Citation: BJOG: An International Journal of Obstetrics and Gynaecology. 2012, 119, 82-83
Author: Myagerimath R.; Azhar L.; Mwenechanya S.; Gul N.
Abstract: Introduction: Primary peritoneal carcinoma (PPC) is a rare malignancy that predominantly affects postmenopausal women and typically displays multicentric peritoneal and omental involvement. Atypical presentations of primary peritoneal carcinoma have been described in english literature but as far as we are aware no reports of primary peritoneal carcinoma which were picked up at caeserean section have been
published. Here we present a case report in a young asymptomatic woman with suspicious peritoneal lesions at elective caesarean section. Case Report: Thirty-seven years old Para 2 had an elective caesarean section for previous caesarean section. During surgery small peritoneal lesions were noted which were suspicious of endometriosis and biopsy was taken. Biopsy result was suggestive of papillary serous carcinoma of ovary.
CT scan of abdomen and pelvis did not show any abnormality. Following MDT meeting she had a total abdominal hysterectomy and bilateral salpingoophrectomy with pelvic clearance. The histology confirmed Primary peritoneal cancer stage 3b with both ovarian and omental involvement. Subsequently she received chemotherapy. Discussion: 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. The sensitivity of CT scans and ultrasound for peritoneal nodules measuring smaller than one cm is approximately 15-30%. Treatment of this malignancy is very similar to that of epithelial ovarian cancer i.e. combination chemotherapy after optimal cytoreductive surgery. The goals of chemotherapy are to induce remission, to prevent complications, and to reduce morbidity.
Different studies quote the 5-year survival rates as 26.5-47%. Conclusion: Direct visualisation of the peritoneal surfaces along with palpation of the abdominal cavity is by far the most sensitive modality for detecting primary peritoneal cancer. Caesarean section is an opportunity for direct visualisation and examination of pelvic organs and peritoneal surface, and any suspicious lesions should be biopsied.
