Unexplained Ascites Leading to the Diagnosis of Primary Fallopian Tube Carcinoma

Abstract

Presentation
A 58-year-old woman with chronic pancreatitis presented with a two-month history of abdominal swelling, peripheral oedema, exertional dyspnoea, and weight loss.

Diagnosis
Initial assessment considered pancreatitis-related ascites and alcoholic liver disease. Elevated CA-125 (800 U/mL) and malignant cells on cytology prompted further evaluation. CT imaging revealed pulmonary emboli, pleural effusions, ascites, and a right adnexal cystic lesion. Omental biopsy, obtained via image-guided percutaneous technique, confirmed high-grade serous carcinoma, WT1 positive, consistent with Müllerian origin.

Treatment
Management included intravenous antibiotics, diuretics, paracentesis, therapeutic anticoagulation, and pigtail drain insertion. Multidisciplinary review established the diagnosis of Primary Fallopian Tube Carcinoma (PFTC), FIGO Stage IIIC.

Discussion
This case highlights the diagnostic complexity of unexplained ascites, especially in patients with chronic pancreatitis. Elevated CA-125, while suggestive, requires cautious interpretation due to potential benign causes. Comprehensive evaluation including fluid analysis and biopsy was essential to distinguish PFTC from ovarian or peritoneal malignancies. Interdisciplinary collaboration ensured timely diagnosis and management.