Transcript Primary peritoneal cancer

Primary Peritoneal Carcinoma found at caeserean section, value of routine abdominal examination at caeserean section
Dr R Myagerimath, Dr L Azhar, Miss Nahid Gul, Miss S Mwenechanya
Wirral University Teaching Hospital NHS Foundation trust ,
UnitedKingdom
Introduction
• Primary peritoneal carcinoma is a rare malignancy that
predominantly affects postmenopausal women.
• Typically displays multicentric peritoneal and omental
involvement.
• Atypical presentations of primary peritoneal carcinoma
have been described in English literature.
• Here we present an unusual case of primary peritoneal
cancer diagnosed in a young asymptomatic woman with
suspicious peritoneal lesions at elective caeserean section.
Case Report
• 37 years old Para 2 , low risk pregnancy
• Had an elective caesarean section for previous caesarean
section at 39 wks.
• During surgery small suspicious peritoneal lesions (vesicles
and papules ) were noted
• Both ovaries were normal.
• Biopsy of peritoneal lesions was taken.
Biopsy and investigations
Primary peritoneal cancer
• Multi disciplinary team referral
• Direct visualization of the peritoneal surfaces along with
palpation of the abdominal cavity is by far the most
sensitive modality for detecting primary peritoneal cancer.
• 2nd opinion : suspicious of Papillary serous Carcinoma of
ovary
• Caeserean section is an opportunity for direct visualisation
and examination of pelvic organs and peritoneal surface.
• CT scan of abdomen and pelvis did not show any
abnormality.
• Any suspicious lesions should be biopsied.
• Initial biopsy result - inconclusive
MDT Decision / Treatment
References
• Total abdominal hysterectomy and bilateral
salpingoophrectomy with pelvic clearance.
• The histology confirmed Primary peritoneal cancer stage
3b with both ovarian and omental involvement.
• Post surgery chemotherapy.
Histology
Primary peritoneal cancer
Diagnostic dilemmas
•The well-documented but rare primary papillary serous
peritoneal tumors can present as diagnostic dilemma for both the
pathologists and the clinicians as primary peritoneal cancer
resembles papillary serous ovarian carcinoma.
•Primary peritoneal cancer has same embryologic origin as
germinal epithelium of the ovary
•The sensitivity of CT scans and ultrasound for peritoneal
nodules measuring smaller than one cm is approximately 1530%.
•USG and CT scans, are insensitive for the detection of
peritoneal tumours.
•The sensitivity of CT and ultrasound for peritoneal nodules
measuring smaller than one cm is 15-30%.
•CT scan findings are nonspecific.
•Treatment of this malignancy is very similar to that of epithelial
ovarian cancer i.e combination chemotherapy after optimal
cytoreductive surgery.
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Conclusions
1. International Journal of Gynaecological Cancer, September
2007, vol./is. 17/5(1140-1143), 1048-891X;1525-1438 (Sep
2007)
2. Human Reproduction, June 2004, vol./is. 19/6(1472-1475),
0268-1161 (Jun 2004)
3. Papillary serous neoplasia of the peritoneum: a
clinicopathologic and ultrastructural study of eight
cases.Raju U Fine G, Greenawald KA Ohorodnik
JM.Department of Pathology, Henry Ford Hospital, Detroit,
MI 48202.