free survival was eight months (range 1~95) and the median overall survival was 14 months (range 1~99). In univariate analysis, stage, the response to adjuvant chemotherapy, and neoadjuvant chemotherapy were associated with survival. However, in multivariate analysis, no variables were associated with survival. CONCLUSION: In spite of aggressive treatments, patients with PPC had poor prognosis. No prognostic factors were identified in this study.

Clinical Characteristics of Primary Peritoneal Carcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The goal of this study was to determine the clinical and therapeutic characteristics of women with a primary peritoneal carcinoma (PPC). MATERIALS AND METHODS: A retrospective clinical study was conducted to evaluate 22 women diagnosed with a PPC from 1993 to 2007 at the Hospitals of The Catholic University of Korea. Diagnoses were based on the Gynecologic Oncology Group criteria and clinical data. We collected patient clinicopathological data including age, presenting symptoms, pretreatment CA-125 values (U/ml), clinical stage (based on the FIGO stage), performance status (using the Eastern Cooperative Oncology Group scale), whether cytoreductive surgery was optimal or not, types of chemotherapy and response to treatment. We evaluated the clinical characteristics and response to treatment, time to treatment failure and overall survival. RESULTS: The median overall survival of all patients was 23.1 months. The estimated 3-year survival rate was 29% (SE, 13%). The response rate to first-line platinum-based chemotherapy was 79% and the median time to treatment failure was 9.9 months (95% confidence interval, 1.38~18.4 months). By univariate and multivariate analysis, performance status was the only significant factor associated with overall survival (p<0.05). CONCLUSION: We evaluated the clinical characteristics and treatment response of patients with a primary peritoneal carcinoma. Our results showed that it is possible to achieve long-term survival in patients with PPC. A further clinical study is to need to establish clinical characteristics and treatment outcomes.

Diagnosis and Treatment of Primary Peritoneal Carcinoma / 医学研究杂志

Objective To investigate the relationship between diagnosis and treatment of the primary peritoneal carcinoma(PPC)and its prognosis.Methods The clinical materials of 10 women,who were diagnosed with PPC,were analyzed retrospectively from Mar.2000 to Nov.2006.Results We found that PPC has lower rate of incidence,higher rate of wrong diagnosis,wider spread in pelvis cavity and abdominal cavity and had no significant clinical signs and symptoms specificity.All of the patients needed cytoreductive surgery,but the majority of rudimental focus diameter is larger than 2 cm.After the operation,platinum combined other chemotherapeutic drug were needed.Conclusion Abdominal distention,ascites,abdominal pain are the main symptoms and signs of PPC.we need choose cytoreductive surgery as much as possible.Extra trauma to patients will affect restoration and survival time of patients and the effect of chemotherapy.We also found the effect of abdominal cavity chemotherapy may be better than that of chemotherapy in vein.

The prognostic factors and survival analysis of primary peritoneal carcinoma / 대한산부인과학회지

OBJECTIVE: To date, few attempts have been made at clinical features and prognostic factors of primary peritoneal carcinoma (PPC) because of low prevalence. The aim of this study is to evaluate the clinical characteristcs and determine the prognosis factors of PPC. METHODS: From March 1996 to March 2004, a total of 23 women newly diagnosed with PPC were recruited into the study. Overall survival and prognostic factors were evaluated using Kaplan-Meier method and Cox regression model. RESULTS: The mean age of patients was 58.7+/-7.6 years and the FIGO stage was advanced disease; stage IIIc (73%) and IV (27%). The mean survival time for patients enrolled was 26.0 months. By univariate analysis, tumor state (p=0.028), performance status (p=0.045), the presence of initial debulking operation (p=0.035), and normalization of CA125 at 3 months of treatment (p=0.003) were significantly correlated with survival. On multivariate analysis, only the normalization of CA125 at 3 months of treatment remained as the independent factor for survival (Odds ratio, 6.896; 95% Confidence interval, 1.504-31.623; p=0.013). CONCLUSION: The mean survival time for patients with PPC was 26.0 months, and the normalization of CA125 at 3 months of treatment was identified as the independent prognostic factor. From this study, we analysis the clinical characteristics of PPC and provide more precise understanding of this disease.

A Case of Primary Peritoneal Carcinoma / 대한부인종양콜포스코피학회잡지

Primary papillary serous carcinomas (PPC) of the peritoneum are very rare and classically present with widespread intraperitoneal dissemination, superficial invasion, and minimal ovarian stromal involvement. Because of clinically and histologically similar to advanced stage epithelial ovarian carcinoma the treatment has been a similar fashion-cytoreductive surgery followed by systemic chemotherapy. Histologic differentiation between papillary mesotheliomas, primary ovarian tumors, borderline tumors of the ovary with peritoneal deposits and primary peritoneal carcinoma may be difficult. The prognosis is very poor and the median lifespan 4 months. We experienced a case of primary peritoneal carcinoma and reported with the brief review of the literature.

Two Cases of Primary Carcinoma of the Peritoneum / 대한부인종양콜포스코피학회잡지

The primary malignant tumor of the peritoneum also known as primary peritoneal carcinoma or primary peritoneal papillary serous carcinoma is rare and involves the peritoneum, especially the pelvic peritoneum of female patients. It is difficult to differentiate histologically between papillary mesothelioma, primary ovarian tumor and primary peritoneal carcinoma. We report two cases of the primary peritoneal carcinoma with clinical presentation and histologic characteristics.