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

摘要

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.