ABSTRACT
Pseudomyxoma peritonei (PMP) is a disease surrounded by misunderstanding and controversies. Knowledge about the etymology of pseudomyxoma is useful to remove the ambiguity around that term. The word pseudomyxoma derives from pseudomucin, a type of mucin. PMP was first described in a case of a woman alleged to have a ruptured pseudomucinous cystadenoma of the ovary, a term that has disappeared from today's classifications of cystic ovarian neoplasms. It is known today that in the majority of cases, the origin for PMP is an appendiceal neoplasm, often of low histological grade. Currently, ovarian tumors are wrongly being considered a significant recognized etiology of PMP. PMP classification continues to be under discussion, and experts' panels strive for consensus. Malignancy is also under discussion, and it is shown in this review that there is a long-standing historical reason for that. Surgery is the main tool in the treatment armamentarium for PMP, and the only therapy with potential curative option.
ABSTRACT
Fundamento y objetivos: La neoplasia apendicular con extensión extraapendicular puede mostrarse con diferentes patrones clínicos, entre ellos el pseudomixoma peritoneal (PMP). Analizamos los resultados de una serie clínica tratada en nuestro centro. Material y métodos: Estudio retrospectivo de pacientes con carcinomatosis peritoneal apendicular (desde enero de 2012 hasta mayo de 2015). Resultados: Veintisiete pacientes consecutivos. Edad mediana 63 años (26-73), 14 varones. Índice de carcinomatosis peritoneal=16±8 (3-31). El origen tumoral supuesto preoperatoriamente fue el apéndice en 23, el ovario en 3 y urotelial en uno. Mortalidad postoperatoria 2 pacientes (7,4%). El 36% de los restantes presentó morbilidad. Morbilidad mayor (Clavien-Dindo grados 3 y 4) en 3 pacientes (12%). Conclusiones: Los adenocarcinomas mucinosos extraapendiculares pueden manifestarse como PMP con ascitis mucinosa, carcinomatosis nodular gelatinosa sin ascitis, carcinomatosis nodular o placas desmoplásicas sin masas/nódulos gelatinosos. La histología no se correlaciona con la forma de presentación. La sospecha preoperatoria de cáncer de ovario mucinoso en el contexto de carcinomatosis peritoneal obliga a descartar que se trate de metástasis ováricas apendiculares (AU)
Background and objectives: Appendiceal neoplasms with extra-appendiceal spread may show different clinical patterns with pseudomyxoma peritonei (PMP) being one of them. We analyse the results in a series of patients treated in our center. Material and methods: Retrospective study of patients operated on for appendiceal peritoneal carcinomatosis from January 2012 to May 2015. Results: Twenty-seven consecutive patients were included. Median age 63 years (26-73); 14 were men. Peritoneal carcinomatosis index=16±8 (3-31). The suspected preoperative origins were appendix in 23, ovary in 3 and urothelial in one. Postoperative mortality in 2 patients (7.4%). The remaining 36% presented morbidity. Major morbidity (Clavien-Dindo grades 3 and 4) occurred in 3 patients (12%). Conclusions: Mucinous adenocarcinomas with extra-appendiceal spread may present as PMP with mucinous ascites, jelly-nodular carcinomatosis without ascites, nodular or desmoplasic plates carcinomatosis without jelly mass/nodules. Histology is not correlated to clinical picture. Preoperative diagnosis of mucinous ovarian cancer in peritoneal carcinomatosis scenario may increase the doubt of their ovarian origin and force an appendiceal origin to be ruled out (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Adenocarcinoma, Mucinous/pathology , Appendiceal Neoplasms/pathology , Pseudomyxoma Peritonei/epidemiology , Antineoplastic Agents/administration & dosage , Retrospective Studies , Infusions, Parenteral , Ovarian Neoplasms/pathology , Peritoneal Neoplasms/secondaryABSTRACT
BACKGROUND AND OBJECTIVES: Appendiceal neoplasms with extra-appendiceal spread may show different clinical patterns with pseudomyxoma peritonei (PMP) being one of them. We analyse the results in a series of patients treated in our centre. MATERIAL AND METHODS: Retrospective study of patients operated on for appendiceal peritoneal carcinomatosis from January 2012 to May 2015. RESULTS: Twenty-seven consecutive patients were included. Median age 63 years (26-73); 14 were men. Peritoneal carcinomatosis index=16±8 (3-31). The suspected preoperative origins were appendix in 23, ovary in 3 and urothelial in one. Postoperative mortality in 2 patients (7.4%). The remaining 36% presented morbidity. Major morbidity (Clavien-Dindo grades 3 and 4) occurred in 3 patients (12%). CONCLUSIONS: Mucinous adenocarcinomas with extra-appendiceal spread may present as PMP with mucinous ascites, jelly-nodular carcinomatosis without ascites, nodular or desmoplasic plates carcinomatosis without jelly mass/nodules. Histology is not correlated to clinical picture. Preoperative diagnosis of mucinous ovarian cancer in peritoneal carcinomatosis scenario may increase the doubt of their ovarian origin and force an appendiceal origin to be ruled out.
Subject(s)
Adenocarcinoma, Mucinous/pathology , Appendiceal Neoplasms/pathology , Peritoneal Neoplasms/pathology , Pseudomyxoma Peritonei/pathology , Adenocarcinoma, Mucinous/diagnosis , Adenocarcinoma, Mucinous/mortality , Adenocarcinoma, Mucinous/surgery , Adult , Aged , Appendiceal Neoplasms/diagnosis , Appendiceal Neoplasms/mortality , Appendiceal Neoplasms/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasm Invasiveness , Peritoneal Neoplasms/diagnosis , Peritoneal Neoplasms/mortality , Peritoneal Neoplasms/surgery , Prognosis , Pseudomyxoma Peritonei/diagnosis , Pseudomyxoma Peritonei/mortality , Pseudomyxoma Peritonei/surgery , Retrospective StudiesABSTRACT
La hiperplasia nodular focal coincidente con la gestación es una entidad que puede generar dudas y alarmas en cuanto al curso del embarazo. Su descripción en la literatura médica es muy escasa y son menos aún los datos en cuanto al curso del parto. Presentamos un caso de una gestante a quien se había diagnosticado previamente una lesión hepática y se realiza una revisión de las series existentes hasta el momento (AU)
Focal nodular hyperplasia of the liver in pregnancy may lead to doubts and in appropriate fears regarding the course of the pregnancy. There is ascarcity of literature addressing focal nodular hyperplasia during gestation, and there are even less data focused on delivery. We report the case of a pregnant woman previously diagnosed with an hepatic lesion and present a review of the literature (AU)
