Peritoneal borderline cystoadenocarcinoma

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This case report describes a peritoneal borderline mucinous carcinoma in a patient with anatomopathologically normal ovaries, an entity with implications for prophylactic oophorectomy and potentially shared pathogenesis with endosalpingiosis and endometriosis.

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This 1998 case report describes a 51-year-old woman with progressive abdominal distension and cramp pain, found on imaging to have a predominantly cystic mass with a small internal solid component; laparotomy showed a voluminous retroperitoneal cystic tumor with normal uterus and ovaries. After tumor excision and bilateral oophorectomy, pathology diagnosed a peritoneal mucinous borderline cystoadenocarcinoma, with atrophic ovaries despite normal ovaries reported anatomopathologically. The authors discuss that peritoneal carcinomas can occur in patients despite prophylactic oophorectomy and propose possible etiologic links to processes resembling endosalpingiosis and some cases of endometriosis via peritoneal metaplasia/hyperplasia, but they note the overall etiology remains poorly understood. This paper is centrally about peritoneal borderline cystoadenocarcinoma—specifically a case of peritoneal mucinous borderline tumor with normal ovaries, and it relates to endometriosis by explicitly proposing shared pathogeny mechanisms (peritoneal metaplasia/hyperplasia) with some endometriosis cases.

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Abstract

Carcinomas of peritoneal origin represent a seldom diagnosed entity of unknown etiology, with important implications in terms of prophylactic oophorectomy. Initially described in patients belonging to families at high risk for ovarian cancer, it possibly has a pathogeny similar to that of endosalpingiosis and of some cases of endometriosis. We report a case of peritoneal borderline mucinous carcinoma with an anatomopathological diagnosis of normal ovaries.
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J. 116 (1) • Feb 1998 • https://doi.org/10.1590/S1516-31801998000100008 link copy Peritoneal borderline cystoadenocarcinoma Authorship SCIMAGO INSTITUTIONS RANKINGS Abstract Carcinomas of peritoneal origin represent a seldom diagnosed entity of unknown etiology, with important implications in terms of prophylactic oophorectomy. Initially described in patients belonging to families at high risk for ovarian cancer, it possibly has a pathogeny similar to that of endosalpingiosis and of some cases of endometriosis. We report a case of peritoneal borderline mucinous carcinoma with an anatomopathological diagnosis of normal ovaries. Peritoneum; Peritoneal carcinoma; Peritoneal adenocarcinoma Resumo O carcinoma de peritôneo é raro, de etiologia desconhecida, tendo grande importância quando se dicute a ooforectomia profilática como prevenção do carcinoma de ovário. Foi inicialmente descrito em pacientes de famílias de alto risco para carcinoma de ovário, o que possibilita haver patogenia semelhante àquela observada em endossalpingiose ou alguns casos de endometriose. Relata-se, no presente estudo, caso de carcinoma mucinoso "borderline" de peritôneo, com exame histopatológico mostrando ovários normais. CASE REPORT Peritoneal borderline cystoadenocarcinoma Manoel João Batista Castello Girão; Marair Gracio Ferreira Sartori; Wagner José Gonçalves; Geraldo Rodrigues de Lima Department of Gynecology of Escola Paulista de Medicina - Universidade Federal de São Paulo – São Paulo, Brazil Address for correspondence ABSTRACT Carcinomas of peritoneal origin represent a seldom diagnosed entity of unknown etiology, with important implications in terms of prophylactic oophorectomy. Initially described in patients belonging to families at high risk for ovarian cancer, it possibly has a pathogeny similar to that of endosalpingiosis and of some cases of endometriosis. We report a case of peritoneal borderline mucinous carcinoma with an anatomopathological diagnosis of normal ovaries. Uniterms: Peritoneum. Peritoneal carcinoma. Peritoneal adenocarcinoma. RESUMO O carcinoma de peritôneo é raro, de etiologia desconhecida, tendo grande importância quando se dicute a ooforectomia profilática como prevenção do carcinoma de ovário. Foi inicialmente descrito em pacientes de famílias de alto risco para carcinoma de ovário, o que possibilita haver patogenia semelhante àquela observada em endossalpingiose ou alguns casos de endometriose. Relata-se, no presente estudo, caso de carcinoma mucinoso "borderline" de peritôneo, com exame histopatológico mostrando ovários normais. INTRODUCTION Reports of peritoneal tumors histologically similar to ovarian carcinoma have been published over the last few years, usually relating to patients with previous oophorectomy and with high familial risk. Several investigators have reported cases of peritoneal carcinoma in patients whose families are at high risk for ovarian cancer, who had been submitted to prophylactic oophorectomy (1) . This fact appears to demonstrate that in these families gonadal exeresis may not provide total protection against ovarian cancer. Since serous ovarian carcinomas are usually disseminated in the peritoneal cavity at the time of diagnosis, a hypothesis of multifocal rather than metastatic origin may be proposed for these neoplasias. This possibility may justify the slight involvement of the ovaries observed in some cases, where extensive peritoneal involvement has already occurred. The pathogeny is probably similar to that of endosalpingiosis and to some cases of endometriosis, possibly involving processes of peritoneal metaplasia and hyperplasia similar to the precursor alterations detected in the surface epithelium of the ovary. Gene instability may arise as a consequence of these processes, or its intensity may be directly related to the extent of hyperplasia. The pelvic peritoneum may apparently have a great capacity for transformation into several mullerian epithelia, especially into tubal and endometrial types (2) . CASE REPORT A 51-year old white woman sought the Department of Gynecology at Escola Paulista de Medicina complaining of having had progressive swelling of the abdomen during the preceding 2 years, accompanied by cramp pain irradiating toward the dorsal region, and retrosternal pyrosis. She denied having epidemiological risk factors for malignant genital neoplasias. Physical examination revealed a body mass index of 27.8, as well as a tumor of precise limits, elastic consistency, smooth surface, and little mobility, occupying the mesogastrium and hypogastrium; it measured approximately 16 x 20 mm. Abdominal ultrasound revealed a predominantly cystic formation of regular limits and with a small internal solid area. The uterus was normal and the ovaries were not identified. At laparotomy, a voluminous cystic tumor originating from the retroperitoneum and measuring approximately 20 mm in diameter was seen. The uterus and ovaries were normal, as well as the rest of the abdominal cavity. Tumor exeresis and bilateral oophorectomy were performed. Anatomopathological examination of the tumor revealed the presence of a peritoneal mucinous borderline cystoadenocarcinoma , with atrophic ovaries. DISCUSSION AND CONCLUSIONS Little is known about the possible etiological and predisposing factors involved, making prevention extremely difficult. However, extraovarian peritoneal carcinoma behaves like its gonadal counterpart, ranging from benign and borderline to frankly malignant varieties. The prognosis is similar to ovarian carcinomas and the response to chemotherapy is estimated at 63% (3) . It should be pointed out that the incidence of the borderline form tends to be higher among young women and that this form frequently has psammomatose bodies. The borderline form accounts for 8 to 15% of the lesions diagnosed in stages III and IV. This type of neoplasia may possibly be observed with greater frequency in the future, as pathologists start to recognize it and establish better diagnostic criteria. ACKNOWLEDGMENTS We thank L.C. Granero, MD, PhD and F.M. Callegari, MD, Division of Pathology, Escola Paulista de Medicina, for the pathological analysis of the material. References 1. Piver MS, Jishi MF, Tsukada Y, Nava G. Primary Peritoneal carcinoma after prophylatic oophorectomy in women with a family history of ovarian cancer: a report of a Gilda Radner familial ovarian cancer registry. Cancer 1993;71(9):2751. 2. Morrow CP, Curtin JP, Townsend DE . Synopsis Gynecologic Oncology. 4 th ed., New York, Churchill Livingstone 1993;209. 3. Disaia PJ, Creasman WT. Clinical Gynecology Oncology. 4 th ed., St. Louis, Mosby Year Book 1993;458. Address for correspondence: Manoel João Batista Castello Girão Av. Onze de Junho, 1006, ap. 51 São Paulo/SP - Brasil - CEP 04041-003 Publication Dates Publication in this collection 16 Oct 2008 Date of issue Feb 1998 This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. Authorship .author-card { border-bottom: 1px solid #ccc; padding: 1rem 0; } .author-card:last-child { border-bottom: 0px; } .author-name { font-weight: 600; } .orcid-button { padding-left: 2.5rem; } .modal-body { padding-bottom: 3rem; } .orcid-button::before { content: ""; position: absolute; background-image: url(https://ds.scielo.org/img/logo-orcid.svg); background-repeat: no-repeat; background-size: 1.5em auto; background-position: .5em center; display: block; width: 60px; height: 60px; top: -10px; left: 0; } person Manoel João Batista Castello Girão school Universidade Federal de São Paulo, Escola Paulista de Medicina , Department of Gynecology, São Paulo, São Paulo, Brazil Universidade Federal de São Paulo Brazil São Paulo, São Paulo, Brazil Universidade Federal de São Paulo, Escola Paulista de Medicina , Department of Gynecology, São Paulo, São Paulo, Brazil person Marair Gracio Ferreira Sartori school Universidade Federal de São Paulo, Escola Paulista de Medicina , Department of Gynecology, São Paulo, São Paulo, Brazil Universidade Federal de São Paulo Brazil São Paulo, São Paulo, Brazil Universidade Federal de São Paulo, Escola Paulista de Medicina , Department of Gynecology, São Paulo, São Paulo, Brazil person Wagner José Gonçalves school Universidade Federal de São Paulo, Escola Paulista de Medicina , Department of Gynecology, São Paulo, São Paulo, Brazil Universidade Federal de São Paulo Brazil São Paulo, São Paulo, Brazil Universidade Federal de São Paulo, Escola Paulista de Medicina , Department of Gynecology, São Paulo, São Paulo, Brazil person Geraldo Rodrigues de Lima school Universidade Federal de São Paulo, Escola Paulista de Medicina , Department of Gynecology, São Paulo, São Paulo, Brazil Universidade Federal de São Paulo Brazil São Paulo, São Paulo, Brazil Universidade Federal de São Paulo, Escola Paulista de Medicina , Department of Gynecology, São Paulo, São Paulo, Brazil SCIMAGO INSTITUTIONS RANKINGS Universidade Federal de São Paulo, Escola Paulista de Medicina , Department of Gynecology, São Paulo, São Paulo, Brazil Universidade Federal de São Paulo Brazil São Paulo, São Paulo, Brazil Universidade Federal de São Paulo, Escola Paulista de Medicina , Department of Gynecology, São Paulo, São Paulo, Brazil How to cite link copy function currentDate() { var today = new Date(); var months = ['January', 'February', 'March', 'April', 'May', 'June', 'July', 'August', 'September', 'October', 'November', 'December'] today.setTime(today.getTime()); return today.getDate() + " " + months[today.getMonth()] + " " + today.getFullYear(); } var citation = 'Girão, Manoel João Batista Castello et al. Peritoneal borderline cystoadenocarcinoma. Sao Paulo Medical Journal [online]. 1998, v. 116, n. 1 [Accessed CURRENTDATE], pp. 1634-1636. Available from: . Epub 16 Oct 2008. ISSN 1806-9460. https://doi.org/10.1590/S1516-31801998000100008.'.replace('CURRENTDATE', currentDate()); document.getElementById('citation').innerHTML = citation; document.getElementById('citationCut').value = citation.replace('<', ' "); more_horiz Ferramentas do artigo file_download PDFs show_chart Metrics image Figuras e tabelas translate Versions and translations link How to cite this article article Related articles location_on Associação Paulista de Medicina - APM APM / Publicações Científicas, Av. 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Condition tags

endometriosis

MeSH descriptors

Adenocarcinoma, Mucinous Peritoneal Neoplasms Adenocarcinoma, Mucinous Female Humans Middle Aged Ovarian Neoplasms Ovarian Neoplasms Peritoneal Neoplasms

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