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Shi QMM, Shaote WMD, Yao DMD, Feixiang XMD, Xiaojuan QMD. Characterization of Pseudomyxoma Peritonei Originating from Ovarian Borderline Mucinous Tumor Using Ultrasonography: A Case Report. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2023. [DOI: 10.37015/audt.2023.220022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Fred HL, Aisenberg GM, Guthrie AM, van Dijk HA. Jelly from the belly button: What's the diagnosis? Proc (Bayl Univ Med Cent) 2018; 31:355-358. [DOI: 10.1080/08998280.2018.1446886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 10/16/2022] Open
Affiliation(s)
- Herbert L. Fred
- Department of Medicine, McGovern Medical School, UT Health, Houston, Texas
| | | | - Agnes M. Guthrie
- Department of Diagnostic and Interventional Imaging, McGovern Medical School, UT Health, Houston, Texas
| | - Hendrik A. van Dijk
- Department of Graphic Communications, McGovern Medical School, UT Health, Houston, Texas
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Morotti A, Busso M, Consiglio Barozzino M, Cinardo P, Angelino V, Familiari U, Veltri A, Guerrasio A. Detection and management of retroperitoneal cystic lesions: A case report and review of the literature. Oncol Lett 2017; 14:1602-1608. [PMID: 28789385 DOI: 10.3892/ol.2017.6323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 11/04/2016] [Indexed: 12/25/2022] Open
Abstract
The identification of cystic lesions within the retroperitoneal space is a rare event that poses clinicians the challenge of a difficult diagnosis and disease management. Retroperitoneal cystic lesions account for a group of lesions that range from common benign lesions (e.g., lymphoceles developing as a surgical complication) to rare aggressive malignant neoplasms. Currently, in the majority of cases, image-guided procedures allow for a pathological diagnosis to be achieved in these challenging lesions, thus offering the chance of an appropriate treatment; however, the overall clinical assessment of retroperitoneal cysts is highly demanding. The present study reports the management of a representative clinical case, presenting with a voluminous cystic mass able to dislocate cave vein, whose diagnosis was preceded by a deep vein thrombosis. Computed tomography-scan and ultrasound guided percutaneous drainage were performed to achieve the diagnosis. Following the discussion of the current case report, a review of the pathological and radiological characteristics of retroperitoneal cystic lesions is presented.
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Affiliation(s)
- Alessandro Morotti
- Division of Internal Medicine, University of Turin, Orbassano, I-10043 Turin, Italy.,Department of Clinical and Biological Sciences, University of Turin, Orbassano, I-10043 Turin, Italy
| | - Marco Busso
- Department of Oncology, University of Turin and San Luigi Hospital, Orbassano, I-10043 Turin, Italy
| | - Maria Consiglio Barozzino
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, I-10043 Turin, Italy
| | - Paola Cinardo
- Department of Clinical and Biological Sciences, University of Turin, Orbassano, I-10043 Turin, Italy
| | - Valeria Angelino
- Department of Oncology, University of Turin and San Luigi Hospital, Orbassano, I-10043 Turin, Italy
| | - Ubaldo Familiari
- Department of Pathology, San Luigi Hospital, Orbassano, I-10043 Turin, Italy
| | - Andrea Veltri
- Department of Oncology, University of Turin and San Luigi Hospital, Orbassano, I-10043 Turin, Italy
| | - Angelo Guerrasio
- Division of Internal Medicine, University of Turin, Orbassano, I-10043 Turin, Italy.,Department of Clinical and Biological Sciences, University of Turin, Orbassano, I-10043 Turin, Italy
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"The Jelly Belly": Diagnostic Dilemmas and Current Concepts. J Obstet Gynaecol India 2016; 66:573-7. [PMID: 27651663 DOI: 10.1007/s13224-016-0921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/11/2016] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Pseudomyxoma peritonei (PMP) is a rare and poorly understood clinicopathological entity characterized by gelatinous ascites with neoplastic or non-neoplastic mucinous implants in the peritoneum. Although its origin was debated, current evidence in literature favours the appendix as the origin of the disease, over the ovaries. The changing terminologies in the classification of this entity pose diagnostic and management challenges. CASE REPORTS Herein, we report three cases of PMP in postmenopausal women, their clinical presentation, pathological staging based on the peritoneal tumor deposits and the treatment administered. Two patients recovered uneventfully, while one had recurrence of adenocarcinoma. CONCLUSION The rarity of this disease and the diagnostic challenges associated with it are discussed with an emphasis on the current concepts in its origin and management. Appropriate classification and complete removal of the tumor is mandated to prevent disease-related mortality.
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Puranik AD, Purandare NC, Agrawal A, Shah S, Rangarajan V. Imaging spectrum of peritoneal carcinomatosis on FDG PET/CT. Jpn J Radiol 2014; 32:571-8. [DOI: 10.1007/s11604-014-0346-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 07/28/2014] [Indexed: 11/28/2022]
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Appelman Z, Zbar AP, Hazan Y, Ben-Arie A, Caspi B. Mucin stratification in pseudomyxoma peritonei: a pathognomonic ultrasonographic sign. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 41:96-97. [PMID: 22689180 DOI: 10.1002/uog.11211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Liu L, Sun L, Wang J, Ji G, Chen B, Zhang H. Ovarian cystadenocarcinoma and pseudomyxoma peritonei. BMJ Case Rep 2010; 2010:2010/jun28_1/bcr0620080137. [PMID: 22753161 DOI: 10.1136/bcr.06.2008.0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Mucoceles resulting from cystadenomas of the ovary are uncommon. Although rare, rupture of the mucoceles can occur without causing any abdominal issue. This report concerns an unusual and interesting case of the right ovary associated with liver, spleen and kidney cysts. CASE PRESENTATION A case of ruptured mucocele resulting from cystadenoma of the ovary occurred in a 63-year-old woman. The patient underwent x-ray, ultrasound and a CT scan. Localised pseudomyxoma peritonei associated with adenocarcinoma of the right ovary was diagnosed. The patient underwent resection of the ovary, uterus, uterine tube and appendix with excision of the mesenteric lymph nodes and removal of about 5000 ml of yellowish mucoid jelly. She was free of symptoms at 1-year follow-up. CONCLUSIONS Pseudomyxoma peritonei may occur in patients with ovarian cystadenocarcinoma. In such patients, the ovary should be investigated and transvaginal ultrasound can be carefully performed in cases of ruptured mucoceles and localised pseudomyxoma peritonei. Surgical intervention is the current choice of management.
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Affiliation(s)
- Lili Liu
- Institute of Digestive Diseases Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Winer I, Buckanovich RJ. Bevacizumab for the Treatment of Non-Resectable Pseudomyxoma peritonei Associated with Mucinous Ovarian Tumor of Low Malignant Potential - A Comparison of Two Cases. Case Rep Oncol 2009; 3:1-8. [PMID: 20740150 PMCID: PMC2918834 DOI: 10.1159/000270179] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pseudomyxoma peritonei (PMP) is a rare tumor syndrome that can be diagnosed in association with mucinous ovarian tumors of low malignant potential. Surgical debulking is the primary treatment modality as chemotherapy has generally proven ineffective in this slowly progressive tumor. When patients with PMP are not surgical candidates, there is no effective treatment, and patients will die of progressive disease. We report two patients with PMP with associated mucinous ovarian tumor of low malignant potential treated with Bevacizumab therapy. Both patients demonstrated disease response to single agent Bevacizumab therapy. One patient had a prolonged response while on therapy, remained stable for 6 months when treatment was held, and then after progressing responded to a second course of therapy. We discuss here (1) the clinical features which may predict a better response to Bevacizumab therapy, and (2) evidence for the use of chemotherapy for inoperable PMP. These cases suggest that Bevacizumab may represent a rare effective therapy for patients with inoperable PMP with ovarian involvement and should be considered for clinical trials in this patient population.
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Affiliation(s)
- Ira Winer
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Mich., USA
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Subramanya D, Grivas PD, Styler M. Appendiceal carcinoma: a diagnostic and therapeutic challenge. Postgrad Med 2008; 120:95-100. [PMID: 19020371 DOI: 10.3810/pgm.2008.11.1944] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Appendiceal carcinoma is a very rare clinical entity, constituting 1% of all colorectal malignancies and 1% of all appendectomy specimens. Appendiceal malignancies often present atypically, thus creating diagnostic challenges. We present a patient with mucinous carcinoma of the appendix who presented with hematuria and abdominal pain. Similar case reports are extremely rare in the literature, while typical presentations of appendiceal carcinoma include abdominal pain, abdominal mass, early satiety, nausea, and iron-deficiency anemia. Initially, the diagnostic investigation in our patient was focused on urinary tract disorders, but ultimately resulted in finding a mucinous appendiceal carcinoma. The carcinoma had invaded the urinary bladder and was disseminated in the peritoneal cavity. Aggressive cytoreductive surgery is the most common therapeutic approach for disseminated tumors, often followed by intraperitoneal chemotherapy. However, treatment should be individualized based on patient-specific parameters, such as the presence of comorbidities, performance status, as well as the presence of metastatic disease. Our patient had optimal cytoreduction with subsequent systemic therapy with 5-fluorouracil, leucovorin, oxaliplatin, and bevacizumab, a monoclonal antibody directed against vascular endothelial growth factor. She completed her treatment regimen without complications and is currently being restaged. An integrative approach is required in the diagnostic investigation and management of appendiceal malignancies.
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Affiliation(s)
- Deepthi Subramanya
- Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, PA 19102, USA
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Royal RE, Pingpank JF. Diagnosis and Management of Peritoneal Carcinomatosis Arising From Adenocarcinoma of the Colon and Rectum. Semin Oncol 2008; 35:183-91. [DOI: 10.1053/j.seminoncol.2007.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Brueggen C, Baird G, Meisheid A. Pseudomyxoma peritonei syndrome of appendiceal origin: an overview. Clin J Oncol Nurs 2007; 11:525-32. [PMID: 17723965 DOI: 10.1188/07.cjon.525-532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pseudomyxoma peritonei (PMP) syndrome is an uncommon, slowly progressive condition that usually arises from perforation of an adenoma in the appendix. PMP syndrome is characterized by mucin accumulation in the peritoneal cavity. Mucinous implants are found on all peritoneal surfaces and the omentum. PMP syndrome rarely metastasizes outside the abdominal cavity but remains a fatal illness as the space in the abdomen and pelvis required for normal function of the gastrointestinal tract becomes filled with copious amounts of the mucinous tumor. Treatment options include observation, aggressive debulking surgery, intraperitoneal chemotherapy, radiotherapy, and mucolytic agents.
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Beyrouti MI, Beyrouti R, Frikha F, Ben Amar M, Abid M, Ben Ameur H, Ben Salah K, Guirat A, Boujelben S. [Peritoneal gelatinous ascites]. Presse Med 2007; 36:1141-7. [PMID: 17603922 DOI: 10.1016/j.lpm.2006.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Indexed: 10/22/2022] Open
Abstract
Pseudomyxoma peritonei or gelatinous ascites is a rare clinical entity, and its pathogenesis remains obscure. It most often follows a mucinous tumor of the appendix. An ovarian origin in woman has been suggested but remains controversial. Its onset is often insidious: an increase in the abdominal perimeter may be the first sign noted. Preoperative diagnosis is facilitated by modern imaging techniques. Ultrasonography and computed tomography provide complementary signs: septa and scalloping of the liver margins, respectively. Effusion in the lesser peritoneal cavity suggests this diagnosis. Magnetic resonance imaging, by showing the gelatinous ascites, their septa and the scalloping of liver and spleen, can strengthen the probability of the diagnosis. Only laparotomy can confirm it, however. Appendectomy is required in all cases. Recurrence is more frequent in the forms associated with malignant or bipolar tumors. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy is the only therapy shown to be effective in cases of recurrence or malignant forms.
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Abstract
Pseudomyxoma peritonei (PP) produces abundant mucoid material from the rupture of low grade ovarian or appendiceal mucinous tumours. The unique pattern of cancer dissemination and intraperitoneal mucous re-distribution makes it a distinct clinical condition. It has diverse presentations, mainly as a result of narrowing of the gastrointestinal tract and entrapment of other viscera by gelatinous mucoid material. Imaging is helpful, but not diagnostic of this condition. We report a patient with pseudomyxoma perotonei who had perforation at the recto-sigmoid junction into a large mucinous cyst adjacent to the sigmoid colon. The patient improved clinically with conservative management, with persisting communication and no adverse symptoms reported at 4 months follow-up.
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Affiliation(s)
- L S Naidu
- Department of Radiology, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK.
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Taii A, Sakagami J, Shinoda M, Taniguchi H, Tosa M, Baba T, Motoyoshi T, Ito R, Mitsufuji S, Kataoka K, Okanoue T. Pseudomyxoma peritonei occurring after an uneventful 23 years interval from appendectomy. Intern Med 2007; 46:1109-12. [PMID: 17634709 DOI: 10.2169/internalmedicine.46.0079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 77-year-old male was admitted to our hospital for a bulky abdominal mass. He had a history of appendectomy under the diagnosis of appendiceal rupture 23 years previously. He also had received a radical lung resection for an early lung cancer 2 years earlier in another hospital. Tentative diagnosis of peritoneal metastases from the lung cancer was made. He then received 3 courses of chemotherapy, but failed to reach a remission. The final diagnosis of pseudomyxoma peritonei was made by means of abdominocentesis, and he underwent debulking surgery. However, he died on day 56 after the surgery. Pseudomyxoma peritonei requires careful observation, as it has the possibility to be detected after a long-term follow-up period of more than 20 years.
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Affiliation(s)
- Atsuko Taii
- Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science.
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Caballero Carrasco A, López Crespo M, Blasco Montero R, Almeida Rebollo J. Diagnóstico diferencial del estreñimiento crónico. A propósito de un caso. Semergen 2006. [DOI: 10.1016/s1138-3593(06)73314-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Eisele L, Sheu SY, Müller-Beissenhirtz H, Welt A, Seeber S. Response of pseudomyxoma peritonei to gemcitabine. Acta Oncol 2006; 45:98-100. [PMID: 16464804 DOI: 10.1080/02841860500341165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Blecha MJ, Gupta A, Hoover JD, Madonna MB. Chronic abdominal pain secondary to a mucous cystadenoma of the appendix in a 10-year-old boy. J Pediatr Surg 2005; 40:1792-4. [PMID: 16291172 DOI: 10.1016/j.jpedsurg.2005.07.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mucocele of the appendix is a thin-walled dilated appendix filled with mucus. It occurs secondary to chronic obstruction of the appendiceal lumen because of a range of pathologies. Cystadenomas in children are exceedingly rare and most frequently of ovarian origin. A mucous cystadenoma of the appendix in a 10-year-old boy with chronic abdominal pain is presented.
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Affiliation(s)
- Matthew J Blecha
- Department of Pediatric Surgery, Children's Memorial Hospital, Chicago, IL 60657, USA.
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Devine C, Szklaruk J, Tamm EP. Magnetic resonance imaging in the characterization of pelvic masses. Semin Ultrasound CT MR 2005; 26:172-204. [PMID: 15987066 DOI: 10.1053/j.sult.2005.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Female pelvic masses most commonly arise from the reproductive tract, although masses may arise from other structures in the pelvis, such as the gastrointestinal or urinary tracts. The evaluation of a pelvic mass often begins with the physical exam and proceeds to ultrasound, computed tomography, or magnetic resonance imaging. Each of these modalities has a role in the work-up of pelvic masses and each modality has inherent advantages and disadvantages. The focus of this article is to demonstrate the imaging features and role of MRI, in contrast to CT, for detecting, characterizing, and staging pelvic masses. The differential diagnosis for pelvic masses is extremely broad. Clinical history, precise anatomical localization, and MR imaging characterization can significantly narrow the differential diagnosis. With recent advances in therapeutic strategies, a non-invasive, preoperative diagnosis is highly desirable to suggest prognosis and to tailor the treatment approach.
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Affiliation(s)
- Catherine Devine
- Diagnostic Radiology, Department of Diagnostic Imaging, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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