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Abstract
Pseudomyxoma peritonei is a very rare condition, and even rarer in patients with history of cancer. A 70-year old woman with a history of breast cancer was admitted with abdominal pain and distention. Abdominal computed tomography revealed ascites collection, diffuse engorgement and infiltration of the mesenteric vessel, suggesting peritonitis or peritoneal carcinomatosis. Diagnostic paracentesis was attempted several times, but a sufficient specimen could not be collected due to the thick and gelatinous nature of the ascites. Therefore, the patient underwent diagnostic laparoscopy for tissue biopsy of the peritoneum, which indicated pseudomyxoma peritonei. However, the origin of the pseudomyxoma peritonei could not be identified intraoperatively due to adhesions and large amount of mucoceles. Systemic chemotherapy was performed using Fluorouracil, producing some symptomatic relief. After discharge, abdominal pain and distention gradually worsened, so at 18 months after initial diagnosis the patient received palliative surgery based on massive mucinous ascites and palpable mass at the omentum. The patient expired after surgery due to massive bleeding.
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Fig. 1.
Abdominopelvic CT findings on the day of admission. Ascites collection in the lower abdomen, pelvic cavity with diffuse peritoneal enhancement and segmental wall thickening of the distal ileal loops.
Fig. 2.
Biopsy on peritoneal tissues taken from laparoscopy. Pools of mucin with a few clusters of mucinous columnar epithelium (H&E, ×100).
Fig. 3.
Colonoscopic findings of the orifice of appendix. (A) Colonoscopy showing mucin leaking out from the appendix orifice and (B) mucoceles on the appendix orifice.
Fig. 4.
Abdominopelvic CT findings before the palliative surgery. (A) Ascites and hepatic surface scalloping and (B) soft tissue mass at the omentum.
Fig. 5.
Biopsy on peritoneal tissues taken from palliative surgery (H&E). (A) Peritoneal involvement of mucinous neoplasm (×40). (B) Abundant extracellular mucin with strips of low grade mucinous epithelium (×200). (C) Foci of mucinous epithelium with high grade cytologic atypia were identified. Findings are consistent with mucinous carcinoma peritonei (×200).
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