Primary Papillary Serous Carcinoma of the Peritoneum: CT-Pathologic Correlation

Abstract

We present the CT findings of three cases of primary papillary serous carcinoma of the peritoneum. All patients presented with massive ascites. CT of the abdomen and pelvis showed omental caking in all patients. The parietal peritoneum of the pelvis showed diffuse enhancement with nodular thickening in all patients. No calcification was noted in the omental and parietal peritoneal masses, although psammoma bodies were present microscopically in one case. The ovaries were normal in size but showed a fine enhancing surface nodularity similar to the pelvic peritoneum. The CT findings of primary papillary serous carcinoma of the peritoneum are nonspecific, but this diagnosis should be considered when peritoneal carcinomatosis is seen on CT with normal-sized ovaries in the absence of other primary malignant neoplasms.

Extraovarian primary peritoneal carcinoma: staging with 18F-FDG PET/CT

“…Calcifications within peritoneal and omental nodules represent psammoma bodies, and have been thought to be a distinguishing characteristic of EOPPC [18], however a recent review of three patients showed absence of calcification in all three patients. In that study, patients with EOPPC had massive omental caking and more extensive involvement of the pelvic peritoneum than the abdominal peritoneum, in the form of diffuse enhancing thickening with fine nodularity, creeping onto the ovarian and uterine surfaces [19]. This pattern of disease distribution was present in our patient on the MRI images and the CT portion of the PET/CT images and was confirmed on histopathological evaluation.…”

Serous Surface Papillary Carcinoma of the Peritoneum: Clinical, Radiologic, and Pathologic Findings in 11 Patients

“…In a report by Zissin et al [14], six of 30 patients with serous surface papillary carcinoma had adnexal masses or ovarian enlargement on CT, but no evidence of tumor involvement was seen in the underlying ovaries or fallopian tubes on pathologic examination in any of the patients [14]. In the other three radiology studies, the ovaries were neither detected nor enlarged on CT [4,7,8].…”

“…Swerdlow [17] in 1959 first reported serous surface papillary carcinoma that was found in a patient with peritoneal carcinomatosis with no known primary lesion. Patients with serous surface papillary carcinoma are mostly found in a state of peritoneal carcinomatosis, which shows ascites, peritoneal thickening and nodules, and omental caking on CT and MRI [4,7,8,14]. Serous surface papillary carcinoma is found in 7-21% of patients with epithelial ovarian cancer [5,13].…”

“…Serous surface papillary carcinoma is defined as a primary tumor of the peritoneum that diffusely involves the peritoneal surface but spares or only superficially invades the ovaries [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Serous surface papillary carcinoma has been reported under various names including peritoneal serous papillary carcinoma [4,5], extraovarian peritoneal serous papillary carcinoma [1,6], primary papillary serous carcinoma of the peritoneum [7,8], and serous surface papillary carcinoma of the peritoneum [9,10] since it was initially described in 1959 by Swerdlow [17] as "mesothelioma of pelvic peritoneum." Serous surface papillary carcinoma is considered to originate from embryonic nests of the mülle-rian cells in the peritoneum [11].…”

“…However, most of them are in the form of a small series or reports of a single case. To our knowledge, only four radiology papers discuss serous surface papillary carcinoma, and those mainly describe CT findings [4,7,8,14]. The purpose of our study was to comprehensively describe the clinical, radiologic, and pathologic findings of serous surface papillary carcinoma in 11 patients.…”