Malignant Extrarenal Rhabdoid Tumors of the Omentum with Hemoperitoneum: Report of a Case

Malignant extrarenal rhabdoid tumors (MERT) of the omentum which results in massive hemoperitoneum is extremely rare. We herein report a case of a 25 year-old male with a spontaneously ruptured MERT from the omentum presenting with hemoperitoneum. The patient was brought to our emergency department with an 11- day history of poor appetite and progressive abdominal distension. An abdominal computed tomography scan revealed soft tissue infiltration into the omentum and mesenteric fat of the bowel loop, which caused suspicion of omentum cake formation, and a hypervascular liver mass with a hypoattenuated center was also noted. Abdominal angiography showed no active bleeders. After admission, progressive hemoperitoneum with exacerbated hypovolemia and elevated intraabdominal pressure were noted. At emergent laparotomy, massive hemoperitoneum of about 7,000 ml, and an omentum cake with diffuse peritoneal tumor seeding and oozing from the surface of the tumor were noted. Debulking resection of the omental tumor was done. Immunohistochemical examination revealed a tumor positive for cytokeratin and vimentin, but negative for CD31, CD34, desmin and INI1. The patient had an uneventful postoperative course without residual tumor bleeding. However, tumor bleeding induced by chemotherapy with ifosfamide and carboplatin occurred.