>Corresponding Author : Lyafi Yasmine
>Article Type : Case Report
>Volume : 5 | Issue : 2
>Received Date : 18 Feb, 2025
>Accepted Date : 03 March, 2025
>Published Date : 27 March, 2025
>DOI : https://doi.org/10.54289/JCRMH2500109
>Citation : Yasmine L, Sanaa B, Dounia H, Rihab M, Mohammed J, et al. (2025) Primary Peritoneal Serous Papillary Carcinoma Misdiagnosed as Ovarian Cancer: A Case Report and Literature Review. J Case Rep Med Hist 5(2): doi https://doi.org/10.54289/JCRMH2500109
>Copyright : © 2025 Yasmine L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Case Report | Open Access | Full Text
1Resident Physician, Department of Gynecology and Obstetrics, at Ibn Rochd University Hospital, Casablanca, Morocco
2Professor in the Department of Gynecology and Obstetrics at Ibn Rochd University Hospital, Casablanca, Morocco
*Corresponding author: Lyafi Yasmine, Resident Physician in the Department of Gynecology and Obstetrics at Ibn Rochd University Hospital, Casablanca, Morocco
Serous papillary peritoneal carcinoma (SPPC) is a rare tumor, often mistaken for ovarian cancer due to their clinical and histological similarities. It primarily affects postmenopausal women and presents as peritoneal carcinomatosis without significant ovarian involvement. Preoperative diagnosis is challenging, and histopathological analysis is essential to confirm the diagnosis.
We present the case of a 44-year-old woman with chronic pelvic pain. After clinical and radiological examinations, surgical exploration revealed a well-defined mass on the left pelvic wall. Histopathological analysis confirmed a diagnosis of primary peritoneal serous papillary carcinoma. This case highlights the peritoneum as a potential primary site of malignancy, and its management should be similar to ovarian cancer.
Keywords: Papillary, Serous, Peritoneum, Ovary, CA¬125
Abbreviations: SPPC: Serous Papillary Peritoneal Carcinoma
Serous papillary carcinoma of the peritoneum is a rare tumor, often mistaken for ovarian cancer due to their clinical and histological similarities. It predominantly affects postmenopausal women and presents as peritoneal carcinomatosis without significant ovarian involvement.
We presented this case report to highlight that the peritoneum can also be a primary site of malignancy and that it is diagnosed and treated in a manner similar to primary ovarian cancer. Preoperative diagnosis of this condition is challenging, and histopathological analysis is essential to confirm the diagnosis.
This is a 44-year-old female patient who consulted for chronic pelvic pain She did not report any previous medical conditions, including significant gynecological issues or relevant family history.
The onset of symptoms dates back to eight months ago, characterized by chronic, non-cyclic pelvic pain without digestive or urinary symptoms and no abnormal uterine bleeding, all evolving in a context of preserved general health.
On general examination, the patient was in good hemodynamic condition. Abdominal examination revealed non-distended but diffusely tender abdomen without any palpable mass.
Gynecological examination was unremarkable. Pelvic ultrasound revealed a normal-sized uterus large, oval-shaped mass with a mixed composition in the left adnexa with a normal-sized uterus. The mass measured 80 × 67.5 mm and extended over 100 mm. It was associated with a moderate amount of peritoneal effusion, located in the left iliac fossa and between bowel loops, with a partly echoic content.
Pelvic MRI suggested a suspicious 9 cm latero-uterine left-sided tumor, likely of ovarian origin. The CA125 level was elevated at 516.10.
Given this suspicious clinical and radiological presentation, a laparoscopic surgical exploration was performed. Intraoperatively, a well-circumscribed, multilobulated mass with both solid and cystic components was identified, arising from the left lateral pelvic wall, measuring 9 × 8 cm. The uterus and bilateral adnexa were atrophic and free of any pathological involvement. Examination of the omentum, liver, and diaphragm revealed no macroscopic lesions. No peritoneal carcinomatosis nodules were detected in the upper peritoneal cavity. There was no evidence of lymphadenopathy in the pelvic, pericolic, or para-aortic regions.
A complete resection of the mass was performed, along with systematic peritoneal staging biopsies, omentectomy, and bilateral ovarian sampling. Histopathological analysis confirmed the diagnosis of primary serous papillary carcinoma of the peritoneum. The postoperative course was uneventful, and the surgical report was provided to the patient. She was subsequently referred to the oncology department at Ibn Rochd University Hospital for further management and oncologic follow-up.
Serous papillary carcinoma of the peritoneum is a rare malignant epithelial tumor that is histologically indistinguishable from serous ovarian papillary carcinoma [1-3].
Typically, PSPC gives rise to dissemination on the peritoneal surface and greater omentum in its early phase of growth. Furthermore, it is not uncommon to observe tumor implants on the surface of the liver, diaphragm or mesentery [4].
As serous adenocarcinomas constitute the majority of malignant tumours arising from the ovary or fallopian tube, a gynaecologic diagnostic work-up is promptly instituted in a female patient with serous peritoneal deposits or serous malignant ascites. In 80–90% of cases, a clinical, radiological or pathological diagnosis of stage III–IV ovarian adenocarcinoma is established. However, in 10–15% of cases, no malignant pathology is evident in the ovaries, fallopian tubes or uterus, in which case a diagnosis of serous papillary peritoneal carcinoma (SPPC) is made [2].
Patients with serous papillary peritoneal cancer have typically been treated in the same way as those with stage III/IV ovarian cancer and have often been included in ovarian cancer clinical trials.
Management of patients with SPPC generally consisted of surgical debulking and cytotoxic chemotherapy. As emphasized above, optimal debulking at surgery was often problematic: in chronologically older series, the rate of minimal residual disease (maximum deposits < 1 cm) [5–9]. Zivanovic reported a significant increase in optimal cytoreduction in patients with bulky upper abdominal tumour after 2001 40 G. Pentheroudakis, N. Pavlidis / Critical Reviews in Oncology/Hematology 75 (2010) 27–42 (40% before 2001 vs. 78% after 2001; p < 0.001) [8].
This progress, along with the advent of taxane/platinum regimens, translated to quoted median survival times of 35–40 months in patients with stage III/IV SPPC. Although these data show at first glance that optimal debulking is important for long term disease control, not all series confirm this finding. In several series, debulking status was not prognostic for outcome, though the small sample size and often heterogeneous surgical management in terms of expertise and aggressiveness make it unsafe to draw firm conclusions. Moreover, it is possible that biologically aggressive tumours are the ones with diffuse high-volume peritoneal spread which are ultimately difficult to debulk: this would make the tumour biology rather than debulking status the defining parameter for patient outcome [7].
Primary peritoneal serous papillary carcinoma (SPPC) is a rare and challenging condition that closely mimics ovarian cancer both clinically and histologically. This case highlights the difficulty in preoperatively diagnosing SPPC and underscores the importance of histopathological analysis for accurate identification. Despite its similarities to ovarian cancer, SPPC requires specific attention as it is managed in a manner comparable to ovarian malignancies. Early detection and proper surgical and oncological management are key to improving prognosis and patient survival [9].