Presentation
Unexplained weight loss, loss of appetite and fatigue. ? Right iliac fossa mass. Previous history of appendectomy and release of adhesion.
Patient Data
There is marked peritoneal disease on the undersurface left hemidiaphragm, supracolic omentum, gastrosplenic and gastrohepatic ligaments. There is large volume omental cake lying deep to transverse colon and low volume disease in the right paracolic gutter and pelvic peritoneal carpeting. There is low volume ascites.
There is a small ill-defined area low attenuation liver parenchyma indeterminate, but likely reflects a cyst or hemangioma.
No obvious lesion lumen of stomach, pancreas or colon. No obvious pelvic mass. There are sterilization clips in situ.
No destructive bony disease.
Summary: Disseminated intra-abdominal disease, pattern could fit with primary peritoneal carcinoma or tuboovarian origin but requires biopsy for confirmation. .
3 satisfactory 18-gauge cores obtained from the epigastric peritoneal cake. Sample to pathology.
No significant procedural complications.
Case Discussion
Biopsy showed stage 3c high grade serous ovarian carcinoma and underwent chemotherapy with a good response at 6 months.
Initial images show the difficulty of differentiating primary peritoneal carcinoma from primary ovarian malignancy in the absence of a large ovarian mass.
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