Incidental finding of pseudomyxoma peritonei at primary cesarean section.

Primary appendiceal carcinoma is extremely rare and is found in approximately 1% of appendectomy specimens. When cancer is present, the most frequent histology is mucinous adenocarcinoma. Neoplasms of the appendix that secrete mucin such as adenocarcinoma may rupture, leading to intraperitoneal seeding of the peritoneum and producing the clinical picture of pseudomyxoma peritonei (PMP). PMP is characterized by mucin-producing neoplastic cells that have seeded the peritoneum from the ruptured viscous and continue to secrete copious amounts of gelatinous material that accumulates in the abdomen producing the characteristic "jelly belly." A review of the medical literature revealed no cases of PMP diagnosed at time of cesarean section. A previously healthy gravida 5, para 3 underwent cesarean section. Upon opening of the peritoneum, copious amounts of gelatinous, yellow-tinged mucoid material was noted. A general surgeon was consulted, and grossly necrotic-appearing appendix was noted. The patient underwent appendectomy with right hemicolectomy. Pathology showed well-differentiated mucinous adenocarcinoma of the appendix. PMP is associated with gastrointestinal and ovarian carcinomas. Although somewhat rare, these cancers may occur in pregnancy. Because nonspecific abdominal pain and increasing abdominal girth are common in pregnancy, patients' complaints may go ignored. Early diagnosis of a potentially life-threatening disease requires that clinicians expand the differential diagnosis and consider the possibility of a malignant neoplasm presenting in the pregnant female.

Primary mucinous adenocarcinoma of appendix treated with chemotherapy and radiotherapy: a case report.

A rare case of primary appendiceal mucinous adenocarcinoma is reported. The presenting signs and symptoms were suggestive of acute appendicitis. An appendectomy was performed resulting in a histological diagnosis of grade 2 mucinous adenocarcinoma of the appendix. The patient was referred to our clinic where he underwent a complementary right hemicolectomy with lymph node dissection. Two of the 17 resected lymph nodes were tumor positive but there was no residual tumor in the hemicolectomy specimen. The patient was staged as T4N1M0 and adjuvant multimodality treatment was planned because he was considered at high risk for local-regional recurrence and distant metastasis. Three cycles of capecitabine 1250 mg/m2 on days 1-14 and oxaliplatin 130 mg/m2 on day 1, every 21 days (CAPOX) were administered, then a total dose of 50.4 Gy external-beam radiation therapy was delivered to the primary tumor region and 45 Gy to the lymphatics, and finally 3 further cycles of the CAPOX regimen were administered. Multimodality treatment was well tolerated by the patient, who is still alive 25 months after the hemicolectomy procedure with no evidence of disease progression.

[Clinical, pathological and radiological characters of appendiceal mucocele].

OBJECTIVE: To improve capability of appendiceal mucocele diagnosis via analyzes its clinical, pathological basis and radiological results. METHODS: Summarize 18 cases with pathological diagnosed appendiceal mucocele in PUMC Hospital since January 1985 till september 2004, including 4 males and 14 females (1:3.5), age ranged from 31 to 78 yrs old (average 59.8 years old). Eleven cases underwent barium enema, in which 9 cases received abdominal CT scanning and 1 case received CT virtual colonography. RESULTS: (1) CLINICAL RESULTS: 8 cases (44.4%) had right lower abdominal pain, 12 cases (66.7%) had palpable abdominal mass. (2) Radiological results: barium enema showed extrinsic oppressed filling defect at the end of cecum without destruction of mucosa; CT scanning showed right lower abdominal cystic mass, 75% with cystic wall calcification, massive septal mucous ascites was seen in one case with pseudomyxoma peritonei; CT virtual colonography showed clearly the extra cavity and intracavity changes at cecum. (3) Pathological results: simple mucocele (4 cases, 22.2%), mucous cystadenoma (12 cases, 66.7%) and mucous cystadenocarcinoma (2 cases, 11.1%) CONCLUSION: There are four pathological types in appendiceal mucocele. Radiological characters of appendiceal mucocele have distinct specificities while its clinical ones not. Radiological procedures are vital for correct clinical diagnosis.

Absorbed dose estimates for 131I-labelled monoclonal antibody therapy in patients with intraperitoneal pseudomyxoma.

Seven patients with intraperitoneal pseudomyxoma originating from the appendix (4 cases) and from the ovary (3 cases) were treated with radioimmunotherapy. During the therapy, nine infusions of 3.0-4.2 GBq of 131I-labelled B72.3 monoclonal antibody were administered. We developed three-dimensional dose calculation software that can utilize activity maps based on SPET images to calculate the absorbed dose distribution using point source kernels. The dose calculation program was employed to calculate absorbed doses to various organs. The calculated dose distributions enable us to evaluate the variation in dose within the organs, which is normally not available using approaches based on geometric models. The patient-specific absorbed dose calculations were compared with doses based on a model that uses photon S-factors derived from a standard phantom. The compared doses agreed well on average, but in some organs showed large discrepancies.

The benefits of quality of life measurement in patient care--Part II: A case study.

A case is presented in which quality of life (QOL) assessments were seen to be beneficial. QOL was found to have markedly deteriorated following treatments. As a direct result, appropriate intervention was instigated and QOL improved.

Complications associated with intraperitoneal 32P.

The charts of all patients having received intraperitoneal 32P in the Indiana University Department of Radiation Oncology were retrospectively reviewed for complications and potentially related factors. Ninety-five patients had received this therapy, with a mean follow-up of 43.6 months. The majority of patients (81) had ovarian cancer. Complications were defined as mild if no intervention was required, moderate if medical intervention was required, and severe if the event was life-threatening or required surgical correction. Twenty patients (21%) had acute side effects recorded, with 15 of them (16%) being mild. The moderate complications (five patients) consisted of three cases of bowel obstruction, and two cases of abdominal pain requiring narcotics. There were no severe acute side effects. Chronic complications were found in 15 patients (20% actuarial 5-year incidence). Seven cases were mild (12% 5-year incidence), one was moderate (1%), and seven cases were classified as severe (7.4% 5-year incidence). All moderate and severe cases were bowel obstructions. Acute side effects were found to be related only to the volume of instillate (P = 0.049). Chronic complications were found to be related only to adjunctive pelvic/abdominal radiotherapy, with a 44% 5-year rate in patients receiving the combination having complications vs 17% (P = 0.04) (or 4.7% if mild complaints are excluded, P = 0.002) of those with 32P only. Comparison is made to other reports in the literature.

[A primary mucus-producing adenocarcinoma of the appendix with a bilateral Krukenberg tumor]. / Een primair slijmvormend adenocarcinoom van de appendix met dubbelzijdige Krukenbergtumor.

A patient is described with a primary mucous adenocarcinoma of the appendix with bilateral Krukenberg tumours. On the basis of the available literature the value of diagnosing a Krukenberg tumour of the ovaries is elucidated. Finally the question is raised whether this matter should influence policy as regards colorectal tumours.

Primary carcinoma of the appendix.

Primary adenocarcinoma of the appendix is rare and less than 200 cases are on record. The present material consisted of 20 cases collected from different hospitals. The cases are described in respect of sex and age-distribution, symptoms, treatment and prognosis. Of 7 patients with malignant mucocele, 6 subjected to appendectomy only, were still alive 5 years after the operation. Of 12 patients with colonic type of adenocarcinoma, 3 had been treated with appendectomy only. Of these, 2 were still alive 5 years after the operation. The remaining 9 patients had undergone right hemicolectomy. Only one of them was alive 5 years after the operation. A compilation of a further 39 cases garnered from the literature, however, showed that 60% had survived at least 5 years after right hemicolectomy, compared with 46% after appendectomy alone. Appendectomy alone is probably a sufficiently radical operation for malignant mucocele provided the tumor has not grown through the submucosa and that it is confined to the tip of the appendix. Right hemicolectomy is indicated for the colonic type of adenocarcinoma.