Introduction/Background Peritoneal carcinomatosis with/without lymph node involvement is a particularly common clinical scenario in gynaecological oncology. However, unexpected diagnoses may occur following an exploratory laparotomy. We present three exceptional cases of patients that were finally diagnosed with cancer of hepatobilliary origin.

Methodology The first patient, age 55, had a history of high grade endometrial cancer stage I that had been managed with surgery and brachytherapy. Three years post surgery, she presented with extensive paraortic nodal disease, which was surgically resected. The second patient, age 66, had a history of gallbladder cancer, that had been managed with cholocystectomy. She presented with an adnexal mass and omental metastases; she underwent exploratory laparotomy. The third patient, age 75, presented with tension ascites and peritoneal carcinomatosis; she also underwent exploratory laparotomy.

Results The first patient’s pathology report revealed a poorly differentiated carcinoma with Hepar-1 expression; differential diagnosis had to be made between hepatocellular carcinoma and clear cell carcinoma (Hepar-1 expression is a very distant possibility in clear cell endometrial carcinomas). She has been receiving multiple regimens of adjuvant chemotherapy during the last four years. She had been in remission for the first two years; she has recently progressed with newly found metastases in the anterior abdominal wall. The second patient was diagnosed with metastatic adenocarcinoma of biliary origin and synchronous early stage primary ovarian carcinoma. She received adjuvant chemotherapy and remains in remission 1 year post surgery. The third patient was diagnosed with metastatic cholangiocarcinoma. She was eventually referred to palliative care due to poor performance status. She eventually died one month postoperatively.

Conclusion Gynaecological oncologists should be suspicious of non gynaecological diagnoses when tackling extensive abdominal disease. Multidisciplinary approaches and consultations are crucial for decision making, diagnosis and improvement of patient outcomes.