Obstet Gynecol Sci.  2015 May;58(3):246-250. 10.5468/ogs.2015.58.3.246.

Primary peritoneal serous papillary carcinoma presenting as a large mesenteric mass mistaken for ovarian cancer: a case of primary peritoneal carcinoma

• Kim JW
• Lee HS
• Shin KS
• Gam YH
• Baik KD

• KMID: 2148938
• DOI: http://doi.org/10.5468/ogs.2015.58.3.246

Abstract

Peritoneal origin serous papillary carcinoma is an uncommon primary malignancy occurring in the abdominal or pelvic peritoneum lining. It is characterized by peritoneal carcinomatosis with massive ascites, uninvolved or minimally involved ovary, and is histologically indistinguishable from ovarian serous tumors. Better recognition of this phenomenon in recent years has contributed to an increasing diagnostic frequency. We describe a rare case of peritoneal origin serous papillary carcinoma with unusual clinical presentations involving a solitary primary tumor originating from the peritoneal lining of the sigmoid colonal mesentery, without pelvic lymph node involvement or distant metastasis. Because of the location and morphological similarity, it was misdiagnosed as an ovarian malignancy. We aim to assist in the diagnosis of this disease with the following case report, thereby improving the management of patients with this condition.

Keyword

Carcinomatosis; Mesenteric tumor; Ovary; Peritoneum; Serous papillary carcinoma

MeSH Terms

Ascites
Carcinoma
Carcinoma, Papillary*
Colon, Sigmoid
Diagnosis
Female
Humans
Lymph Nodes
Mesentery
Neoplasm Metastasis
Ovarian Neoplasms*
Ovary
Peritoneum

Figure

• 

  Fig. 1 (A) Transvaginal ultrasonography showed a large mixed component mass (arrow pointing) regarded as a left ovarian tumor. (B) Dynamic computed tomography scans were obtained after starting the contrast material injection. There was a large mass (arrow pointing) with attenuation similar to that of blood vessels that tightly adhered to and externally compressed the colonic wall. In the early phase, the mass was strongly and rapidly enhanced. (C) On the TORSO Fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography, an approximately 6.3×6.5×5-cm-sized cystic mass was identified, with thick hypermetabolic rim excluding anterior and right lateral margin in the lower abdomen above the uterus.

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  Fig. 2 Histopathological and immunohistochemical findings. (A) The photomicrographic result. It shows a fibrocystic wall and necrotic tissue from the mesenteric mass (H&E, ×10). (B) Photomicrograph from mesenteric mass showing papillary architecture of tumor (H&E, ×20). (C) Left periovarian mass. It is soft tissue from left adjacent to papillary growing mass (H&E, ×10). (D) The photomicrograph result. It shows a multilayered papillary growing tumor. Numerous scattered psammoma bodies were present (H&E, ×10). (E) Immunohistochemically, the tumor cells were positive for only cytokeratins 7 (CK7); others (vimentin [VMT], carcinoembryonic antigen [CEA] and calretinin) were negative.

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