腹腔鏡下手術が診断、治療に有効であったTrousseau症候群を伴った腹膜癌の1例

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Background: Primary peritoneal carcinoma is a relatively rare malignant neoplasm of the female genital tract, and is managed in the same way as advanced ovarian carcinoma. Although laparotomy is usually the method of choice for diagnosis and treatment, it may be associated with postoperative morbidity or mortality. Furthermore, co-existent medical complications may rule out this surgical approach. We report a case of primary peritoneal carcinoma complicated by Trousseau's syndrome that was successfully diagnosed and treated with laparoscopic surgery.

Case: A 58-year-old woman presented to the emergency room with left hemiplegia, facial paralysis, and dysarthria. She was diagnosed with multiple cerebral infarction. A computed tomography was performed to investigate the underlying cause of the coagulopathy and the elevated level of serum CA125. It demonstrated a thickening of the omentum, without other abnormalities. As we suspected primary peritoneal carcinoma, a laparoscopic exploration was performed, which revealed a solid tumorous mass in the omentum, although no intraperitoneal tumor spread was observed. A partial omentectomy and bilateral salpingo-oophorectomy were performed. The omental mass was diagnosed as high-grade serous carcinoma. The ovaries and fallopian tubes were free of tumorous involvement. The patient received six cycles of carboplatin and paclitaxel for stage IIIc primary peritoneal carcinoma, and is currently free of recurrence or metastases.

Conclusion: Laparoscopic surgery is a safe and useful surgical approach for the diagnosis and treatment of primary peritoneal carcinoma, even in patients with significant comorbidities.