PRIMARY SEROUS CARCINOMA OF PERITONEUM: A CASE REPORT

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1 PRIMARY SEROUS CARCINOMA OF PERITONEUM: A CASE REPORT Dott. Francesco Pontieri (*) U.O. di Anatomia Patologica P.O. di Rossano (CS) Dott. Gian Franco Zannoni Anatomia Patologica Facoltà di Medicina e Chirurgia Università Cattolica Roma (*) Relatore Facebook

2 The papillary serous carcinoma of the peritoneum is a rare malignant epithelial tumor histologically indistinguishable from high-grade papillary serous carcinoma of the ovary. The distinction between both of these is sometimes difficult, especially in cases of advanced metastatic disease.

3 In this study, we report the case of a woman 57 years old, previously operated by bilateral hysteroannessiectomy because of uterine fibromatosis, with a clinical history characterized by abdominal ache associated with fever, weight loss and ascites. The laparoscopic exploration of the peritoneal cavity, revealed the presence of diffuse and multiple nodular structures with papillary aspects, involving the omentum, the ascending and transverse colon, and cecum.

4 The histological evaluation showed a high-grade papillary serous carcinoma, exhibits sheets of cells with marked nuclear atypia, isolated bizarre cells, high mitotic activity and foci of necrosis. The immuno-histochemical profile showed a diffuse and strong positivity to p53, WT-1, CK7 and CK18, a moderate nuclear positivity to Estrogen receptors and a negativity to CK20, Calretinin and Progesterone receptors.

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9 The first histological diagnosis was peritoneal carcinomatosis incidental to papillary serous carcinoma of high-grade ovarian cancer. However, the revision of the uterus and the uterine annexes ruled out the presence of invasive or in situ carcinomatous sores in bilateral ovarian site.

10 The differential diagnosis of high-grade primary peritoneal serous papillary carcinoma (PPSPC) includes metastatic (primary) ovarian serous papillary carcinoma (POSPC), endometrial serous carcinoma, malignant mesothelioma, metastatic adenocarcinoma of the breast, and metastatic papillary thyroid carcinoma arising within struma ovarii.

11 Type of neoplasm POSPC Endometrial serous carcinoma Malignant mesothelioma Metastatic carcinoma from breast Metastatic papillary thyroid carcinoma Morphologic and immunohis. features Diffuse parenchima involvement of ovaries; WT- 1+ and p53+ Uterine endometrial involvement; weak or absent staining with WT-1 Cells are cuboidal to rounded with eosinophilic cytoplasm; positive mesothelial markers, including calretinin and CK5/6. Clinical history of the primary breast carcinoma; BRST-2 + (*) and mammaglobin+ Nuclear inclusion and grooves may be seen; Thyroglobin + and TTF-1+ (*) Gross Cystic Disease Fluid Protein-15 (GCDFP-15)

12 Criteria for the separation of POSPC from PPSPC have been establisched by the Gynecologic Oncology Group: the neoplasm is classified as a primary peritoneal serous carcinoma if the majority of the tumour is situaded in the peritoneum with unremarkable ovaries, or if only ovarian surface or minimal ovarian stromal invasion is present.

13 These clinical and instrumental data associated with the Gynecologic Oncology Group criteria relating to the differential diagnosis, allowed to carry out the diagnosis of primary peritoneal papillary serous carcinoma.

14 In conclusion, a careful clinical, anamnestic, histological and immuno-histochemical evaluation is essential to express a correct diagnosis and to plan a suitable treatment. The primary peritoneal papillary serous carcinoma requires a close follow-up because of poor prognosis that is comparable or worse than the papillary serous ovarian carcinoma.

15 References: 1) Vang R., Shih IeM, Kurman R.J. Ovarian low-grade and high-grade serous carcinoma: pathogenesis, clinicopathologic and molecular biologic features, and diagnostic problems. Adv. Anat. Pathol 2009; 16: ) Kurman R.J., Shih IeM, The origin and pathogenesis of epithelial ovarian cancer: a proposed unifying theory. Am. J Surg Pathol 2010; 34: ) Gross AL, Kurman RJ, Vang R, et al. Precursor lesions of high-grade serous ovarian carcinoma: morphological and molecular characteristics. J Oncol 2010; 2010: ) Liu Q, Lin JX, Shi QL, et al. Primary peritoneal serous papillary carcinoma: a clinical and pathological study. Pathol Oncol Res 2011; 17: ) Shelly Sehgal, Reena Agarwal, et al. Primary serous carcinoma of peritoneum: a case report ; IJCRI 2012; vol 3, N.10; 6) Gilani S., Tashjian R., Fathallah L., High-grade primary peritoneal serous papillary carcinoma with a wide differential diagnosis: a diagnostic challenge ; Pathologica 2012; 104: