CASE 298: Carcinomatosis Ascites, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM.

Woman  64 yo, abdomen distension slowly for 3 months (photo).

Ultrasound  first  found out ascites  with slouge fluid  and  scattered fragments, normal liver, omentum thickening  like cake with  many hypoechoic nodules  and  no tumor in pelvis.

Chest X-Rays  was  normal.

MSCT of abdomen reported  a large amount of  ascites and  great omentum  thickening  with  many  nodules,  enhanced with  CE  and no  ovary  tumor.

Punction of  yellowish  ascites  that cytology was  negative and  ADA negative. Blood test  was  very high CA 125.

Laparoendoscopy cannot detect  primary tumor, but many white  nodules  covered  the  great omentum  but not in parietal peritoneum.

Biopsy the great omentum nodule. Microscopic report  was  undiffentiated adenocarcinoma, suspected  come from GI TRACT or  OVARIAN CARCINOMA.

Discussion

Acites with  large volume is easy  diagnosed  by clinical and ultrasound.

Ascites  fluid analysis rules out  some common diseases.

In this case, CA 125 was very  high in the blood test,  but  CT scanning  cannot detect ovarian tumor.

Laparoscopy for  diagnosis and  biopsy made sure  the case being  carcinomatosis.

This case  also had  gastro-colonoscopic result  and CEA negative.

The  most  suggestion  of diagnosis for  this case is  PPSC  ( PRIMARY PERITONEAL SEROUS CARCINOMA) .

Wait for  histo immunostaining  report.

REF  CASE of  PPSC.