41-year-old woman, abdominal pain six weeks after caesarean section.
At surgery: ascites; numerous micronodules affecting the peritoneal cavity, the omentum, the surface of the uterus, and ovaries. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy.
Short remission period following surgery. Recurrent abdominal pain. Laparascopy: intestinal fistula. Patient referred to our hospital for the treatment of intestinal fistula.
Heteregenous nodule of the parietal pleura invading the dermis, with osteolysis of the rib, revealed by Computed tomography. Two weeks later, laparotomy: loops of small bowel matted together, covered by numerous deposits of firm white tissue, which formed nodules and plaques on both visceral and parietal peritoneal surface as well as in Pouch of Douglas. Resection of matted loops of small bowel.
The patient’s condition gradually deteriorated and she died 14 months after the onset of symptoms.
肉眼检查：
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姓 名：
×××
性别：
女
年龄：
41
标本名称：
多处腹腔肿瘤
简要病史：
41-year-old woman, abdominal pain six
weeks after caesarean section.
At surgery: ascites; numerous
micronodules affecting the peritoneal cavity, the omentum, the surface of the
uterus, and ovaries. Total abdominal hysterectomy, bilateral
salpingo-oophorectomy, and omentectomy.
Short remission period following
surgery. Recurrent abdominal pain. Laparascopy: intestinal fistula. Patient
referred to our hospital for the treatment of intestinal fistula.
Heteregenous nodule of the parietal
pleura invading the dermis, with osteolysis of the rib, revealed by Computed
tomography. Two weeks later, laparotomy: loops of small bowel matted together,
covered by numerous deposits of firm white tissue, which formed nodules and
plaques on both visceral and parietal peritoneal surface as well as in Pouch of
Douglas. Resection of matted loops of small bowel.
The patient’s condition gradually
deteriorated and she died 14 months after the onset of symptoms.
Thanks you for sharing such an interesting case with me.
There is no big problem to make the diagnosis of malignancy,
owing to extensively metastasis in peritoneal cavity (Carcinomatosis). The
difficult question is to clarify what kind tumor. In terms of histogenesis,
there are several origins of cancers should be considered. 1) Metastatic GI
poorly differentiated adenocarcinoma; 2) arriving from female reproductive
system, such as ovary, uterus corpus or fallopian tubes; 3) primary tumor is
outside the peritoneal, such as lung (large cell carcinoma), and other rare
tumor types (rhabdoid tumor, melanoma) and so on, also could not rule out.But,my first choice will be malignant mesothelioma with deciduoid features, clear
cells, epitheliod cells, papillary structure, and vesicular in cytoplasm, which
all refer to the mesothelium origin. Of course the IHC labeling should be done, the markers include Vimentin, AE1/AE3, CK5/6, HBME-1, calretinin,
CA125, CDX-II, CEA, TTF-1, desmin and others. Maybe you already have the final
diagnosis because there was some useful diagnostic patterns in other slides.
I'd like to see other slides including IHC results in near future.
Thanks again,
Best Regards,
XLJ
以下是引用xljin8在2010-1-20 2:52:00的发言：
Dear Dr. Wang,
Thanks you for sharing such an interesting case with me.
There is no big problem to make the diagnosis of malignancy,
owing to extensively metastasis in peritoneal cavity (Carcinomatosis). The
difficult question is to clarify what kind tumor. In terms of histogenesis,
there are several origins of cancers should be considered. 1) Metastatic GI
poorly differentiated adenocarcinoma; 2) arriving from female reproductive
system, such as ovary, uterus corpus or fallopian tubes; 3) primary tumor is
outside the peritoneal, such as lung (large cell carcinoma), and other rare
tumor types (rhabdoid tumor, melanoma) and so on, also could not rule out.But,my first choice will be malignant mesothelioma with deciduoid features, clear
cells, epitheliod cells, papillary structure, and vesicular in cytoplasm, which
all refer to the mesothelium origin. Of course the IHC labeling should be done, the markers include Vimentin, AE1/AE3, CK5/6, HBME-1, calretinin,
CA125, CDX-II, CEA, TTF-1, desmin and others. Maybe you already have the final
diagnosis because there was some useful diagnostic patterns in other slides.
I'd like to see other slides including IHC results in near future.
图2
图3
图4
图5
图6
图7
图8
