Spectrum of diagnoses and surgical interventions as well as outcome in a representative case series on rare peritoneal tumor lesions (PTLs) in abdominal surgery at a tertiary center

Aim Exemplary demonstration of 8 cases with rare PTLs and their histopathological

results in abdominal surgery emphasizing biological diversity.

Method Representative scientific case Reports

Results

1) Diverticulum of the jejunum with pancreatic metaplasia: Intraoperative incidental finding of a jejunal PTL during gynecological surgery of endometrium carcinoma lead to segmental resection and reconstruction with side-to-side jejunojejunostomy.

2) Twisted “appendix epiploicae” (with lipofibrosis and necrosis of the appendix): Pat. with progressive abdominal pain in the right lower abdomen was diagnosed with acute appendicitis followed by laparoscopic appendectomy with partial resection of the greater omentum.

3) Acute epiploic appendagitis: In laparoscopic hernioplasty of incarcerated trocar hernia, a suspicious inflamed fatty tumor-like tissue was resected from the descending colon.

4) “Appendagitis epiploicae” of the descending/sigmoid colon: A 53-year-old pat. with pain in the left lower abdomen displayed an oval paracolic mass in abdominal CT scan leading to the consequence of a conservative therapeutic approach.

5) Primary peritoneal cancer: During explorative laparotomy for ovarian tumor, multiple 8- to 15-mm PTLs were found and subsequently resected along with radical hysterectomy resulting in R0 resection status (5 years ago, mastectomy for breast cancer).

6) Primary serous papillary adenocarcinoma of the peritoneum (histological finding): Pat. underwent subtotal peritonectomy, right hemicolectomy, partial resection of the urinary bladder and HIPEC.

7) Pseudomyxoma peritonei: Pat. with PTL (PCI:32) of unknown origin underwent palliative ileocoecal resection including 4 PTLs of mucinous adenocarcinoma.

8) Plant food ingredients (plus older fat necrosis mimicking PTL): In a pat. with chronic subileus, small PTLs were found causing scarring adhesion of the jejunum after previous appendectomy and ileum resection.

Conclusion PTL can comprise diverse origins and entities. Histopathological investigation and close cooperation of the pathologist and surgeon can be considered a substantial prerequisite (necessary due to their rareness) for definite diagnosis-finding, following decision-making and further therapeutic steps using various modi.

Publication History

Article published online:
07 September 2021