Pseudomyxoma peritonei in the pleural cavity: report of a case

A huge pseudomyxoma pleurii mimicking hydatid cyst: A case report

INTRODUCTION

Pseudomyxoma pleurii is a rare disease that is defined by the pleural extension of pseudomyxoma peritonei, usually secondary to a mucinous neoplasm of the appendix or ovary. It is characterized by diffuse mucinous deposits on the pleural surface.

CASE PRESENTATION

A 31-year-old woman presented to the hospital with dyspnea, an increased respiratory rate, and decreased oxygen saturation. Following an appendectomy for a perforated mucinous appendiceal tumor eight years ago, the patient underwent multiple surgeries for the resection of mass deposits in the peritoneal cavity. At presentation, her chest computed tomography with contrast revealed cystic mass deposits on the right-side pleura with a massive multi-locular pleural effusion mimicking hydatid cyst. Upon histopathologic examination, multiple small cystic structures lined by tall columnar epithelium with basally placed bland nuclei floating in the mucin pools were noted.

CLINICAL DISCUSSION

Pseudomyxoma peritonei often leads to abdominal distention, intestinal blockage, anorexia, cachexia, and eventually death. It rarely spreads outside the abdomen, and its extension to the pleura is extremely unusual, with only a small number of cases documented in the literature to date. Radiologically, pseudomyxoma pleurii may resemble hydatid cyst of the lung and pleura.

CONCLUSION

Pseudomyxoma pleurii is a rare entity with a poor prognosis that usually arises secondary to Pseudomyxoma peritonei. The risk of morbidity and mortality is reduced by early diagnosis and treatment. The present case places emphasis on the inclusion of pseudomyxoma pleurii in the differential diagnosis of pleural lesions in patients with the history of appendiceal or ovarian mucinous tumors.

Diagnosis and treatment of a caecal mucocoele in a dog

An 11-year-old male intact Staffordshire Bull terrier was referred for diabetic ketoacidosis. Abdominal ultrasonographic examination revealed a 5 cm × 2 cm intraluminal caecal mass-like structure. Exploratory laparotomy and typhlectomy were subsequently performed. Histopathology of the caecal mass-like structure was consistent with a caecal mucocoele, defined as a cystic dilation of the caecal lumen with stasis of mucus. This lesion has been previously described in humans, where it is termed an appendiceal mucocoele. The patient was euthanased 58 days post-operatively due to unrelated diabetic complications.

Pseudomyxoma extraperitonei: a rare presentation of a rare tumour

Pseudomyxoma extraperitonei is rare lesion resulting from the rupture of an appendiceal mucocele into the extraperitoneal tissues. We report a case of an 80-year-old woman with a medical history for a left hemicolectomy and a laparoscopic cholecystectomy 11 and 6 years, respectively, referred to our hospital for abdominal pain of increasing severity localised to the right hemiabdomen. The abdominal examination revealed a mobile mass a multidetector CT was performed; the patient was taken to surgery which was performed with no complications. Histopathological analysis of the tumour reported a pseudomyxoma associated to a moderately differentiated adenocarcinoma. The patient remains asymptomatic at a 1-year follow-up.

[Pseudomyxoma of the pleura and of the peritoneum -- case report of a rare disease]

INTRODUCTION

Pseudomyxoma Peritonei (PMP) is a rare condition, which arises from the abdominal cavity and it may also involve the pleural cavity occasionally. Concomitant involvement of both cavities is rare. The disease is characterized by production of mucinous ascites, and a low-grade carcinoma deriving mostly from the appendix. Pleural seeding may be due to diaphragmatic perforation during surgical intervention, tumour progression, or persistent congenital malformation between the abdominal and pleural cavities.

CASE REPORT

A 44 year-old female patient was treated with pleuropulmonary involvement of pseudomyxoma. Since both the lungs and pleura were involved, radical resection could not have been carried out, and cytoreduction with intraoperative chemotherapy was applied only.

DISCUSSION

Pleural progression of pseudomyxoma is uncommon and carries a poor prognosis. Management is similar to abdominal PMP, which involves aggressive cytoreduction and local and/or systemic chemotherapy, if possible.

CONCLUSION

PMP is a very uncommon disease with poor prognosis. Extra-abdominal manifestation is rare, too. However, early recognition of the condition may enhance treatment options.

Pseudomyxoma peritonei: disseminated peritoneal adenomucinosis variant

Pseudomyxoma peritonei (PMP) is a rare disease and even after advances in its understanding and management it often has a protracted course and multiple recurrences despite aggressive surgery and intraperitoneal chemotherapy. The current preferred treatment of ultraradical surgery and hyperthermic intraperitoneal chemotherapy is associated with considerable morbidity and significant mortality. With better understanding we know that the prognosis of the disease is dependent on the degree of total excision of the disease and type of histology. The authors propose the need to be selective in applying aggressive treatment regimens in all patients with PMP regardless of factors like age, low malignant variants and expected morbidities. Our patient had a good outcome with a conservative approach. However, large studies are needed before reaching a conclusion.

[Laparoscopic treatment of appendiceal mucocele]

Mucocele is a mucin-filled cavity, which can be multi-loculated as well. Mucocele is relatively rarely found in the appendix. The disease does not cause any symptoms in most cases, and it is usually an accidental finding. A thorough investigation should be carried out to exclude malignancy. Depending on the operative findings and the full histological report, the spectrum of surgery extends from appendectomy to right hemicolectomy. In this paper, we discuss the presentation, diagnostical options, and the possible surgical treatment--based on our experience with five cases. In three cases a non-tender mass was palpable in the right lower quadrant of the abdomen, while another patient presented with right lower quadrant abdominal pain and one with abdominal pain and diarrhoea. Abdominal and pelvic ultrasound and CT scans raised the possibility of mucocele, however colonoscopy was negative. After laparoscopic exploration, laparoscopy assisted partial caecum resection was carried out in two cases, in further two cases laparoscopic appendectomy, and in one case laparoscopic partial caecum resection was done. The hystological examinations showed appendiceal mucocele with no malignancy demonstrated. All patients recovered without complications, they were discharged from hospital on postoperative day five. The patients have been disease free after a 6-30 month follow-up period. We concluded that laparoscopy is a recommended method for the surgery of appendiceal mucocele.

Giant appendiceal mucocele: Report of a case and brief review

Mucocele of the appendix is a rare lesion, characterized by distension of the lumen due to accumulation of mucoid substance. This disease is often asymptomatic and pre-operative diagnosis is rare. If untreated, one type of mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The type of surgical treatment is related to the dimensions and to histology of the mucocele. Appendectomy is used for simple mucocele or for cystadenoma. Right hemi-colectomy is recommended for cystadenocarcinoma. In this paper, we report a case of a 51-year-old woman with a mobile, painless mass in the right lower quadrant of abdomen caused by a giant appendiceal mucocele. Imaging showed a large, tubular, cystic structure extending below from the inferior wall of the cecum. Surgery revealed a giant retro-cecal appendix measuring 17 cm in length and 4 cm in diameter. The final pathologic diagnosis was mucocele caused by mucinous cystadenoma.

Pseudomyxoma peritonei: extraperitoneal spread to the pleural cavity and lung

Abdominal and pelvic recurrence of pseudomyxoma peritonei after the surgery is occasionally seen but extraperitoneal spread and hematogeneous metastases are rare. This case of pseudomyxoma peritonei provides interesting radiologic findings of extraperitoneal spread, which occurred after an extremely long interval from initial diagnosis.