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CASE REPORT
Year : 2017  |  Volume : 44  |  Issue : 2  |  Page : 106-109

Primary peritoneal serous adenocarcinoma mimicking carcinoma ovary with omental metastasis


The Oncopathology Centre, Mahatma Gandhi Cancer Hospital, Miraj, Maharashtra, India

Date of Web Publication11-Oct-2017

Correspondence Address:
Yash Rajendra Kale
The Oncopathology Centre, Mahatma Gandhi Cancer Hospital, Miraj - 416 410, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jss.JSS_35_16

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  Abstract 

Primary peritoneal serous adenocarcinoma (PPSA) is a rare primary peritoneal tumor in women. Ovarian, tubal, and peritoneal serous carcinomas have similar pathologic findings. CA125 is the common biomarker used for diagnosis, monitoring treatment response, and tumor progression. To differentiate PPSA from metastasis of primary ovarian serous adenocarcinoma, histopathological criteria were laid down by gynecologic oncology group (GOG) for the diagnosis of PPSA. We present a case of primary peritoneal serous adenocarcinoma clinically mimicking ovarian serous adenocarcinoma with omental metastasis.

Keywords: Immunohistochemistry, ovarian epithelial tumors, primary peritoneal serous adenocarcinoma


How to cite this article:
Pol JN, Phadke MD, Kale YR, Kadkol GA. Primary peritoneal serous adenocarcinoma mimicking carcinoma ovary with omental metastasis. J Sci Soc 2017;44:106-9

How to cite this URL:
Pol JN, Phadke MD, Kale YR, Kadkol GA. Primary peritoneal serous adenocarcinoma mimicking carcinoma ovary with omental metastasis. J Sci Soc [serial online] 2017 [cited 2020 Nov 29];44:106-9. Available from: https://www.jscisociety.com/text.asp?2017/44/2/106/216499


  Introduction Top


Primary peritoneal serous adenocarcinoma (PPSA) is a primary peritoneal tumor in women. PPSA is a rare malignancy compared to their ovarian counterpart.[1] These tumors arise primarily from the peritoneal surface epithelium.[2] To differentiate PPSA from metastasis of primary ovarian serous adenocarcinoma, histopathological criteria were laid down by gynecologic oncology group (GOG) for the diagnosis of PPSA.[3]

The PPSA is staged and treated in a similar way to epithelial ovarian tumors. However, these tumors present with advanced stage and have a shorter survival when compared to their ovarian counterpart.[4]


  Case Report Top


A 58-year-old female with chief complaint of pain in the abdomen underwent computed tomography (CT) abdomen and pelvis. CT showed enlarged cystic right ovarian mass measuring 7 cm × 5 cm × 3 cm, multiple peritoneal deposits in the right iliac fossa, largest of them measured 2.5 cm × 2 cm × 1.3 cm and moderate hepatomegaly with multiple cysts. Her cancer antigen 125 (CA125) level was 455 U/ml. Considering the above findings, a clinical diagnosis of carcinoma ovary with omental metastasis was made.

We received panhysterectomy specimen with omentum. Panhysterectomy specimen showed enlarged right ovary. Cut section of the right ovary was cystic and filled with pultaceous material. We extensively sampled the right ovary. The left adnexa, cervix, and endomyometrium were unremarkable grossly. Omentum showed multiple nodular lesions, and largest nodule measured 2.5 cm × 2 cm × 1.3 cm [Figure 1].
Figure 1: Right ovarian cyst (H and E, ×10)

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Microscopic examination of the right ovary showed a dermoid cyst. The left adnexa, cervix, and endomyometrium were unremarkable microscopically also. Omentum showed a tumor composed of cells arranged predominantly in papillae and glands and infiltrating adjacent fat spaces. Cells had high N/C ratio, pleomorphic vesicular nuclei with prominent nucleoli, and scanty eosinophilic cytoplasm [Figure 2] and [Figure 3].
Figure 2: Omental deposits (H and E, ×10)

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Figure 3: Omental deposits (H and E, ×40)

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Considering microscopic findings, we considered three differential diagnoses: metastatic papillary adenocarcinoma, PPSA, and mesothelioma. We went ahead with immunohistochemistry consisting of the following antibodies: cytokeratin 7 (CK7), CK20, CA125, WT1, and calretinin to arrive at diagnosis. The tumor cells were positive for CK7 [Figure 4] and negative for CK20 [Figure 5]. The tumor cells also expressed CA 125 [Figure 6] and WT1 [Figure7]. Calretinin [Figure 8] was not negative in tumor cells. Correlating the morphology and immunohistochemical findings, we gave a final diagnosis of PPSA.
Figure 4: Immunohistochemistry for cytokeratin 7. Tumor cells express cytokeratin 7 (×10)

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Figure 5: Immunohistochemistry for cytokeratin 20. Tumor cells are negative for cytokeratin 20 (×10)

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Figure 6: Cancer antigen 125 tumor cells express cancer antigen 125 (×10)

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Figure 7: Immunohistochemistry for WT1. Tumor cells express WT1 (×10)

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Figure 8: Immunohistochemistry for calretinin. Tumor cells are negative for calretinin (×10)

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  Discussion Top


Ovarian, tubal, and peritoneal cancers have similar pathologic findings which vary based on histologic subtype but not by primary site of origin.[5] CA125 is the only biomarker commonly used for diagnosis, monitoring treatment response, and cancer progression in epithelial ovarian cancer,[6] as well as tubal and peritoneal cancers.[7] CA125 is a glycoprotein encoded by the gene MUC16. This explains elevated CA125 in our case.

Serous carcinoma of the ovary, fallopian tube, and peritoneum are almost identical in histopathology. Microscopically, the architecture could vary from glandular to complex papillary to solid pattern, with the tumor cells infiltrating or replacing the surrounding normal tissues. In our case, the similar microscopic picture was seen. Immunophenotypically, ovarian and tubal serous carcinomas strongly and diffusely express CK7, WT1, PAX8, estrogen receptor, CA125, p16, and E-cadherin in most cases [Figure 7]. They do not express Her2, calretinin, or CK20 and have a high Ki-67 proliferative index. Overall, the peritoneal serous carcinomas almost always demonstrate the same immunohistochemistry pattern as ovarian and tubal serous carcinomas, with minor and inconsistent differences in WT1, beta-catenin, vimentin, and CK20 expression. In our case, tumor cells were positive for CK7, CA125, and WT1 and negative for CK20 and calretinin.[8],[9],[10],[11],[12]

GOG criteria used for diagnosis of PPSA include (i) both ovaries must be normal in size or enlarged by a benign process, (ii) the involvement in the extraovarian sites must be greater than the involvement on the surface of either ovary, (iii) the ovarian tumor component must be either nonexistent, confined to ovarian surface epithelium without stromal invasion, or involving the cortical stroma with tumor size up to 5 mm × 5 mm, and (iv) serous histology is present.[5]

We present this case because it was diagnosed clinically as carcinoma ovary with omental metastasis, but on histopathological examination, it turned out to be a case of PPSA with benign dermoid cyst of the right ovary and normal left ovary. In our case, all four GOG criteria were fulfilled. Although the PPSA is staged and treated in a similar way to epithelial ovarian tumors, we must differentiate them because these tumors present with an advanced stage and have a shorter survival when compared to their ovarian counterpart.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Grant DJ, Moorman PG, Akushevich L, Palmieri RT, Bentley RC, Schildkraut JM, et al. Primary peritoneal and ovarian cancers: An epidemiological comparative analysis. Cancer Causes Control 2010;21:991-8.  Back to cited text no. 1
    
2.
Goodman MT, Shvetsov YB. Incidence of ovarian, peritoneal, and fallopian tube carcinomas in the United States, 1995-2004. Cancer Epidemiol Biomarkers Prev 2009;18:132-9.  Back to cited text no. 2
[PUBMED]    
3.
Bloss JD, Liao SY, Buller RE, Manetta A, Berman ML, McMeekin S, et al. Extraovarian peritoneal serous papillary carcinoma: A case-control retrospective comparison to papillary adenocarcinoma of the ovary. Gynecol Oncol 1993;50:347-51.  Back to cited text no. 3
[PUBMED]    
4.
Pentheroudakis G, Pavlidis N. Serous papillary peritoneal carcinoma: Unknown primary tumour, ovarian cancer counterpart or a distinct entity? A systematic review. Crit Rev Oncol Hematol 2010;75:27-42.  Back to cited text no. 4
[PUBMED]    
5.
Cobb LP, Gaillard S, Wang Y, Shih IeM, Secord AA. Adenocarcinoma of mullerian origin: Review of pathogenesis, molecular biology, and emerging treatment paradigms. Gynecol Oncol Res Pract 2015;2:1.  Back to cited text no. 5
    
6.
Tanyi JL, Scholler N. Oncology biomarkers for gynecologic malignancies. Front Biosci (Elite Ed) 2012;4:1097-110.  Back to cited text no. 6
[PUBMED]    
7.
Levy T, Weiser R, Boaz M, Ben Shem E, Golan A, Menczer J, et al. The significance of the pattern of serum CA125 level ascent to above the normal range in epithelial ovarian, primary peritoneal and tubal carcinoma patients. Gynecol Oncol 2013;129:165-8.  Back to cited text no. 7
    
8.
Nofech-Mozes S, Khalifa MA, Ismiil N, Saad RS, Hanna WM, Covens A, et al. Immunophenotyping of serous carcinoma of the female genital tract. Mod Pathol 2008;21:1147-55.  Back to cited text no. 8
    
9.
Wiseman W, Michael CW, Roh MH. Diagnostic utility of PAX8 and PAX2 immunohistochemistry in the identification of metastatic Müllerian carcinoma in effusions. Diagn Cytopathol 2011;39:651-6.  Back to cited text no. 9
    
10.
Hou T, Liang D, He J, Chen X, Zhang Y. Primary peritoneal serous carcinoma: A clinicopathological and immunohistochemical study of six cases. Int J Clin Exp Pathol 2012;5:762-9.  Back to cited text no. 10
    
11.
Liu Q, Lin JX, Shi QL, Wu B, Ma HH, Sun GQ, et al. Primary peritoneal serous papillary carcinoma: A clinical and pathological study. Pathol Oncol Res 2011;17:713-9.  Back to cited text no. 11
    
12.
Attanoos RL, Webb R, Dojcinov SD, Gibbs AR. Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum. Histopathology 2002;40:237-44.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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