Peritoneal carcinomatosis

Case contributed by Dr Michael P Hartung

Presentation

Abdominal discomfort.

Patient Data

Age: 60 years
Gender: Female
CT

Subtle thickening/nodularity of the omentum. No free fluid. Slightly ill-defined area of low-attenuation in hepatic segment six without definite solid organ metastasis (favored to be geographic fat, but should be followed). Prominent left extrarenal pelvis versus narrowing at the proximal pelviureteral junction (a chronic finding). Uterus surgically absent. No discrete adnexal mass. No primary tumor identified within the abdomen. Incidental note of very heavy calcifications of the aortic valve.

PATHOLOGY REPORT
SPECIMEN TYPE: FNA-DEEP
BODY SITE: PERITONEAL
SLIDE(S): 6 Smear(s) 2 CB Slide(s).


RESULTS: Malignant cells present derived from poorly differentiated carcinoma, with features suggestive of origin from Mullerian primary.
REMARKS: The poorly differentiated carcinoma, exhibiting nonsmall cell cytology, is immunoreactive for BER-EP4, Cytokeratin 7, And PAX-8, With Negativity For TTF-1, Cytokeratin 20, And Calretinin.

Case Discussion

Thickening/nodularity of the omentum (omental cake) as in this case should immediately raises the concern of peritoneal carcinomatosis, despite the lack of fluid or definite primary tumor. 

If no other suspicious findings in the abdomen are identified, it is most appropriate to direct the patient toward ultrasound-guided biopsy of the omentum, which can be easily and safely performed without sedation in most cases.

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