M a n o e l J o a o B a tis ta C a s te llo G J ra o , M a ra ir G ra c io F e rre ira S a rto ri, W a g n e r J o s e G o n 9 a lv e s , G e ra ld o R o d rig u e s d e L im a
Peritoneal borderline cystoadenocarcinoma
Department
of Gynecology of Escola Paulista de Medicina - Universidade Federal de Slio Paulo - Slio Paulo, Brazil
C a rc in o m a s o f p e rito n e a l o rig in re p re s e n t a s e ld o m d ia g n o s e d e n tity o f u n k n o w n e tio lo g y , w ith im p o rta n t im p lic a tio n s in te rm s o f p ro p h y la c tic o o p h o re c to m y . In itia lly d e s c rib e d in p a tie n ts b e lo n g in g to fa m ilie s a t h ig h ris k fo r o v a ria n c a n c e r, it p o s s ib ly h a s a p a th o g e n y s im ila r to th a t o f e n d o s a lp in g io s is a n d o f s o m e c a s e s o f e n d o m e trio s is . W e re p o rt a c a s e o f p e rito n e a l b o rd e rlin e m u c in o u s c a rc in o m a w ith a n a n a to m o p a th o lo g ic a l d ia g n o s is o f n o rm a l o v a rie s .
U N IT E R M S : P e rito n e u m . P e rito n e a l c a rc in o m a . P e rito n e a l a d e n o c a rc in o m a .
.1N T R O D U C T IO N
R
eports of peritonealto ovarian carcinom atum ors histologicallyhave been publishedsim ilarover the last few years, usually relating to patients withprevious oophorectom y and with high fam ilial risk.
Several investigators have reported cases of
peritoneal carcinom a in patients whose fam ilies are at high
risk for ovarian cancer, who had been subm itted to
prophylactic oophorectom y ( 1 ) . This fact appears to
dem onstrate that in these fam ilies gonadal exeresis m ay
not provide total protection against ovarian cancer.
Since serous ovarian carcinom as are usually
dissem inated in the peritoneal cavity at the tim e of
diagnosis, a hypothesis of m ultifocal rather than m etastatic
A d d re s s fo r c o rre s p o n d e n c e : M a n o e l J o a o B a tis ta C a s te llo G ira o A v . O n z e d e J u n h o , 1 0 0 6 , a p e 5 1 S a o P a u lo /S P - B ra s il - C E P 0 4 0 4 1 -0 0 3
orIgIn m ay be proposed for these neoplasias. This
possibility m ay justify the slight involvem ent of the ovaries
observed in som e cases, where extensive peritoneal
involvem ent has already occurred.
The pathogeny is probably sim ilar to that of
endosalpingiosis and to som e cases of endom etriosis,
possibly involving processes of peritoneal m etaplasia and
hyperplasia sim ilar to the precursor alterations detected
in the surface epithelium of the ovary. Gene instability
m ay arise as a consequence of these processes, or its
intensity m ay be directly related to the extent of
hyperplasia. The pelvic peritoneum m ay apparently have
a great capacity for transform ation into several m ullerian
epithelia, especially into tubal and endom etrial types (2).
C A S E R E P O R T
A 51-year old white wom an sought the Departm ent
of Gynecology at Escola Paulista de M edicina
1635
Figure 1a - The epithelium demonstrates multilayering, nuclear abnormalities and increased mitotic activity; (hematoxylin-eosin, X 160)
Figure 1b - The epithelium demonstrates multilayering, nuclear abnormalities and increased mitotic activity; (hematoxylin-eosin, X 390)
GIRAO, M.J.B.C.; SARTORI, M.G.F.; GONCALVES, W .J.; LIMA, G.R. -Peritoneal borderline cystoadenocarcinoma
1 6 3 6
com plaining of having had progressive sw elling of the
abdom en during the preceding 2 years, accom panied by
cram p pain irradiating tow ard the dorsal region, and
retrosternal pyrosis. She denied having epidem iological
risk factors for m alignant genital neoplasias.
Physical exam ination revealed a body m ass index
of 27.8, as w ell as a tum or of precise lim its, elastic
consistency, sm ooth surface, and little m obility, occupying
the m esogastrium and hypogastrium ; it m easured
approxim ately 16 x 20 m m .
A bdom inal ultrasound revealed a predom inantly
cystic form ation of regular lim its an~ w ith a sm all internal
solid area .. The uterus w as norm al and the ovaries w ere
not identified.
A t laparotom y,' a volum inous cystic tum or
originating from the retroperitoneum and m easuring
approxim ately 20 m m in diam eter w as seen. The uterus
and ovaries w ere norm al, as w ell as the rest of the
abdom inal cavity. Tum or exeresis and bilateral
oophorectom y w ere perform ed.
A natom opathological exam ination of the tum or
revealed the presence of a peritoneal m ucinous borderline
cystoadenocarcinom a , w ith atrophic ovaries.
D I S C U S S I O N A N D C O N C L U S I O N S
Little is know n about the possible etiological and
predisposing factors involved, m aking prevention
extrem ely difficult. H ow ever, extraovarian peritoneal
carcinom a behaves like its gonadal counterpart, ranging
from benign and borderline to frankly m alignant varieties.
The prognosis is sim ilar to ovarian carcinom as and the
response to chem otherapy is estim ated at 63% (3).
It should be pointed out that the incidence of the
borderline form tends to be higher am ong young w om en
and that this form frequently has psam m om atose bodies.
The borderline form accounts for 8 to 15% of the lesions
diagnosed in stages III and IV .
This type of neoplasia m ay possibly be observed w ith
greater frequency in the future, as pathologists start to
recognize it and establish better diagnostic criteria.
A C K N O W L E D G M E N T S
W e thank L.C . G ranero, M D , PhD and F.M .
C allegari, M D , D ivision of Pathology, Escola Paulista de
M edicina, for the pathological analysis of the m aterial.
REFERENCES
1. Piver M S, Jishi M F, Tsukada Y , N ava G . Prim ary Peritoneal carcinom a after prophylatic oophorectom y in w om en w ith a fam ily history of ovarian cancer: a report of a G ilda R adner fam ilial ovarian cancer registry. C ancer 1993;71(9):2751.
2. M orrow C P, C urtin Jp, Tow nsend D E . Synopsis G ynecologic O ncology. 4th ed., N ew Y ork, C hurchill
Livingstone 1993;209.
3. D isaia PJ, C reasm an W T. C linical G ynecology O ncology. 4th ed., St. Louis, M osby Y ear B ook 1993;458.
