Contributed by Irina Pushkar, MD and Uma NM Rao, MD
Published on line in April 2000
This 72 year-old woman presented with a three-day history of constipation and a five-year history of a large anterior abdominal mass in the right lower quadrant. Gynecologic examination showed prolapse of the uterus. She underwent exploratory laparotomy, which revealed an incarcerated umbilical hernia. Histopathological examination of omental tissue showed metastatic poorly differentiated carcinoma with diffuse angiolymphatic invasion, focal perineural invasion and psammoma bodies were noted. With immunostains, tumor was positive for CK7, PLAP and negative for CK20 and monoclonal CEA. (Image 01 and 02). The genital tract was considered the most likely site of primary.
Few days later patient underwent hemicolectomy for small perforation, a microscopic focus of poorly differentiated carcinoma was found. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. The patient developed right lower extremity deep venous thrombosis, which prompted anticoagulation. Few days later she presented with signs of anemia, coagulopathy, hypotension, tachycardia, acute renal failure and distended abdomen. She had episodes of hypotension that eventually did not respond to resuscitation.
Post-mortem examination revealed a large intra-abdominal hemorrhage and extensive metastatic tumor within abdominal and thoracic lymph nodes, small intestine, porta hepatis and splenic capsule.