Ascites, peritoneal implants and elevated Ca-125

A 75-year-old Ethiopian-born woman (emigrated aged 48 years) was admitted with acute recurrent vomiting and mild abdominal pain. She had long-standing orally treated diabetes, hypertension and glaucoma. Examination, ECG, chest and abdominal X-rays were unremarkable save for tachycardia 130/min. Hb was 10.2 g/dl, blood urea nitrogen (BUN) 18 mg/dl, creatinine 1.6 mg/dl (previously 1.0), C-reactive protein (CRP) 30.4 mg/dl, normal amylase and liver enzymes. Her ‘gastroenteritis’ improved with fluids and she was quickly discharged, only to be readmitted within 6 days with anorexia and diffuse abdominal pain. Examination now revealed ascites with neither leg oedema nor increased jugular venous pressure (JVP). CT demonstrated omental infiltration (‘omen tal cake’) (Figure  1) with normal liver/spleen and no lymphadenopathy or masses. The ascites (1600 ml removed) was sanguinous with WBC 0.4X109/L (65% lymphocytes), albumin 22 g/l (serum albumin 29 g/l), LDH 551 IU/ml, negative cytological and microbiological stains and cultures including Ziehl-Neelsen stains, mycobacteria cultures and polymerase chain reactions (PCRs) for mycobacterium tuberculosis (M. TB). Gynecological ultrasound could not visualize the ovaries. Tumour markers were normal except Ca-125 945 U/ml (normal<37). erythrocyte sedimentation rate (ESR) was 20 mm/h, ferritin 561 ng/ml (normal 13 –150). Suspected as peritoneal carcinomatosis due to probable ovarian cancer, a CT-guided omental biopsy was perfo...
Source: QJM - Category: Internal Medicine Source Type: research