A Case of Peritoneal Serous Papillary Carcinoma in a Woman -A Study on the Clinical Entity of this Disease with Literature-

Hiroshi Takahashi, Tetsuya Yamaguchi, Ryoji Takeda, Shingo Sakata and Michihiro Yamamoto

Department of Surgery, Rakuwakai Otowa Hospital

A 66-year-old woman admitted for abdominal distension and left lower abdominal pain was found in abdominal CT and MRI to have massive acites and omental tumor mass with normal-sized ovaries. Serum CA-125 was 6,125 U/ml. Aspiration cytology showed adenocarcinoma cells but no primary tumor. Laparotomy conducted based on a diagnosis of peritoneal serous papillary carcinoma (PSPC) showed peritoneal implants throughout the peritoneal cavity, necessitating reduction surgery, including omentectomy. The definitive diagnosis was PSPC based on pathological findings and immunohistochemical results of Ber-EP4 (+) CEA (+) Calretini (-) CK5/6 (±). According to the literature the term "surface" in serous surface papillary carcinoma (SSPC) which is another name for PSPC originally meant surface epithelium of ovary, and didn't mean peritoneal surface. It is also confusing that PSPC is defined as being of peritoneal origin even though small lesions are found in the ovary. Although multicentric and synchronous origins of peritoneal implants of PSPC have recently been proposed in gynecological area, we found a patient in the urological literature who had ascites and omental tumors 5 years after orchiectomy for serous papillary adenocarcinoma of the tunica vaginalis testis, a vestige of the mullerian duct in a man, and we assumed that this case showed the possibility of metachronous and metastatic origin of peritoneal implants of PSPC.

Key words
peritoneal serous papillary carcinoma, surface epithelium, mullerian vestiges

Reprint requests
Hiroshi Takahashi Department of Surgery, Rakuwakai Otowa Hospital
2 Chinji-cho, Otowa, Yamashina-ku, Kyoto, 607-8062 JAPAN

Accepted
November 30, 2005

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