Transcoelomic spread of tumour and ‘omental cake’

Clinical notes: 80 yo female presents with large bowel obstruction, 12 months after a hysterectomy for endometrial carcinoma.

Macroscopic: A sheet of omental adopse tissue with a central broad, grey, firm plaque 50 x 25mm.

Omental plaque of tumour

Macroscopic appearance of 'cake' of omental fat with depressed, firm plaque of tumour involvement

Microscopic: The omemental adipose tissue shows irregular, intersecting bands of fibrous tissue, within which are embedded angular to elongate glands lined by atypical epithelium, in areas with surface short papillae and tufting.

Histology of omentum with tumour

Low power - Omental fat with fibrous bands and infiltrative glands

Histology with high grade serous papillary carcinoma

High power - Localised glands show serous papillary morphology


Discussion: This case demonstrates the potential of adenocarcinoma from the endometrium to spread within the coelomic cavity via transperitoneal route, even in the setting of a previously organ confined tumour. In this case, the patient had a past history of high grade endometrial carcinoma and although the histological typing was not available, serous papillary carcinoma is a common sub-type of endometrial carcinoma in this age group. Immunohistochemical stains showed the tumour cells to be positive for the epithelial marker CK7 and oestrogen receptor (ER), and negative for the differential cytokeratin CK20. The transcoelomic spread of tumour is most common in ovarian tumours (not always carcinoma either! – read about ovarian borderline tumours)  and gastric and colorectal carcinoma (Kruckenberg tumours) but can occur in any tumour that gains access to the peritoneal cavity.

Reference: Faratian D, Stillie A, Busby-earle RM et-al. A review of the pathology and management of uterine papillary serous carcinoma and correlation with outcome. Int. J. Gynecol. Cancer. 16 (3): 972-8. doi:10.1111/j.1525-1438.2006.00576.xPubmed citation

Contributed by Dr Andrew Ryan

The case has been de-identified and is intended for educational purposes only.

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