Extraovarian Primary Peritoneal Carcinomatosis: A Case Report

Patient: Female, 66 Final Diagnosis: Extraovarian primary peritoneal carcinomatosis Symptoms: Abdominal distension with constipation of 3 days, while still passing flatus. She further complained of mild postprandial epigastric pain, but denied nausea or vomiting as well as fever Medication: — Clinical Procedure: — Specialty: Surgery OBJECTIVE: Rare disease BACKGROUND: Extraovarian primary peritoneal carcinoma (EOPPC) is a rare malignant epithelial tumor with an age-adjusted incidence rate of 6.78 per million, which arises from the peritoneal lining with minimal or no ovarian involvement. EOPPC is a diagnosis of exclusion with the absence of other identifiable primary sites and after surgical assessment and consideration of the histological report to evaluate the extent of ovarian invasion. CASE REPORT: A 66-year-old woman complained of mild postprandial epigastric pain. Physical exam revealed positive bowel sounds over all 4 quadrants, with a soft, non-tender abdomen. Distension and dullness to percussion were noted. A CT scan revealed peritoneal fluid, and evaluation of the peritoneal fluid showed an elevated white blood cell count, while fulfilling criteria for exudate. There was no bacterial growth from the peritoneal fluid. Serum tumor markers CEA were significantly elevated, suggestive of an underlying malignancy. An exploratory laparoscopy confirmed diffuse carcinomatosis in the omentum, the coloparietal region bilaterally, as well as surrounding small bowel loops, the transverse and sigmoid colon, and the rectum. A bilateral oophorectomy was performed and 2 biopsies from the thickened peritoneum were taken. The histomorphological features from the pathology examination concluded the patient had peritoneal serous carcinoma with uninvolved ovaries. CONCLUSIONS: EOPPC may be misdiagnosed as epithelial ovarian cancer, and should be considered in patients with peritoneal carcinomatosis, normal-sized ovaries, and no identifiable primary lesion. Since the common therapeutic strategies achieve comparable survival rates, failed recognition may be without consequences. However, to further improve survival, optimal cytoreductive surgery is essential and should be made a priority in disease management.