Pseudomyxoma Peritonei: An Incidental Diagnosis With Atypical Intraoperative Findings Discovered During a Laparoscopic Cholecystectomy.

Although pseudomyxoma peritonei (PMP) classically presents with profuse mucinous ascites within the peritoneal cavity, the physical manifestations of this disease exist on a spectrum, with the possibility of milder forms that lack typical findings. The authors report an indolent case of PMP diagnosed incidentally during workup and treatment for chronic cholecystitis in a 43-year-old male. This presentation of PMP was atypical due to a lack of discernible symptoms as well as uncharacteristic intraoperative findings consisting of numerous omental and pelvic adhesions with only sparse mucinous deposits. This case contributes to the growing understanding of PMP by exploring an uncharacteristic presentation of the disease with the hope that it may assist clinicians in diagnosing those cases of PMP that are more indolent and insidious in nature.

Pseudomyxoma Peritonei Misdiagnosed as Liver Cirrhosis: A Case Report and Literature Review.

Pseudomyxoma peritonei (PMP) is a rare intra-abdominal malignancy characterized by diffuse dissemination of mucinous tumor cells, leading to mucinous ascites. Accurate diagnosis is crucial for appropriate management. This report presents a case of a 55-year-old Lebanese male farmer initially misdiagnosed with liver cirrhosis who presented with progressive abdominal distension refractory to diuretics and dietary modifications. Paracentesis revealed a mucinous exudate, with subsequent clinical and histopathological examination confirming PMP. The patient was referred for further evaluation at a specialized center equipped for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). This case highlights the diagnostic challenges of PMP due to its non-specific presentation, emphasizing the importance of prompt and accurate diagnosis to facilitate optimal therapeutic intervention.

The Cancer Diaspora: A Rare Case of Pseudomyxoma Peritonei of Appendiceal Origin.

Pseudomyxoma peritonei (PMP) is a rare clinical entity characterized by widespread mucinous implants in the peritoneal cavity. Commonly seen in females in their 50s, PMP typically originates from ruptured appendiceal mucoceles that find refuge in the peritoneal space. Rarely, PMP may originate from the ovary, stomach, colon, or pancreas. Pseudomyxoma peritonei of colorectal origin is more malignant and has a lower survival rate. We report a case of a 59-year-old Hispanic woman with PMP who presented to the emergency room with a 3-month history of progressive abdominal distention. Pseudomyxoma peritonei was confirmed by computed tomography (CT) scan of the abdomen and pelvis and histopathology, and the patient underwent partial cytoreductive surgery. Given her Eastern Cooperative Oncology Group (ECOG) performance status of 1 despite extensive carcinomatosis, our patient may benefit from hyperthermic intraperitoneal chemotherapy (HIPEC) in the future.

Pseudomyxoma peritonei originating from intestinal duplication: A case report and review of the literature.

BACKGROUND: Pseudomyxoma peritonei (PMP) is a rare mucinous neoplasm with a relatively low incidence of 1 to 2 per million individuals. It is typically characterized by a type of gelatinous ascites named "jelly belly". Most cases of PMP occur in association with ruptured primary mucinous tumors of the appendix (90%). Periodically, PMP can originate from mucinous carcinomas at other sites, including the colorectum, gallbladder, and pancreas. However, unusual origin can occur, as noted in this case report. CASE SUMMARY: A 52-year-old woman had an unusual derivation of PMP from intestinal duplication. The patient complained of abdominal distension and increasing abdominal girth. Abdominal contrast-enhanced computed tomography showed a mass in the greater omentum located on the left side of the abdomen, likely to be a cystic mass of peritoneal origin. A PMP diagnosis was presumed based on the specific signs of the mass with flocculent and stripe-like echoes in ultrasound images. Ultrasound-guided percutaneous aspiration suggested a high likelihood of PMP. Once the PMP diagnosis was recognized, identification of the origin of the primary tumor was indicated. Thus, an exploratory laparoscopy was performed. In the absence of a primary tumor of appendix origin, the diagnosis of a low-grade mucinous neoplasm of intestinal duplication origin was finally confirmed by histopathology. CONCLUSION: PMP is secondary to mucinous carcinomas of the appendix mostly. This case resulted from an unusual derivation from intestinal duplication.

[Pseudomyxoma peritonei : a cause of ascites that should not be underestimated]. / Pseudomyxome péritonéal : une cause d'ascite à ne pas négliger.

Pseudomyxoma peritonei (PMP) is a rare condition that refers to a clinical syndrome resulting from the accumulation of mucin in the peritoneal cavity. It results from the intraperitoneal rupture of a mucinous epithelial neoplasm which is classically appendiceal. The prognosis of a limited appendiceal tumor is favourable. Nevertheless, in the case of peritoneal dissemination, the prognosis could be different according to the histological type and therapeutic management. We report the case of a 71-year-old female patient who developed a pseudomyxoma peritonei originating from an appendiceal adenocarcinoma.

Le pseudomyxome péritonéal (PMP) est une condition rare qui se réfère à un syndrome clinique résultant d'une accumulation de mucine dans la cavité péritonéale. Il est secondaire à la rupture intrapéritonéale d'une néoplasie épithéliale mucineuse dont l'origine est classiquement appendiculaire. Le pronostic d'une tumeur appendiculaire limitée est favorable. Toutefois, en cas de dissémination péritonéale, il est variable selon le type histologique et la prise en charge thérapeutique. Nous rapportons le cas d'une patiente de 71 ans ayant développé un pseudomyxome péritonéal secondaire à un adénocarcinome appendiculaire.

Management of an inguinal hernia in patients with pseudomyxoma peritonei.

BACKGROUND: Pseudomyxoma peritonei is a disease that results from a perforated mucinous neoplasm of the appendix so that mucinous ascites and mucin-producing tumor cells are widely disseminated in a characteristic pattern throughout the abdomen and pelvis. The intraabdominal mucus can accumulate in the inguinal canal and by physical examination be indistinguishable from the usual inguinal hernia. METHODS: A database of patients with pseudomyxoma peritonei was used to identify patients who had an inguinal hernia prior to or at the time of cytoreductive surgery (CRS) and perioperative hyperthermic chemotherapy (HIPEC). At the time of CRS, care was taken in all patients to remove the peritoneal lining of the inguinal canal. Patients who had the inguinal hernia repaired prior to definitive treatment with CRS and HIPEC had all tissue and mesh associated with prior herniorrhaphy resected. RESULTS: In 178 pseudomyxoma peritonei patients, 17 had a new onset or previously repaired inguinal hernia that required extraction of mucus and mucinous tumor from the hernia site. No repair of the open inguinal canal was attempted at the time of CRS. No recurrent inguinal hernias were recorded and no patients required an inguinal incision at a later time to resect progressive disease within the inguinal canal. CONCLUSIONS: Inguinal hernias caused by mucinous ascites and tumor were definitively treated by cytoreductive surgery plus HIPEC. Extraction of tumor and peritoneum from the inguinal canal facilitates fibrous closure of the hernia defect so that hernia recurrence was not observed.

A rare cause of ascites: pseudomyxoma peritonei and a review of the literature.

Pseudomyxoma peritonei is rare. The rarity is highlighted by the lack of published evidence regarding management. The latest treatments have altered the prognosis of a once incurable disease. This report serves to both raise awareness and critically appraise the literature regarding the latest management.

A formulation for in situ lysis of mucin secreted in pseudomyxoma peritonei.

Although numerous clinical attempts have been made to disintegrate mucin secreted by pseudomyxoma peritonei (PMP), none are clinically recommended. Through examination of the pharmacologic characteristics of two novel agents, we titrated an optimized combination of bromelain and N-acetyl cysteine (NAC) that demonstrates in vitro and in vivo efficacy in the dissolution of mucinous ascites from PMP. In the in vitro experiments, 1 g of mucin was incubated in varying concentrations of bromelain (0-400 µg/ml) and NAC (0-5%) individually followed by a combination before arriving at a therapeutic combination dose of 300 µg/ml bromelain+4% NAC. This established an effective dose of bromelain 300 µg/ml+4% NAC at pH 7.0, when tested in a rat model implanted with 3 g of mucin intraperitoneally (IP). IP administration of the drug in a rat model of PMP was shown to result in mucin disintegration within 72 hr with no toxicity observed.

Masa post apendicectomia (pseudomixoma peritoneal): A propósito de un caso / Post appendectomy mass (peritoneal pseudomyxoma): On the subject of a case

Se presenta un caso de pseudomixoma peritoneal originado en un adenocarcinoma mucinoso del apéndice cecal manejado en el Instituto Nacional de Cancerología (I.N.C.), Bogotá, Colombia. Se revisa la literatura disponible sobre el tema haciendo énfasis en los aspectos etiopatogénicos y patológicos, y en las diferentes modalidades de tratamiento de esta rara y enigmática entidad cuyo diagnóstico casi siempre es inesperado durante la laparotomía.

A case of Pseudomyxoma Peritonei originated in a mucinous adenocarcinoma of the appendix is presented. The patient was attended at the National Cancer Institute of Bogotá, Colombia. Literature is reviewed, making emphasis on the etiopathogenic and pathology aspects, and treatment modalities of this infrequent and enigmatic entity.