Consequences of abdominal adenocarcinoma in post-menopausal woman in relation to surgical and non-surgical management.

ABSTRACT

The umbilical tumor as a presenting symptom must be investigated for the possibility of metastasis. In this case, it was unlikely, as there was no primary carcinoma found elsewhere. Primary peritoneal carcinoma (also termed serous surface papillary carcinoma) is a malignancy that arises primarily from peritoneal cells. The mesothelium of the peritoneum and the germinal epithelium of the ovary arise from the same embryological origin. Although primary peritoneal carcinoma has a very poor prognosis, our patient had a disease-free interval of two years post surgery. Clinically, primary peritoneal carcinoma may be difficult to distinguish from ovarian carcinoma. Compared to ovarian carcinoma, primary peritoneal carcinoma has a higher rate of abdominal distension, volume of ascites, malignant cells in the ascitic fluid, lower rate of pelvic palpable mass, and personal breast cancer history. However, primary ovarian cancer can be excluded in this case, based on both ovaries being of normal size with no tumor involvement and a histology that favors serous carcinoma. The disease is normally disseminated throughout the peritoneum. Our patient's disease was confined to the umbilicus with no evidence of dissemination. We report a rare case of adenocarcinoma confined to the umbilicus of a 64-year-old menopausal woman presented with an umbilical lump of nine years. After five years, she presented with a 6-cm irregular periumbilical mass. She agreed to undergo an excision biopsy of the mass with total abdominal hysterectomy and bilateral salpingo-oopherectomy with omentectomy. The excision biopsy showed adenocarcinoma with an appearance suggestive of metastasis from an ovarian cystadenocarcinoma. The frozen section of the tumor showed a papillary adenocarcinoma. Histology showed adenocarcinoma favoring serous cancer. It was found that tumor markers of ovarian malignancy were normal. There was no tumor seen in the ovaries, uterus and omentum. On follow-up, there was no disease recurrence. The patient has been disease-free for two years post surgery (Fig. 5, Ref. 10).