History

Peritoneal tumors usually do not cause symptoms in the early stages of the diseases. The advanced stages usually present as abdominal fullness after eating, abdominal distention, and diffuse abdominal pain secondary to ascites. This tumor is described almost exclusively in women. Atypical presentations of primary peritoneal carcinoma have been described, including a case of severe glandular dysplasia on a screening Papanicolaou test (Pap smear).

Patients with malignant peritoneal mesothelioma usually present with symptoms and signs of advanced disease, including pain, ascites, weight loss, or an abdominal mass. Diffuse involvement of the peritoneal cavity is typical, often including omental caking and diaphragmatic and pelvic tumor deposits. The clinical presentation of primary peritoneal cancer is often typical of advanced ovarian cancer, with elevated serum level of cancer antigen 125 (CA125).

Thrombocytosis is common and is associated with a poor prognosis. Other common clotting abnormalities include phlebitis, emboli, hemolytic anemia, and disseminated intravascular coagulation.

Esophageal achalasia, secondary amyloidosis, and dermatomyositis have been reported.

Most patients die without metastasis or involvement of the chest.

Desmoplastic small round cell tumors occur typically in young patients and manifest with extensive involvement of the peritoneal surfaces. Rapid multifocal growth and hematogenous metastasis to the liver, lungs, and lymph nodes are common.

Leiomyomatosis peritonealis disseminata is found most commonly in women of reproductive age, often during pregnancy. These patients are usually asymptomatic, have a long-term history of oral contraceptive use, or have uterine leiomyomas at the time of diagnosis. Almost all cases of this disease have been discovered intraoperatively during obstetric and gynecologic surgical procedures.^{[14, 15]}

Peritoneal hemangiomas are usually associated with hemangiomas of the GI tract. They are rare and can manifest as ascites, anemia (from chronic blood loss), thrombocytopenia, and coagulopathy.

Complications

Complications of peritoneal tumors include the following:

Small Bowel obstruction
Urinary tract obstruction secondary of blockage of the ureters by tumor
Shortness of breath due to malignant pleural effusion

Rarely, a paraneoplastic syndrome may develop during the course of the disease. Features may include any of the following:

Cerebellar degeneration
Polyneuritis
Dermatomyositis
Hemolytic anemia
Disseminated intravascular coagulation
Acanthosis
Nephrotic syndrome

Differential Diagnoses

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Media Gallery

Dr. Oliver Zivanovic, MD, PhD, discusses the role of hyperthermic intraperitoneal chemotherapy in ovarian cancer. Courtesy of Memorial Sloan-Kettering Cancer Center.
Dr. Oliver Zivanovic, MD, PhD, demonstrates hyperthermic intraperitoneal chemotherapy for ovarian cancer. Courtesy of Memorial Sloan-Kettering Cancer Center.

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Peritoneal Cancer Clinical Presentation

History

Complications

References

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