Case Of Primary Peritoneal Carcinoma Research Articles

Primary Peritoneal Carcinoma – A Rare Challenging Cytological Diagnosis

Primary peritoneal carcinoma (PPC) is a rare multicentric malignant tumour of the peritoneal cavity often morphologically indistinguishable from primary ovarian serous carcinoma and carcinoma of the fimbrial end of the fallopian tube. A correct differential diagnosis of PPC is highly challenging. The current case report describes the case of PPC in a 70 year old female presented with abdominal distension and elevated CA 125 levels. The case report highlights the importance of high index of suspicion, role of cytology and imaging techniques in the diagnosis of this rare entity.

A Case of Primary Peritoneal Carcinoma \_h(\/PPC\_h) \/Associated with Uterine Myoma Presenting with Acute Respiratory Failure due to Massive Pleural Effusion

A Case of Primary Peritoneal Carcinoma \_h(\/PPC\_h) \/Associated with Uterine Myoma Presenting with Acute Respiratory Failure due to Massive Pleural Effusion

A case of primary peritoneal carcinoma diagnosed as cancer of unknown primary revealed by laparoscopic surgery

A case of primary peritoneal carcinoma diagnosed as cancer of unknown primary revealed by laparoscopic surgery

Serous Tubal Carcinogenesis: The Recent Concept of Origin of Ovarian, Primary Peritoneal and Fallopian Tube High-Grade Serous Carcinoma.

Pelvic (non-uterine) high-grade serous carcinomas (PHGSC) including ovarian, tubal and primary peritoneal serous carcinomas have increased death: incidence ratio due to presentation at advanced stage, rapid progression, poor prognosis and high morbidity. Ambiguity regarding their pathogenesis and lack of a proper screening method is the cause of their late detection and high fatality rate. This study was undertaken to assess the fallopian tube for the presence of precursor lesions in pelvic serous carcinoma. This was a prospective case-control study carried out in a tertiary care center. Consecutive specimens of 55 cases of pelvic high-grade serous carcinoma and 41 controls inclusive of 21 low-grade serous carcinoma, 10 benign adnexal masses and 10 normal adnexa were included in the study. Both side fallopian tubes in each case were subjected to histopathological examination and p53, Ki67 immunohistochemistry. There were 55 cases of PHGSC comprising of 50 cases of ovarian HGSC, two cases of primary peritoneal carcinoma (PPC) and three cases of tubal carcinoma. Serous tubal intraepithelial carcinoma (STIC) was detected in 14 cases (28%), p53 signature in 13 cases (26%) and tubal intraepithelial lesion in transition in 10 cases (20%) of ovarian HGSC. One case (50%) of PPC and one (33%) case of tubal carcinoma revealed the presence of STIC. None of the controls exhibited any precursor lesion except ovarian low-grade serous carcinoma where p53 was detected in 20% of cases. This revelation concludes that fallopian tubes are the sites of precursors of PHGSC to a large extent. In the absence of a proper screening method of HGSC, prophylactic bilateral salpingectomy at hysterectomy for benign diseases can achieve ultimate goal of reduction in incidence of PHGSC.

Primary peritoneal carcinoma metastasizing to breast: a single case report and literature review from clinic to biology.

Primary peritoneal carcinoma (PPC) is a type of rare malignant epithelial tumor. Metastasis from PPC to breast has been rarely reported. PPC originates de novo from the peritoneal tissues rather than invasion or metastasis from adjacent or remote organs. PPCs have been implicated in many cases of carcinomas of unknown primary origin. It is similar to ovarian cancer (OvCa), because it shares the same common embryonic origin, the coelomic epithelium (mesodermal origin). The mechanism of oncogenesis remains elusive. In this article, we report a rare case of PPC in a patient 10 years after total abdominal hysterectomy and bilateral salpingooophorectomy for uterine leiomyoma, which was widely spread in the abdomen and metastasized to the colon, liver and distant organs including breast. The treatment is similar to that of primary ovarian cancer. We also reviewed the primary peritoneal cancer metastatic to breast and discuss the possible mechanisms and biology of primary peritoneal cancer, using experimental and animal model.

Outcomes following interval debulking surgery in primary peritoneal carcinoma.

e15515 Background: Primary peritoneal carcinoma (PPC) has a poor prognosis with a median survival of 12-25 months. Unlike ovarian cancer, there is no published data on the effectiveness of interval debulking surgery (IDS) in PPC and it is not routine practice. Our series aimed to compare outcomes in patients with PPC treated with IDS following chemotherapy compared with patients treated with chemotherapy alone. Methods: A retrospective case note analysis was undertaken of all patients' of two consultants in 4 hospitals in the West Midlands diagnosed with PPC between May 2000-Nov 2008 identified through medical records. Data was analysed for age, performance status, response to chemotherapy, surgical outcomes, subsequent treatments, site of relapse, median time to progression (TTP), and median overall survival (OS). Analysis for TTP and OS was undertaken using both Kaplan-Meier and log rank analysis. Results: We identified 44 patients with histologically proven PPC between May 2000-October 2008. 41 patients received chemotherapy. 19 received Carboplatin alone, 20 Carboplatin-Paclitaxel and 2 Carboplatin-Gemcitabine. 17/44 patients (39%) went on for IDS following chemotherapy and 15/17 had optimal debulking. 3/17 had a complete pathological response. To date 11/17(65%) patients have recurred in the interval surgical group compared with 24/27(89%) in the non-interval surgery group. Median TTP was 25m (range = 8-33m) vs. 9m (0-30m) p=0.0001. 14/17(82%) in the surgical group have reached 2-year survival vs. 10/27(37%) in the non-surgical group. Median OS was 48 months in the interval surgery group vs. 21 months in the non-surgical group, p=0.0006. The median OS for all patients was 36 months. Conclusions: The median OS for all patients was 36m which compares favourably with previously published survival data of 12-25 months. IDS in selected cases of PPC seems to improve median OS and TTP in PPC and should be considered in all patients who have a good response to chemotherapy.

The invasive malignancy from peritoneal epithelial cell: a report of four cases and review of literature

To analyze the clinical characteristics, diagnosis and treatment of primary peritoneal carcinoma (PPC) and to review the literature, so as to raise the awareness of the disease. Four cases of PPC diagnosed in our department from March 2005 to September 2007 were retrospectively analyzed. Four cases were all treated with platinum-based chemotherapy. They were treated with intraperitoneal chemohyperthermia (IPCH) with cisplatin, carboplatin or oxaliplatin with a closed sterile circuit of 1,000 ml physiologic saline and inflow temperature is 43°C, while they were receiving high-intensity focused microwave hyperthermia (HIFMH) concomitantly. Intravenous paclitaxel or docetaxel was used in three patients, while cyclophosphamide and adriamycin injection in another patient. After two cycles of chemotherapy, ascites decreased significantly or even disappeared. Up to 6 January 2010, the four cases had survived for 38, 51, 33 and 29 months, respectively. PPC is a group of invasive malignancy derived from the peritoneal epithelium, it is common in women and is homogeneous with ovarian cancer in pathology. Diagnosis relies mainly on postoperative pathologic diagnosis and cytology after ruling out ovarian cancer and gastrointestinal cancer. Platinum-containing chemotherapy, IPCH and the administration of taxanes can improve the overall response rate and long-term survival.

Primary peritoneal carcinoma: a rare neoplasm with pleomorphic trophoblastic morphology

We report a case of primary peritoneal carcinoma with trophoblastic morphology in a 78-year-old woman, diagnosed by histological and immunohistochemical analysis of surgically resected specimens, including the omentum and part of the small bowel. Microscopically, the resected specimens showed diffuse infiltration of a poorly differentiated tumor. Numerous large, often multinucleated cells were seen, and mitotic figures were frequent. Immunohistochemical staining showed a positive reaction for most cytokeratins, EP4, EMA, CA-125, Glut1, WT1, beta-hCG and PLAP. We reached a diagnosis of primary peritoneal carcinoma with trophoblastic morphology. To our knowledge this morphology of a primary peritoneal carcinoma has not been described previously.

The Role of Ultrasound Evaluation in the Detection of Early-Stage Epithelial Ovarian Cancer

To determine the usefulness of sonography in the detection of early-stage ovarian cancer, 4526 asymptomatic women at high risk for ovarian cancer participated in a trial of ultrasound screening. The definition of high risk included 1 or more of the following criteria: 1) at least 1 first-degree relative with ovarian cancer; 2) a personal history of breast or ovarian cancer; 3) multiple first- and second-degree relatives with breast or ovarian cancer; 4) positivity for a BRCA mutation; or 5) a recognized family cancer syndrome. All patients underwent ultrasound examination, serum biomarker analysis, and a comprehensive physical examination at 6-month intervals. All adnexal masses identified with ultrasound were graded as cystic, multiloculated, complex, or solid. Risk of malignancy was determined with a combination of gray-scale morphologic parameters and Doppler investigation. Simple cysts or hemorrhagic-like cysts in premenopausal women were rescanned in 6 to 8 weeks to confirm resolution. In menopausal women, stable, simple, thin-walled masses less than 5 cm with no evidence of central blood flow were rescanned in 2 months and at the 6-month visit to confirm stability. A similar protocol was followed for suspected hydrosalpinges or pelvic adhesive disease. Study subjects were enrollees in the National Ovarian Cancer Early Detection Program (NOCEDP) of the National Institutes of Health. Their average age was 46 years. Since 1990, 4526 women, of whom 2610 were premenopausal and 1916 were postmenopausal, have undergone a total of 12,709 ultrasound scans. Both ovaries could be identified in 98% of premenopausal women and 94% of postmenopausal women, of whom 12.6% and 6.4%, respectively, had cystic masses larger than 2.5 cm. In all, 0.4% of premenopausal and 0.3% of postmenopausal women were referred for reexamination before the usual 6-month visit. Of 98 women with persistent adnexal masses, 44 underwent surgical treatment. Suspicious masses were identified using 3-dimensional ultrasonography to determine the presence of a central vascular flow characteristic of ovarian carcinoma. Twelve women were diagnosed with gynecologic malignancy and 37 with benign conditions. Four primary peritoneal carcinomas, 4 fallopian tube carcinomas, 2 epithelial ovarian carcinomas, and 2 endometrial carcinomas were diagnosed (Table 1). Within the study group, there were 184 subjects who had a BRCA-1 or BRCA-2 mutation and elected to undergo prophylactic bilateral salpingo-oophorectomy. Atypical ovarian or fallopian hyperplasia was found in 23% of these women, and 2 cases of primary peritoneal carcinoma were discovered during preoperative laparoscopy. These 2 women and 2 with cancer of the fallopian tube were BRCA-1. Early-stage breast cancer was detected on physical examination in 37 women, of whom 6 were positive for BRCA-1 or -2.

Microsatellite Instability in Ovarian and Other Pelvic Carcinomas

Twenty-six cases of ovarian carcinoma and six cases of other pelvic neoplasms were analyzed for microsatellite instability (MSI) using frozen specimens, fluorescence technology, and four selected markers (D2S123 on chromosome 2, D18S58 on chromosome 18, BAT26 on chromosome 2, and BAT40 on chromosome 1). This procedure also allowed the detection of loss of heterogeneity (LOH) at the four selected loci. One of the cases of ovarian carcinoma exhibited MSI and this was evident at three loci. Of 44 informative loci, 7 exhibited LOH representing 3 cases of ovarian carcinoma, 3 of 4 cases of primary peritoneal carcinoma, and one case of unknown primary. These data support other findings that MSI is not a frequent occurrence in ovarian cancer; however, LOH is a more frequent event and may be a target for the development of diagnostic/prognostic procedures for ovarian and primary peritoneal carcinoma.

Nuclear overexpression of p53 protein does not correlate with gene mutation in primary peritoneal carcinoma

Primary peritoneal carcinoma (PPC) is an aggressive malignancy of the female coelomic epithelium. Previously we had analyzed 29 cases of PPC for p53 protein accumulation by immunocytochemistry. P53 was overexpressed in 83% (24 of 29) of PPCs, including 21 tumors with diffuse intense staining of 100% of tumor nuclei and three additional tumors with significant focal staining. Here we report results of a mutational analysis on the entire p53 coding sequence of 22 of these cases (comprising 18 p53-positive and four negative tumors), using single-strand conformation polymorphism (SSCP) and direct sequence analysis. Only 2 of 22 (9%) patients harbored a p53 mutation (which, interestingly, were identical and consisted of a codon 259 Asp → His exchange), despite diffuse overexpression of high levels of nuclear p53 protein in most cases. This result indicates that (1) the abnormal p53 expression is usually not caused by mutations of the p53 gene in PPC and (2) PPC is part of a growing number of tumors that share evidence of p53 dysfunction in the absence of mutation.

Prophylactic Oophorectomy: Reducing the U.S. Death Rate from Epithelial Ovarian Cancer. A Continuing Debate

The Oncologist 1996;1:326-330 Correspondence: M. Steven Piver, M.D., Department of Gynecologic Oncology, Gilda Radner Familial Ovarian Cancer Registry, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA. Telephone: 716-845-3110; Fax: 716-845-7608. Received August 1, 1996; accepted for publication August 27, 1996. ©AlphaMed Press 1083-7159/96/$5.00/0 If instead of the title “Prophylactic Oophorectomy: Reducing the U.S. Death Rate from Epithelial Ovarian Cancer,” the title were “Drug X Reducing the U.S. Death Rate from Epithelial Ovarian Cancer,” there would be great media and medical attention worldwide to such a report. Correctly so. Regrettably, there probably is no new Drug X in the foreseeable future that will significantly reduce the death rate from ovarian cancer, be it Taxol®, taxotere, topotecan, gemcitabine, or liposomal doxorubicin—although each may result in significant responses and some prolongation of median survival. Epithelial ovarian cancer is a much more complex disease than anyone envisioned, when it was believed that extensive debulking surgery and the newest cytotoxic chemotherapy would radically reduce the death rate from ovarian cancer in the United States. Over 20 years after the first patient was treated with cisplatin for epithelial ovarian cancer, the annual death rate from ovarian cancer continued to increase. Just in the past decade, the number of women in the United States dying from ovarian cancer has increased 18% (Fig. 1) [1]. Although ovarian cancer is estimated to account for 26,700 cases and 14,800 deaths in 1996, it is a low-prevalence disease in comparison with breast cancer, which in 1996 is estimated to account for 185,700 cases and 44,560 deaths. Inexplicably, similar to breast cancer, the lifetime risk for ovarian cancer in the United States continues to increase. The most recent Surveillance, Epidemiology and End Results (SEER) calculations of lifetime risk for ovarian cancer are that 1 in 55 women will develop ovarian cancer over their lifetime, or 1.8%, up from the 1970 figures of 1 in 70, or 1.4% [2]. The 1.8% baseline lifetime risk for the general population is used to estimate the lifetime risk of known ovarian cancer risk factors (Table 1). Even utilizing what are now believed to be two of the most effective cytotoxic drugs against stage III and IV epithelial ovarian cancer, Taxol® and cisplatin, researchers reported that this resulted in an increase in the median disease-free survival of only five months, as compared with those women allocated to receive cisplatin and cyclophosphamide (median diseasefree survival of 18 and 12.9 months, respectively), felt then to be the standard therapy [3]. Patients treated with Taxol® and cisplatin survived a median of 14 months longer than those