Peritoneal carcinomatosis of gynaecological origin

Exam relevance: in 12 of 197 board exam reports · rank 59

Specialty: Gynaecology · Ovary & adnexa
Images: Endoscopy & gross 2 · Mammography/MRI 1 · Histology & cytology 2
Exam relevance: 12 of 197 reports · rank 59
Last updated: 10/2026 · Dr. Pascal Bafteh

Contents

Images (5)
Definition
Classification
Occurrence & epidemiology
Aetiopathogenesis
Clinical features
Diagnosis
Keep learning in the app
Further reading (selection)
Cross-references

Images (5)

Peritoneal carcinomatosis of gynaecological origin – Endoscopy & gross — Image: Cheng IN, Chang C, Tsai HM, Hsu YT, Huang YF. (Discover oncology 2025) · CC BY 4.0 · Source · cropped

Peritoneal carcinomatosis of gynaecological origin – Mammography/MRI: CT (abdomen, axial, contrast-enhanced): peritoneal carcinomatosis with omental cake – plate-like thickened, tumour-infiltrated omentum just beneath the anterior abdominal wall — CT (abdomen, axial, contrast-enhanced): peritoneal carcinomatosis with omental cake – plate-like thickened, tumour-infiltrated omentum just beneath the anterior abdominal wallImage: Subhaschandra Singh, Y. Sobita Devi, Shweta Bhalothia and Dr. Veeraraghavan Gunasekaran (Wikimedia Commons) · CC BY 4.0 · Source

Peritoneal carcinomatosis of gynaecological origin – Histology & cytology: Histology (H&E): omental deposit of serous carcinoma (presumed ovarian origin) – atypical tumour cell nests with psammoma bodies (dark calcified spheres) — Histology (H&E): omental deposit of serous carcinoma (presumed ovarian origin) – atypical tumour cell nests with psammoma bodies (dark calcified spheres)Image: Nephron (Wikimedia Commons) · CC BY-SA 3.0 · Source

Peritoneal carcinomatosis of gynaecological origin – Histology & cytology: Histology (H&E): serous carcinoma in the omentum – tumour cell clusters infiltrating desmoplastic stroma and adipose tissue (right) — Histology (H&E): serous carcinoma in the omentum – tumour cell clusters infiltrating desmoplastic stroma and adipose tissue (right)Image: Nephron (Wikimedia Commons) · CC BY-SA 3.0 · Source

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Definition

Peritoneal surface malignancies are tumours arising from or spreading to the peritoneum, including primary peritoneal tumours, pseudomyxoma peritonei and peritoneal carcinomatosis from gastrointestinal or gynaecological primaries.
Peritoneal carcinomatosis is the implantation of neoplastic cells in the peritoneal cavity; it is often multifocal, appearing as widespread nodules or mucinous deposits.

Classification

Mucinous, non-mucinous and primary peritoneal forms are distinguished.
The Sugarbaker Peritoneal Cancer Index (PCI) records the distribution and size of deposits in nine abdominopelvic regions and four small bowel regions.
In each region the lesion size is graded: no tumour, nodules under 0.5 cm, 0.5–5 cm or over 5 cm.

Occurrence & epidemiology

Epidemiology

In ovarian cancer about 70% of patients are diagnosed at an advanced stage (FIGO III–IV) or with peritoneal carcinomatosis.
Peritoneal carcinomatosis is also relatively frequent in advanced stages of many gastrointestinal tumours such as colonic, gastric and pancreatic cancer.

Aetiopathogenesis

Pathogenesis

Ovarian cancer usually spreads within the abdomen via the peritoneal circulation.
Peritoneal fluid flows from the pelvis via the paracolic gutters to the subdiaphragmatic regions, drawn by negative pressure as the diaphragm rises during expiration; on the right it reaches the anterior subhepatic and right hepatic spaces.
On the left the phrenicocolic ligament limits flow towards the perisplenic spaces.

Clinical features

Complications are malignant ascites, bowel obstruction and malnutrition.

Diagnosis

According to international guidelines CT is the standard imaging modality for ovarian cancer staging, with an accuracy of up to 94%, and assesses the primary tumour, peritoneal implants, lymph nodes and distant metastases.
MRI helps where CT is inadequate, such as subphrenic spaces, the lesser omentum and serosal and mesenteric deposits.
The diagnosis relies on cross-sectional imaging, histology of the implants and tumour markers such as CEA or CA 125; laparoscopy can confirm the extent and allow tissue sampling.

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