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Awad A, Awad M, Alami M, Sablan AA, Shrateh ON, Jubran F. Successful treatment of pseudomyxoma peritonei (PMP) through cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC): A case report and literature review. Int J Surg Case Rep 2024; 119:109656. [PMID: 38677258 PMCID: PMC11067356 DOI: 10.1016/j.ijscr.2024.109656] [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: 03/16/2024] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Pseudomyxoma peritonei (PMP) is characterized by the accumulation of mucinous fluid in the abdominal cavity, typically originating from mucin-producing tumors, most commonly arising in the appendix. CASE PRESENTATION A 63-year-old male patient presented to the hospital with complaints of abdominal pain, significant weight loss, a palpable mass in the right iliac fossa, and evidence of ascites. A diagnosis of PMP was proposed based on findings from a computed tomography (CT) scan, which was subsequently confirmed through histopathological examination of a biopsy. The patient underwent successful treatment with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC). CLINICAL DISCUSSION Diagnosing PMP presents challenges due to its rarity and the potential for extensive spread throughout the peritoneal cavity, necessitating a multidisciplinary approach for successful treatment. CONCLUSION Pseudomyxoma peritonei is a rare yet medically significant condition. Documenting a case of this ailment in Palestine has the potential to advance medical understanding, raise awareness, and improve patient care standards within the local healthcare system. By documenting this uncommon condition, healthcare practitioners in Palestine can gain valuable insights into its manifestations, diagnostic processes, and treatment modalities. This contribution not only enriches the global medical literature but also promotes collaboration in addressing the challenges associated with rare diseases.
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Affiliation(s)
- Areej Awad
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Mahmoud Awad
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Muayyad Alami
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Oadi N Shrateh
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
| | - Fahmi Jubran
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine; Departement of Geneal Surgery, Al-Ahli Hospital, Hebron, Palestine
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Bai M, Chen J, Xu Y, Feng J, Ma R, Jia H, Xu H, Liang G, Wei H. Bland-Altman agreement analysis between CT predicted and surgical peritoneal cancer index in pseudomyxoma peritonei of appendiceal origin. Sci Rep 2023; 13:21520. [PMID: 38057378 PMCID: PMC10700599 DOI: 10.1038/s41598-023-48975-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/02/2023] [Indexed: 12/08/2023] Open
Abstract
Peritoneal cancer index (PCI) is the surgical variable most commonly used to quantify the extent of peritoneal metastases for pseudomyxoma peritonei (PMP) patients. The present study aimed to investigate the agreement between CT predicted and surgical PCI by the Bland-Altman method for PMP of appendiceal origin. A total of 167 PMP patients of appendiceal origin were included between 2016 and 2021. Bland-Altman analysis was performed for both total PCI and selected PCI (regions 2 + 9-12). After the Bland-Altman plot was drawn, the mean bias and its 95% limit of agreements (LoAs) was quantified. Besides, the correlation coefficients between CT-PCI and surgical PCI were also been calculated. The Bland-Altman plot showed the mean bias ± SD between total CT-PCI and surgical PCI as 0.431 ± 3.005, with the LoAs from - 5.459 to 6.321. There were nine points of difference in total PCI exceeded the 95% LoAs, with the rate of 5.39% (9/167). As for selected CT-PCI, Bland-Altman plot showed the mean bias ± SD between selected CT-PCI and surgical PCI as - 0.287 ± 1.955, with the LoAs from - 4.118 to 3.544. There were ten points of difference in selected PCI exceeded the 95% LoAs, with the rate of 5.99% (10/167). The Spearman's rank correlation coefficient between total CT-PCI and surgical PCI was 0.911, P < 0.001, as for selected CT-PCI and surgical PCI, the coefficient was 0.909, P < 0.001. Although there was a strong correlation for both total and selected CT-PCI with surgical PCI, however, the agreement is still not good in Bland-Altman analysis, which suggested that CT-PCI cannot predict surgical PCI accurately even in professional PMP treatment centers. In brief explanation, CT makes it difficult to distinguish the borderline between tumor tissue and mucus and to detect tumor lesions in the small intestine regions, which caused overestimation or underestimation by CT-PCI. In the future, a multiple linear regression model based on CT-PCI might accurately predict surgical PCI preoperatively.
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Affiliation(s)
- Mingjian Bai
- Department of Clinical Laboratory, Aerospace Center Hospital, Beijing, 100049, People's Republic of China
| | - Jingliang Chen
- Department of Clinical Laboratory, Aerospace Center Hospital, Beijing, 100049, People's Republic of China
| | - Yueming Xu
- Department of Literature and Science, University of Wisconsin-Madison, Madison, WI, 50155, USA
| | - Jing Feng
- Department of Clinical Laboratory, Aerospace Center Hospital, Beijing, 100049, People's Republic of China
| | - Ruiqing Ma
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Hongmin Jia
- Department of Radiology, Aerospace Center Hospital, Beijing, 100049, People's Republic of China
| | - Hongbin Xu
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Guowei Liang
- Department of Clinical Laboratory, Aerospace Center Hospital, Beijing, 100049, People's Republic of China.
| | - Hongjiang Wei
- Department of Radiology, Aerospace Center Hospital, Beijing, 100049, People's Republic of China.
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Yang R, Fu YB, Li XB, Ma R, Su YD, Wu HL, Liang XL, Li Y. Long-term survival in patients with PMP: a single-institutional retrospective study from China. World J Surg Oncol 2023; 21:347. [PMID: 37891655 PMCID: PMC10612327 DOI: 10.1186/s12957-023-03232-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND As the standard treatment for pseudomyxoma peritonei (PMP), cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) can significantly prolong the survival of PMP patients, and some patients can even achieve long-term survival (LTS) or clinical cure. The purpose of this study was to analyze the clinicopathological and treatment features of PMP patients with LTS and to explore the survival benefit factors of PMP patients. METHODS The clinicopathological and prognostic data of PMP patients who received CRS + HIPEC at our center from December 2004 to May 2023 were retrospectively analyzed. PMP patients were divided into LTS group (≥ 10 years) and short-term survival (STS) group (< 5 years) according to the length of natural history. Univariate and multivariate analyses were performed to explore the beneficial factors of PMP patients with LTS. RESULTS A total of 609 patients with PMP received CRS + HIPEC treatment at our center. Two-hundred one patients with PMP were included in the study after screening, including 39 patients (19.4%) in the LTS group and 162 patients (80.6%) in the STS group. In STS group and LTS group, median overall survival based on natural history was 29.2 (2.4-59.9) vs. 138.9 (120.3-416.7) months. Univariate analysis revealed 8 factors (P < 0.05) with statistically significant differences between the two groups: gender, chemotherapy history, previous surgical score, Karnofsky Performance Status score, pathological diagnosis, lymphatic metastasis, peritoneal cancer index, and completeness of cytoreduction (CC). Multivariate analysis identified only two factors independently associated with LTS of PMP patients: CC and pathological diagnosis. CONCLUSION Complete CRS and pathological features are two key factors affecting LTS in PMP patients.
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Affiliation(s)
- Rui Yang
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Yu-Bin Fu
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Xin-Bao Li
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Ru Ma
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Yan-Dong Su
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - He-Liang Wu
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China
| | - Xin-Li Liang
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Yan Li
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China.
- Department of Surgical Oncology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China.
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Yang R, Zhao X, Fu YB, Lin YL, Ma R, Su YD, Wu HL, Liang XL, Li Y. Etiological analysis of infection after CRS + HIPEC in patients with PMP. BMC Cancer 2023; 23:903. [PMID: 37752468 PMCID: PMC10521434 DOI: 10.1186/s12885-023-11404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard treatment for pseudomyxoma peritonei (PMP). It can significantly prolong the survival of patients, but at the same time may increase the risk of postoperative infection. METHOD Patients with PMP who underwent CRS + HIPEC at our center were retrospectively analyzed. According to PMP patients, basic clinical data and relevant information of postoperative infection, we analyzed the common sites of postoperative infection, results of microbial culture and the antibiotics sensitivity. Univariate and multivariate analysis were performed to explore infection-related risk factors. RESULT Among the 482 patients with PMP, 82 (17.0%) patients were infected after CRS + HIPEC. The most common postoperative infection was central venous catheter (CVC) infection (8.1%), followed by abdominal-pelvic infection (5.2%). There were 29 kinds of microbes isolated from the culture (the most common was Staphylococcus epidermidis), including 13 kinds of Gram-positive bacteria, 12 kinds of Gram-negative bacteria, and 4 kinds of funguses. All the antibiotics sensitivity results showed that the most sensitive antibiotics were vancomycin to Gram-positive bacteria (98.4%), levofloxacin to Gram-negative bacteria (68.5%), and fluconazole to fungus (83.3%). Univariate and multivariate analysis revealed the infection independent risk factors as follow: intraoperative blood loss ≥ 350 mL (P = 0.019), ascites volume ≥ 300 mL (P = 0.008). CONCLUSION PMP patients may have increased infection risk after CRS + HIPEC, especially CVC, abdominal-pelvic and pulmonary infections. The microbial spectrum and antibiotics sensitivity results could help clinicians to take prompt prophylactic and therapeutic approaches against postoperative infection for PMP patients.
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Affiliation(s)
- Rui Yang
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Haidian District, No. 10 Tieyi Road, Yangfangdian Street, Beijing, 100038, China
| | - Xin Zhao
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Peking University Ninth School of Clinical Medicine, Beijing, 100038, China
| | - Yu-Bin Fu
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Haidian District, No. 10 Tieyi Road, Yangfangdian Street, Beijing, 100038, China
| | - Yu-Lin Lin
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Haidian District, No. 10 Tieyi Road, Yangfangdian Street, Beijing, 100038, China
| | - Ru Ma
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Haidian District, No. 10 Tieyi Road, Yangfangdian Street, Beijing, 100038, China
| | - Yan-Dong Su
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Haidian District, No. 10 Tieyi Road, Yangfangdian Street, Beijing, 100038, China
| | - He-Liang Wu
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Haidian District, No. 10 Tieyi Road, Yangfangdian Street, Beijing, 100038, China
| | - Xin-Li Liang
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Haidian District, No. 10 Tieyi Road, Yangfangdian Street, Beijing, 100038, China
| | - Yan Li
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Haidian District, No. 10 Tieyi Road, Yangfangdian Street, Beijing, 100038, China.
- Department of Surgical Oncology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, 102218, China.
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Bathobakae L, Ozgur SS, Jariwala M, Kesrani J, Ajas S, Kumar M, Akmal A. The Cancer Diaspora: A Rare Case of Pseudomyxoma Peritonei of Appendiceal Origin. J Investig Med High Impact Case Rep 2023; 11:23247096231217822. [PMID: 38102072 PMCID: PMC10725096 DOI: 10.1177/23247096231217822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/29/2023] [Accepted: 11/12/2023] [Indexed: 12/17/2023] Open
Abstract
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.
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Affiliation(s)
| | | | - Mohita Jariwala
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Jaydev Kesrani
- St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Shajla Ajas
- St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Mehandar Kumar
- St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Amer Akmal
- St. Joseph’s University Medical Center, Paterson, NJ, USA
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Ray MD, Gaur MK, Kumar C, Deo SVS. A proposal for changing nomenclature from pseudomyxoma peritonei (PMP) to abdomino-peritoneal mucinous carcinoma (APM) based on its long journey and experience from tertiary oncology center in India. World J Surg Oncol 2022; 20:171. [PMID: 35641982 PMCID: PMC9158346 DOI: 10.1186/s12957-022-02639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 04/19/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Pseudomyxoma peritonei (PMP) is a generalized term, usually known as “jelly belly” since 1884. Incidence is very low, 1–3 per million people per year. Because of its indolent nature, it is usually diagnosed at an advanced stage, thereby impacting the quality of life. The 5-year survival rate varies from 23 to 86% in world literature. Even 10 years and 20 years of survival have been described. With our experience, we like to propose rename of PMP as abdomino-peritoneal mucinous carcinoma (APM) as we strongly feel the time has come to specify the term and standardize the management strategy. Methodology In the premier institute of India and as a tertiary referral center, we experienced the maximum number of advanced cases of APM. From 2012 to 2021, we analyzed all the APM patients based on a prospectively maintained computerized database in the department of surgical oncology and found the reasons for renaming from this traditional one. Results We included a total of 87 patients who underwent surgical intervention. Thirty-five patients underwent cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), and 52 patients underwent debulking. In CRS-HIPEC patients, CC-0 was achieved in 28 patients (80%), CC-1 in 4 patients (11.4%), and CC-2 in 3 patients (8.6%). Palliative intent HIPEC was done in 3 patients (8.6%). Clavien-Dindo grade III and IV morbidity was observed in 18.8% of patients with 90 days mortality of 5.7%. Conclusion With our long-term experience and advancement of scientific evidence, we like to propose a new name for PMP as APM. We strongly believe this paper will give a clear picture of this rare disease and standard management outlines.
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Affiliation(s)
- M D Ray
- Department of Surgical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India.
| | - Manish Kumar Gaur
- Department of Surgical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan Kumar
- Department of Surgical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - S V S Deo
- Department of Surgical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India
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Unusual site of pseudomyxoma peritonei recurrence after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a case report of intraluminal disease manifestation in the small bowel. World J Surg Oncol 2022; 20:147. [PMID: 35538541 PMCID: PMC9088063 DOI: 10.1186/s12957-022-02613-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pseudomyxoma peritonei (PMP) is an uncommon clinical condition characterized by the presence of mucinous ascites, mainly induced by perforated appendiceal mucinous neoplasms (AMN). The peritoneal surface of the small bowel is usually spared from disease manifestation due to peristaltic movements. Mucinous tumours can disseminate as PMP on the entire peritoneum, but are rarely intraluminal. For the first time in literature, we report a case of intraluminal PMP involving the ileum. CASE PRESENTATION A 75-year-old male was treated for perforated AMN and disseminated PMP with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. During follow-up, the patient developed intraperitoneal recurrence together with intraluminal depositions in the ileum, both disease manifestations with identical KRAS and SMAD4 mutations. Hereafter, the patient was treated with palliative care. CONCLUSION This case illustrates the variation in the biological and clinical behaviour of this rare disease. Clinicians should be aware of unusual tumour distribution patterns of PMP, including the presence of mucinous tumour within the small bowel.
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Han XD, Zhou N, Lu YY, Xu HB, Guo J, Liang L. Pseudomyxoma peritonei originating from intestinal duplication: A case report and review of the literature. World J Clin Cases 2021; 9:7459-7467. [PMID: 34616812 PMCID: PMC8464479 DOI: 10.12998/wjcc.v9.i25.7459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/08/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Xue-Di Han
- Department of Ultrasound, Aerospace Center Hospital, Beijing 100049, China
| | - Nan Zhou
- Department of Ultrasound, Aerospace Center Hospital, Beijing 100049, China
| | - Yi-Yan Lu
- Department of Pathology, Aerospace Center Hospital, Beijing 100049, China
| | - Hong-Bin Xu
- Department of Myxoma, Aerospace Center Hospital, Beijing 100049, China
| | - Jun Guo
- Department of Ultrasound, Aerospace Center Hospital, Beijing 100049, China
| | - Lei Liang
- Department of Ultrasound, Aerospace Center Hospital, Beijing 100049, China
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Badhe PV, Ravi Kiran D, Seshadri H. Pseudomyxoma retroperitonei masquerading as a psoas abscess. BMJ Case Rep 2021; 14:14/6/e240299. [PMID: 34083186 DOI: 10.1136/bcr-2020-240299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 52-year-old woman was referred to our department with multiple discharging sinuses and swelling in the right flank and iliac region for the past year. Ultrasound revealed a large collection in the right psoas muscle with the sinus tract reaching up to the skin in the right iliac region. Despite repeated attempts at drainage, the collection continued to increase in size. CT was requested and revealed a large heterogeneous irregular collection in the right psoas with fistulous communication with the cecum and skin with the erosion of the overlying ilium. Because of lack of vertebral involvement, enhancing internal septations, non-visualisation of the appendix and feculent material admixed with mucinous discharge from the sinus, pseudomyxoma retroperitonei secondary to ruptured mucinous neoplasm of the appendix was suspected. Mucoid material at the local site was sent for histopathology, which confirmed our suspicion. Our treatment plan after ileostomy was cytoreductive surgery along with adjuvant radiotherapy (40 Gy in 20 fractions) with chemotherapy (5-fluorouracil and folinic acid given for 30 weeks, once a week). However, after ileostomy, the patient refused further treatment, citing financial reasons.
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Affiliation(s)
- Padma Vikram Badhe
- Radiodiagnosis, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Dasari Ravi Kiran
- Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Harini Seshadri
- Radiology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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Wang B, Yao J, Ma R, Liu D, Lu Y, Shi G, An L, Xia A, Chen F, Pang S, Zhai X, Liu G, Chen S, Xu M, Song L, Xu H. The mutational landscape and prognostic indicators of pseudomyxoma peritonei originating from the ovary. Int J Cancer 2021; 148:2036-2047. [PMID: 33403690 DOI: 10.1002/ijc.33460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 12/12/2022]
Abstract
Pseudomyxoma peritonei (PMP) is a rare disorder with unique pathological and genetic changes. Although several studies have reported the clinical features and mutational changes of PMP that originates from the appendix, few studies on PMP originating from the ovary have been reported due to its extreme rarity. In order to characterize the somatic mutational landscape and to investigate the prognosis predicting factors of ovary-originating PMP, we examined 830 cases of PMP and identified 16 patients with PMP that originated from the ovary. Whole-exome sequencing (WES) was performed on 12 cases using formalin-fixed, paraffin-embedded (FFPE) tissue samples. We found that 25% (3/12) of the patients carried mutations in cancer driver genes, including TP53, ATM and SETD2, and 16.7% (2/12) of the patients carried mutations in cancer driver genes, including ATRX, EP300, FGFR2, KRAS, NOCR1 and RB1. The MUC16 (58.33%), BSN (41.67%), PCNT (41.67%), PPP2R5A (41.67%), PRSS36 (41.67%), PTPRK (41.67%) and SBF1 (41.67%) genes presented the highest mutational frequencies. The PI3K-Akt signaling pathway, human papillomavirus infection pathway, cell skeleton, cell adhesion, and extracellular matrix and membrane proteins were the major pathways or functions that were affected. Patients were followed up to 174 months (median: 48.26 months). The 5-year OS rate for all patients was 71.2% and the median OS was not reached. PTPRK mutations, presurgical CA199 level, completeness of cytoreduction (CCR) and peritoneal cancer index (PCI) were identified as potential predictive factors for patient survival. In conclusion, the mutational landscape for ovary-originating PMP was revealed and exhibited unique features distinct from appendix-originating PMP. PTPRK, CA199, CCR and PCI may predict patient survival.
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Affiliation(s)
- Bing Wang
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Jianfei Yao
- HaploX Biotechnology, Co., Ltd, Shenzhen, China
| | - Ruiqing Ma
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Danni Liu
- HaploX Biotechnology, Co., Ltd, Shenzhen, China
| | - Yiyan Lu
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Guanjun Shi
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Lubiao An
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Ao Xia
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Feng Chen
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Shaojun Pang
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Xichao Zhai
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Guifeng Liu
- HaploX Biotechnology, Co., Ltd, Shenzhen, China
| | - Shifu Chen
- HaploX Biotechnology, Co., Ltd, Shenzhen, China
| | - Mingyan Xu
- HaploX Biotechnology, Co., Ltd, Shenzhen, China
| | - Lele Song
- HaploX Biotechnology, Co., Ltd, Shenzhen, China.,Department of Radiotherapy, the Eighth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Hongbin Xu
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
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Son J, Park YJ, Lee SR, Kim HO, Jung KU. Increased Risk of Neoplasms in Adult Patients Undergoing Interval Appendectomy. Ann Coloproctol 2020; 36:311-315. [PMID: 32054244 PMCID: PMC7714372 DOI: 10.3393/ac.2019.10.15.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 10/15/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE The low rate of recurrent appendicitis after initial nonsurgical management of complicated appendicitis supports the recently implemented strategy of omitting routine interval appendectomy. However, several reports have suggested an increased incidence rate of neoplasms in these patients. We aimed to identify the risk of neoplasms in the population undergoing interval appendectomy. METHODS This study retrospectively analyzed consecutive cases of appendicitis that were treated surgically between January 2014 and December 2018 at a single tertiary referral center. Patients were divided into 2 groups depending on whether they underwent immediate or interval appendectomy. Demographics and perioperative clinical and pathologic parameters were analyzed. RESULTS All 2,013 adults included in the study underwent surgical treatment because of an initial diagnosis of acute appendicitis. Of these, 5.5% (111 of 2,013) underwent interval appendectomy. Appendiceal neoplasm was identified on pathologic analysis in 36 cases (1.8%). The incidence of neoplasm in the interval group was 12.6% (14 of 111), which was significantly higher than that of the immediate group (1.2% [22 of 1,902], P < 0.001). CONCLUSION The incidence rate of neoplasms was significantly higher in patients undergoing interval appendectomy. These findings should be considered when choosing treatment options after successful nonsurgical management of complicated appendicitis.
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Affiliation(s)
- Jungtak Son
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Jun Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Ryol Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Ook Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Uk Jung
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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12
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Lin YL, Zhang J, Yan FC, Jiang X, Ma R, Yang ZR, Xu HB, Peng Z, Chen Q, Li Y. Establishment of patient-derived xenograft model of peritoneal mucinous carcinomatosis with signet ring cells and in vivo study on the efficacy and toxicity of intraperitoneal injection of 5-fluorouracil. Cancer Med 2019; 9:1104-1114. [PMID: 31814323 PMCID: PMC6997068 DOI: 10.1002/cam4.2766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/04/2019] [Accepted: 11/23/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pseudomyxoma peritonei (PMP) is an indolent malignancy and insensitive to systemic chemotherapy. The authors established patient-derived xenograft (PDX) model of PMP, and evaluated the efficacy and toxicity of intraperitoneal (i.p.) administration of 5-fluorouracil (5-FU) in this model. METHODS Human PMP sample was collected to establish subcutaneous (s.c.) and i.p. MODEL In vivo study of i.p. injection of 5-FU was performed in i.p. model, with experimental peritoneal cancer index (ePCI) score and pathological examinations for evaluating the efficacy and toxicity. RESULTS Both s.c. and i.p. models were constructed. The average passage interval of s.c. model was 44.2 ± 5.2 days, and the i.p. model was characterized by disseminated solid tumor nodules in abdominal-pelvic cavity. Both models were diagnosed as peritoneal mucinous carcinomatosis with signet ring cells (PMCA-S). Immunohistochemical characteristics was similar to human. GNAS mutation was detected in both model and patient. In the in vivo study, average ePCI of treatment group was lower than control and vehicle group (P = .004). Histopathology revealed obvious tumor necrosis in treatment group, and decreased Ki67 positive rate (P = .010). In toxicity study, 5-FU significantly influenced body weight (P = .010) and 1 animal from treatment group died on day 14. Congestive splenomegaly was observed (88.9%). Hepatotoxicity presented as acidophilic body (55.6%), cholestasis (100%), bile canaliculus hyperplasia and obstruction (22.2%), and lymphocyte accumulation (77.8%). CONCLUSIONS PDX model of PMCA-S was established successfully, and i.p. 5-FU could inhibit tumor proliferation and progression, with decreased Ki67 positive rate and ePCI score. Hepatotoxicity was the main side effect.
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Affiliation(s)
- Yu-Lin Lin
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Jue Zhang
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Feng-Cai Yan
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xi Jiang
- Department of Pathology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ru Ma
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhi-Ran Yang
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Hong-Bin Xu
- Department of Myxoma, Aerospace Central Hospital, Beijing, China
| | - Zheng Peng
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
| | | | - Yan Li
- Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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13
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Fonseca C, Carvalho S, Cunha TM, Gil RT, Abecasis N. The many faces of pseudomyxoma peritonei: a radiological review based on 30 cases. Radiol Bras 2019; 52:372-377. [PMID: 32047330 PMCID: PMC7007062 DOI: 10.1590/0100-3984.2019.0044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: To determine the most common imaging features of pseudomyxoma peritonei (PMP), as well as the histologic subtypes of the primary tumors. Materials and Methods: We reviewed 30 cases of women with pathologically confirmed PMP. Only computed tomography scans were available. All cases were retrospectively studied by four radiologists, working independently. We identified the most common imaging findings, the predominant primary site of the disease, and the growth pattern. The most common sites of recurrence were also analyzed. Results: The most common computed tomography finding was peritoneal/omental nodules (including “omental caking”), followed by visceral scalloping and non-mucinous ascites. The most common site of the primary tumor was the appendix (in 63.3%), followed by the ovaries (in 16.6%), and 16.6% of the tumors were of undetermined origin. There was one case of synchronous appendiceal and ovarian tumors. Low-grade mucinous neoplasm was the most common histologic subtype, accounting for 84.2% of the appendiceal tumors and 40% of the ovarian tumors. Conclusion: Although PMP is a relatively rare entity, radiologists must be aware of its possible imaging findings, common locations, and possible patterns of recurrence. The origin of the primary tumor should also be investigated. Future studies are needed in order to determine which preoperative imaging findings predict surgical outcomes and to characterize the main findings of radiological recurrence.
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Affiliation(s)
- Cássia Fonseca
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Saulo Carvalho
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | | | - Rui Tiago Gil
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Nuno Abecasis
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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14
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Raimondi A, Corallo S, Niger M, Antista M, Randon G, Morano F, Milione M, Kusamura S, Baratti D, Guaglio M, Cremolini C, Marmorino F, Di Bartolomeo M, Deraco M, De Braud F, Pietrantonio F. Metronomic Capecitabine With Cyclophosphamide Regimen in Unresectable or Relapsed Pseudomyxoma Peritonei. Clin Colorectal Cancer 2019; 18:e179-e190. [DOI: 10.1016/j.clcc.2019.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/09/2019] [Accepted: 03/25/2019] [Indexed: 12/22/2022]
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15
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Ning S, Yang Y, Wang C, Luo F. Pseudomyxoma peritonei induced by low-grade appendiceal mucinous neoplasm accompanied by rectal cancer: a case report and literature review. BMC Surg 2019; 19:42. [PMID: 31023277 PMCID: PMC6485155 DOI: 10.1186/s12893-019-0508-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 04/09/2019] [Indexed: 11/25/2022] Open
Abstract
Background Pseudomyxoma peritonei (PMP) is a disease involving the peritoneum characterized by the production of large quantities of mucinous ascites. PMP has a low incidence, is difficult to diagnose, and has a guarded prognosis. PMP induced by low-grade appendiceal mucinous neoplasm is extremely rare, and PMP accompanied by rectal cancer is even rarer. Case presentation We present a unique case of a 70-year-old male with PMP induced by low-grade appendiceal mucinous neoplasm accompanied by rectal cancer. The patient’s clinical, surgical, and histologic data were reviewed. The patient had persistent distended abdominal pain without radiating lower back pain, abdominal distension for 1 month, and no exhaustion or defecation for 4 days. A transabdominal ultrasound-guided biopsy was performed on the first day. The patient received an emergency exploratory laparotomy because of increased abdominal pressure. We performed cytoreductive surgery, enterolysis, intestinal decompression, special tumour treatment and radical resection of rectal carcinoma. The postoperative course was uneventful. The postoperative histological diagnoses were PMP, low-grade appendiceal mucinous neoplasm and rectal medium differentiated adenocarcinoma. At the 1-year follow-up visit, no tumour recurrence was observed by computed tomography (CT). We also performed a literature review. Conclusions We should be aware that PMP can rarely be accompanied by rectal cancer, which represents an easily missed diagnosis and increases the difficulty of diagnosis and treatment. Additionally, there are some typical characteristics of PMP with respect to diagnosis and treatment.
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Affiliation(s)
- Shili Ning
- Department of General Surgery, The Second Hospital of Dalian Medical University, Zhongshan Road, Shahekou District, Dalian City, Liaoning Province, People's Republic of China, 116023
| | - Yanliang Yang
- Department of General Surgery, The Second Hospital of Dalian Medical University, Zhongshan Road, Shahekou District, Dalian City, Liaoning Province, People's Republic of China, 116023
| | - Chen Wang
- Department of General Surgery, The Second Hospital of Dalian Medical University, Zhongshan Road, Shahekou District, Dalian City, Liaoning Province, People's Republic of China, 116023
| | - Fuwen Luo
- Department of General Surgery, The Second Hospital of Dalian Medical University, Zhongshan Road, Shahekou District, Dalian City, Liaoning Province, People's Republic of China, 116023.
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16
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Mascianà G, Capolupo GT, Carannante F, Caricato M. An omental mass. Any idea? Int J Surg Case Rep 2019; 56:40-44. [PMID: 30831506 PMCID: PMC6403098 DOI: 10.1016/j.ijscr.2019.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/06/2019] [Accepted: 02/08/2019] [Indexed: 11/26/2022] Open
Abstract
Pseudomyxoma peritonei, omental mass, review, abdominal pain, mucinous mass.
Introduction Pseudomyxoma extraperitonei (PE) is a rare finding. The most common cause is the rupture of a mucocele of the appendix into the retroperitoneum. Presentation of case Here we report a case of a 52 years old female patient with a mass in the right abdomen and vague lower abdominal pain underwent resection of a extraperitoneal encapsulated mass. The histopathological examination revealed a mucinous pseudomyxoma with a low grade of differentiation. Discussion We report a case of pseudomyxoma extraperitonei with a review of literature. Conclusion The treatment of pseudomyxoma differs substantially depending on whether it is intraperitoneal or extraperitoneal. The risk of recurrence is such that follow-up, based on a physical examination, CT scan and serum markers, is essential.
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Affiliation(s)
- G Mascianà
- Department of Geriatric Surgery, University Campus Bio-Medico, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - G T Capolupo
- Department of Geriatric Surgery, University Campus Bio-Medico, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - F Carannante
- Department of Geriatric Surgery, University Campus Bio-Medico, Via Alvaro del Portillo 21, 00128 Rome, Italy.
| | - M Caricato
- Department of Geriatric Surgery, University Campus Bio-Medico, Via Alvaro del Portillo 21, 00128 Rome, Italy
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17
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Dolapsakis C, Panagopoulos A. A jelly belly: An unusual cause of ascites. Eur J Intern Med 2019; 61:e5-e6. [PMID: 30017558 DOI: 10.1016/j.ejim.2018.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/07/2018] [Indexed: 12/01/2022]
Affiliation(s)
| | - Andreas Panagopoulos
- Evangelismos General Hospital, 3rd Department of Internal Medicine, Athens, Greece
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18
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Pantiora EV, Massaras D, Koutalas J, Melemeni A, Fragulidis GP. Pseudomyxoma Peritonei: Presentation of Two Cases and Challenging Issues in the Literature. Cureus 2018; 10:e3732. [PMID: 30800542 PMCID: PMC6384033 DOI: 10.7759/cureus.3732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pseudomyxoma peritonei (PMP) is a rather uncommon syndrome in oncology with a unique biological behavior and an estimated incidence of one to two cases per million per year. Clinically, it usually presents with a variety of unspecific signs and symptoms including abdominal pain and distention, ascites, or even bowel obstruction. Despite its intimidating clinical manifestation, PMP is characterized by satisfactory survival rates when treated with cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC). We present two interesting cases of PMP deriving from the appendix with a rather atypical presentation, which was successfully treated with cytoreduction and HIPEC. In addition, we intend to raise clinical suspicion on the diagnosis of PMP and comment on several challenging issues concerning the origin and classification of PMP.
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Affiliation(s)
- Eirini V Pantiora
- Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Dimitrios Massaras
- Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - John Koutalas
- Anesthesiology, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Aikaterini Melemeni
- Anesthesiology, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Georgios P Fragulidis
- Surgery, Aretaieio Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
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19
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Pasquali S, Sommariva A, Mahteme H, Suo T, Ma H, Tropea S, Steenberg JL, Mocellin S. Cytoreductive surgery alone or combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for pseudomyxoma peritonei. Hippokratia 2018. [DOI: 10.1002/14651858.cd005659.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sandro Pasquali
- Fondazione IRCCS Istituto Nazionale dei Tumori; Sarcoma Service; Via G. Venezian 1 Milano Italy 20133
| | - Antonio Sommariva
- Istituto Oncologico Veneto, IOV-IRCCS; Surgical Oncology Unit; Via Gattamelata 64 Padova Veneto Italy 35128
| | - Haile Mahteme
- Uppsala Cancer Clinic; Uppsala Cancer Clinic; Box 833 Uppsala Sweden 75108
| | - Tao Suo
- Zhongshan Hospital, Fudan University; Department of General Surgery, Institute of General Surgery; 180 Fenglin Road, Xuhui District Shanghai Shanghai China 200032
| | - Huaixing Ma
- Anhui Provincial Cancer Hospital, the First Affiliated Hospital of University of Science and Technology of China (The Western Area); Department of Medical Oncology; Hefei Anhui China
| | - Saveria Tropea
- Istituto Oncologico Veneto, IOV-IRCCS; Surgical Oncology Unit; Via Gattamelata 64 Padova Veneto Italy 35128
| | - Josephine L Steenberg
- Bispebjerg Hospital, Region H; Cochrane Colorectal Cancer Group; Bispebjerg Bakke 23 Building 39N Copenhagen NV Denmark 2400
| | - Simone Mocellin
- Istituto Oncologico Veneto, IOV-IRCCS; Surgical Oncology Unit; Via Gattamelata 64 Padova Veneto Italy 35128
- University of Padova; Department of Surgery Oncology and Gastroenterology; Padova Veneto Italy 35128
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20
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Pasquali S, Sommariva A, Mahteme H, Suo T, Ma H, Tropea S, Steenberg JL, Mocellin S. Cytoreductive surgery alone or combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for pseudomyxoma peritonei. Hippokratia 2018. [DOI: 10.1002/14651858.cd005659.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Sandro Pasquali
- Fondazione IRCCS Istituto Nazionale dei Tumori; Sarcoma Service; Via G. Venezian 1 Milano Italy 20133
| | - Antonio Sommariva
- Istituto Oncologico Veneto, IOV-IRCCS; Surgical Oncology Unit; Via Gattamelata 64 Padova Veneto Italy 35128
| | - Haile Mahteme
- Uppsala Cancer Clinic; Uppsala Cancer Clinic; Box 833 Uppsala Sweden 75108
| | - Tao Suo
- Zhongshan Hospital, Fudan University; Department of General Surgery, Institute of General Surgery; 180 Fenglin Road, Xuhui District Shanghai Shanghai China 200032
| | - Huaixing Ma
- Anhui Provincial Cancer Hospital, the First Affiliated Hospital of University of Science and Technology of China (The Western Area); Department of Medical Oncology; Hefei Anhui China
| | - Saveria Tropea
- Istituto Oncologico Veneto, IOV-IRCCS; Surgical Oncology Unit; Via Gattamelata 64 Padova Veneto Italy 35128
| | - Josephine L Steenberg
- Bispebjerg Hospital, Region H; Cochrane Colorectal Cancer Group; Bispebjerg Bakke 23 Building 39N Copenhagen NV Denmark 2400
| | - Simone Mocellin
- Istituto Oncologico Veneto, IOV-IRCCS; Surgical Oncology Unit; Via Gattamelata 64 Padova Veneto Italy 35128
- IOV-IRCCS; Istituto Oncologico Veneto; Padova Italy 35100
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21
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Rana AKS, Agarwal N, Dutta S, Dokania MK, Goyal H. A Modified Low-Cost Technique of Cytoreductive Surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Two Patients: a Solution for Pseudomyxoma Peritonei in the Indian Scenario? J Gastrointest Cancer 2018; 50:983-990. [PMID: 30140971 DOI: 10.1007/s12029-018-0161-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Anil Kumar Singh Rana
- Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Baba Kharak Singh Marg, Delhi, 110001, India
| | - Nitin Agarwal
- Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Baba Kharak Singh Marg, Delhi, 110001, India.
| | - Sushant Dutta
- Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Baba Kharak Singh Marg, Delhi, 110001, India
| | - Manoj Kumar Dokania
- Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Baba Kharak Singh Marg, Delhi, 110001, India
| | - Himank Goyal
- Department of Surgery, Renal Transplant Unit, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr. Ram Manohar Lohia Hospital (RMLH), Baba Kharak Singh Marg, Delhi, 110001, India
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22
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Kwakman R, Schrama AM, van Olmen JP, Otten RH, de Lange-de Klerk ES, de Cuba EM, Kazemier G, Te Velde EA. Clinicopathological Parameters in Patient Selection for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Colorectal Cancer Metastases: A Meta-analysis. Ann Surg 2017; 263:1102-11. [PMID: 26756756 DOI: 10.1097/sla.0000000000001593] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To improve patient selection for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) by evaluating various preoperatively assessable clinicopathological parameters as markers for survival after CRS and HIPEC. SUMMARY BACKGROUND DATA Peritoneal metastases (PMs) originating from colorectal cancer are treated with CRS and HIPEC. Despite increasing survival, high morbidity and mortality warrant selection of patients with optimal benefit from this treatment. Many studies report a number of variables to be associated with survival after CRS and HIPEC, but no definitive analysis has been made to validate various markers. METHODS In concordance with PRISMA guidelines, we performed a literature search encompassing 4110 articles to select 50 articles that reported the influence of 1 or more clinicopathological variables on overall survival after CRS and HIPEC. In absence of RCTs, 25 cohort studies could be used to perform a meta-analysis on 10 prognostic variables. RESULTS We determined that concurrent liver metastasis, lymph node metastasis, Eastern Cooperative Oncology Group score, tumor differentiation, and signet ring cell histology are all negative prognostic variables on overall survival after CRS and HIPEC. Conversely, sex and location of primary could not be validated as prognostic markers. More research is required to make definitive conclusions about neoadjuvant chemotherapy, onset of PMs, and mucinous histology. CONCLUSIONS Current clinical practice, which selects patients based on extraperitoneal metastasis, lymph node stage, performance status, and tumor histology, is validated by our pooled analysis. Our data merit further research into neoadjuvant chemotherapy in the setting of CRS and HIPEC for PMs.
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Affiliation(s)
- Riom Kwakman
- *Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands†Medical Library, VU University, Amsterdam, The Netherlands‡Department of Biomedical Statistics, VU University Medical Center, Amsterdam, The Netherlands§Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands
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Järvinen P, Kivelä AJ, Nummela P, Lepistö A, Ristimäki A, Parkkila S. Carbonic anhydrase II: a novel biomarker for pseudomyxoma peritonei. APMIS 2017; 125:207-212. [PMID: 28233447 DOI: 10.1111/apm.12653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 11/21/2016] [Indexed: 01/12/2023]
Abstract
Altered expression of carbonic anhydrase (CA) II is associated with human carcinogenesis. We analysed CA II protein expression in 89 patients with pseudomyxoma peritonei (PMP) and correlated its association against survival. We determined the expression of CA II by immunohistochemistry and then scored the staining results. The correlations of CA II expression with Peritoneal Cancer Index (PCI) and tumour grade were examined. The effect of CA II and tumour grade on survival was investigated. Positive CA II expression was found in 58 patients (65%) and absent in 31 patients (35%). High-grade (HG) morphology was associated with a loss of CA II expression (p = 0.048). The mean CA II immunostaining intensity score was 1.00 ± 1.1 (median 1, range 0-3) for HG morphology and 1.54 ± 1.1 (median 2, range 0-3) for low-grade (LG) morphology. The 5-year overall survival (OS) for those patients with CA II expression was 80% and 59% for those without (p < 0.001). The 5-year OS rates for those patients with HG morphology and positive CA II expression was 72% and 31% for those with negative CA II expression (p = 0.044). This study suggests that the expression of CA II acts as independent prognostic biomarker for survival in PMP.
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Affiliation(s)
- Petrus Järvinen
- Department of Urology, Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Antti J Kivelä
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of GI Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Pirjo Nummela
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Research Programs Unit, Department of Pathology, Helsinki University Hospital, Helsinki, Finland
| | - Anna Lepistö
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Department of Colorectal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Ari Ristimäki
- Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Research Programs Unit, Department of Pathology, Helsinki University Hospital, Helsinki, Finland.,Department of Pathology at HUSLAB Laboratory Services, Helsinki University Hospital, Helsinki, Finland
| | - Seppo Parkkila
- Fimlab Ltd, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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Delhorme JB, Honoré C, Benhaim L, Dumont F, Dartigues P, Dromain C, Ducreux M, Elias D, Goéré D. Long-term survival after aggressive treatment of relapsed serosal or distant pseudomyxoma peritonei. Eur J Surg Oncol 2017; 43:159-167. [DOI: 10.1016/j.ejso.2016.08.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/19/2016] [Accepted: 08/18/2016] [Indexed: 01/16/2023] Open
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25
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Repeat cytoreductive surgery with or without perioperative intraperitoneal chemotherapy for peritoneal surface malignancy. Am J Surg 2016; 213:1024-1030. [PMID: 27839689 DOI: 10.1016/j.amjsurg.2016.09.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 09/25/2016] [Accepted: 09/29/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND A significant proportion of patients with peritoneal surface malignancy (PSM) experienced recurrence after initial cytoreductive surgery (CRS). Thus the aims of this study were to determine short-term outcomes and long-term survivals associated with repeat CRS. METHODS This was a retrospective study of prospectively collected data of consecutive patients with PSM who underwent CRS by one surgical team at St George Hospital in Sydney, Australia between Jan 1996 and May 2016. RESULTS There was no significant difference in hospital mortality (p=0.343) and major morbidity rate (p=0.454). Patients who underwent repeat surgery had a significantly higher 5-year overall survival (OS) rate (p<0.001) and a longer median disease free interval (DFS) (p<0.001). Repeat CRS was also found to be a significant prognostic factor for OS (p<0.001) and DFS (p<0.001). CONCLUSIONS Repeat CRS with or without perioperative intraperitoneal chemotherapy could provide long-term survival benefits to patients with PSM with acceptable mortality and morbidity rates. SUMMARY 1. Repeat CRS with or without PIC provides long-term survival benefits to patients with PSM. 2. Repeat CRS with or without PIC is feasible and can be performed without acceptable mortality and morbidity rates.
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Medlin EE, Flanagan C, Zavala K, Rose S. Endometriosis inflammation mimicking pseudomyxoma peritonei: A case report. Case Rep Womens Health 2016; 12:3-4. [PMID: 29629301 PMCID: PMC5885992 DOI: 10.1016/j.crwh.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/24/2016] [Indexed: 11/23/2022] Open
Abstract
Endometriosis may mimic other pathologic processes Fertility preservation can be considered in young women with atypical endometriosis Referral to experienced surgeons for maligancy is warranted in atypical endometriosis.
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Ramaswamy V. Pathology of Mucinous Appendiceal Tumors and Pseudomyxoma Peritonei. Indian J Surg Oncol 2016; 7:258-67. [PMID: 27065718 PMCID: PMC4818623 DOI: 10.1007/s13193-016-0516-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/02/2016] [Indexed: 02/07/2023] Open
Abstract
Neoplasms of the appendix are rare, but because of their unusual presentation and unpredictable biologic behavior, it is important to diagnose them correctly. Mucinous tumors account for 58 % of malignant tumors of appendix in SEER database and the remaining are carcinoids. The mucinous appendiceal tumors have a potential to spread to the peritoneum and viscera in the form of gelatinous material with or without neoplastic cells resulting in Pseudomyxoma peritonei. (PMP) PMP is a clinical entity that has a unique biological behavior and can arise from seemingly benign tumors to frankly malignant ones. Several classifications exist for PMP of which Ronnet's classification has been the most popular. In 2010, the WHO proposed a 2 tier classification that classified PMP as either low grade or high grade based on the presence of mucin, cytological and architectural features. According to this classification when the underlying cause for PMP is an appendiceal tumor it is always a mucinous adenocarcinoma rather than a mucocoele or adenoma and these terms should no longer be used. This system of classification helps in predicting the behavior of the tumor and proper treatment strategies. The understanding of the pathogenesis of the disease has also improved with identification of newer biomarkers and molecular genetic alterations. IHC markers CK 20, CDX2 and MUC2 are found to be positive in these tumors in addition to KRAS mutation and loss of heterozygosity in some gene loci. Proper histopathologic classification and predicting the tumor behavior requires a close interaction between the pathologist and the surgeon. The use of the combined modality treatment of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has led to a 5-year survival ranging from 62.5 % to 100 % for low grade, and 0 %-65 % for high grade disease. This article focuses on the etiopathogenesis, clinical behavior, diagnosis and classification of mucinous tumors of the appendix and pseudomyxoma peritonei.
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Affiliation(s)
- Veena Ramaswamy
- SRL LAB, Fortis Hospital, No 154/9, Opposite IIM-B, Bannerghatta Road, Bangalore, 560076 India
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Jung TS, Hong JU, Park SH, Lee HJ, Min IS, Lee JY, Seock CH. Pseudomyxoma Peritonei in a Patient with History of Breast Cancer. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2016; 67:153-7. [PMID: 26996187 DOI: 10.4166/kjg.2016.67.3.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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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Affiliation(s)
- Tae Seob Jung
- Department of Internal Medicine, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
| | - Jung Un Hong
- Department of Internal Medicine, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
| | - Shin Hee Park
- Department of Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
| | - Hee Jeong Lee
- Department of Pathology, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
| | - In Sun Min
- Department of Internal Medicine, Sungae Hospital, Seoul, Korea
| | - Ju Young Lee
- Department of Internal Medicine, Sungae Hospital, Seoul, Korea
| | - Chang Hyeon Seock
- Department of Internal Medicine, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea
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Marques S, Carmo J, Bispo M, Chagas C. Gelatinous Ascites: A Characteristic Finding of a Rare Entity. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2016; 23:54-55. [PMID: 28868432 PMCID: PMC5579985 DOI: 10.1016/j.jpge.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 07/03/2015] [Indexed: 06/07/2023]
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Chen YN, Lee JJ, Cheng SP, Tsai CH. Transformation of low-grade mucinous neoplasm of the appendix with pseudomyxoma peritonei to high-grade sarcomatoid carcinoma. J Clin Med Res 2015; 7:571-4. [PMID: 26015826 PMCID: PMC4432903 DOI: 10.14740/jocmr2178w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 12/04/2022] Open
Abstract
A 66-year-old man initially underwent appendectomy and cytoreductive surgery for a low-grade appendiceal mucinous neoplasm with pseudomyxoma peritonei. One and a half years later, multiple disseminated lesions developed in rectus abdominis muscle and peritoneal cavity. Biopsy showed histopathological transformation to sarcomatoid carcinoma. This case illustrates that evolution of low-grade pseudomyxoma peritonei to high-grade carcinoma truly develops in some patients. The development of this dedifferentiation appears associated with aggressive behavior and poor clinical outcome.
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Affiliation(s)
- Yu-Nung Chen
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Jie-Jen Lee
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan ; Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Shih-Ping Cheng
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan
| | - Chung-Hsin Tsai
- Department of Surgery, MacKay Memorial Hospital and Mackay Medical College, Taipei, Taiwan ; Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
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Järvinen P, Ristimäki A, Kantonen J, Lepistö A. Feasibility of radical cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for pseudomyxoma peritonei of appendiceal origin. Scand J Surg 2015; 102:145-51. [PMID: 23963027 DOI: 10.1177/1457496913490463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIMS We analyzed the feasibility of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with pseudomyxoma peritonei. MATERIAL AND METHODS A prospective database comprised 90 consecutive patients with demonstrable pseudomyxoma peritonei collected during 48 months. These patients, referred to our unit for consideration for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, received both cytoreductive surgery and hyperthermic intraperitoneal chemotherapy if possible. We evaluated the factors associated with a successful procedure. RESULTS Hyperthermic intraperitoneal chemotherapy was successfully delivered to 56 of 90 patients (62%) with demonstrable pseudomyxoma peritonei. Tumor morphology of low grade (p = 0.013), age under 65 years (p = 0.004), and serum carcinoembryonic antigen level under 5.0 µg/L (p = 0.003) were associated with successful administration of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Mean peritoneal cancer index was lower (18.9 vs 32.6, p < 0.001) and age was younger (54.3 vs 61.6, p = 0.003) in patients who underwent hyperthermic intraperitoneal chemotherapy than in patients who did not. Four patients had complete cytoreductive surgery alone, and 20 patients underwent palliative debulking, but 10 were ineligible for this operation. CONCLUSIONS Although the combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy is currently suggested the standard practice for pseudomyxoma peritonei, not all patients are eligible for this protocol. In this study, hyperthermic intraperitoneal chemotherapy was suitable for 62% of patients with pseudomyxoma peritonei of appendiceal origin.
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Affiliation(s)
- P Järvinen
- Department of Surgery, Kanta-Häme Central Hospital, Hämeenlinna, Finland
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Amini A, Masoumi-Moghaddam S, Morris DL. Pseudomyxoma peritonei: current chemotherapy and the need for mucin-directed strategies. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1006627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wright GP, Mater ME, Carroll JT, Choy JS, Chung MH. Is there truly an oncologic indication for interval appendectomy? Am J Surg 2014; 209:442-6. [PMID: 25543294 DOI: 10.1016/j.amjsurg.2014.09.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/29/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The rate of recurrent appendicitis is low following nonoperative management of complicated appendicitis. However, recent data suggest an increased rate of neoplasms in these cases. METHODS The study was a retrospective review of patients with acute appendicitis at 2 university-affiliated community hospitals over a 12-year period. The primary outcome measure was the incidence of appendiceal neoplasm following interval appendectomy. RESULTS Six thousand thirty-eight patients presented with acute appendicitis. Appendectomy was performed in 5,851 (97%) patients at the index admission. Of the 188 patients treated with initial nonoperative management, 89 (47%) underwent interval appendectomy. Appendiceal neoplasms were identified in 11 of the 89 (12%) patients. These included mucinous neoplasms (n = 6), carcinoid tumors (n = 4), and adenocarcinoma (n = 1). The rate of neoplasm in patients over age 40 was 16%. CONCLUSIONS There is a significant rate of neoplasms identified in patient over age 40 undergoing interval appendectomy. This should be considered following nonoperative management of complicated appendicitis.
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Affiliation(s)
- Gerald Paul Wright
- Grand Rapids Medical Education Partners, General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Department of Surgery, Grand Rapids, MI, USA.
| | - Megan E Mater
- Grand Rapids Medical Education Partners, General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Department of Surgery, Grand Rapids, MI, USA
| | - Joseph T Carroll
- Grand Rapids Medical Education Partners, General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Department of Surgery, Grand Rapids, MI, USA
| | - Jennifer S Choy
- Michigan State University College of Human Medicine, Department of Surgery, Grand Rapids, MI, USA
| | - Mathew H Chung
- Grand Rapids Medical Education Partners, General Surgery Residency Program, Grand Rapids, MI, USA; Michigan State University College of Human Medicine, Department of Surgery, Grand Rapids, MI, USA; Spectrum Health Medical Group, Division of Surgical Specialties, Grand Rapids, MI, USA
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Testerman TL, Morris J. Beyond the stomach: An updated view of Helicobacter pylori pathogenesis, diagnosis, and treatment. World J Gastroenterol 2014; 20:12781-12808. [PMID: 25278678 PMCID: PMC4177463 DOI: 10.3748/wjg.v20.i36.12781] [Citation(s) in RCA: 195] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/17/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023] Open
Abstract
Helicobacter pylori (H. pylori) is an extremely common, yet underappreciated, pathogen that is able to alter host physiology and subvert the host immune response, allowing it to persist for the life of the host. H. pylori is the primary cause of peptic ulcers and gastric cancer. In the United States, the annual cost associated with peptic ulcer disease is estimated to be $6 billion and gastric cancer kills over 700000 people per year globally. The prevalence of H. pylori infection remains high (> 50%) in much of the world, although the infection rates are dropping in some developed nations. The drop in H. pylori prevalence could be a double-edged sword, reducing the incidence of gastric diseases while increasing the risk of allergies and esophageal diseases. The list of diseases potentially caused by H. pylori continues to grow; however, mechanistic explanations of how H. pylori could contribute to extragastric diseases lag far behind clinical studies. A number of host factors and H. pylori virulence factors act in concert to determine which individuals are at the highest risk of disease. These include bacterial cytotoxins and polymorphisms in host genes responsible for directing the immune response. This review discusses the latest advances in H. pylori pathogenesis, diagnosis, and treatment. Up-to-date information on correlations between H. pylori and extragastric diseases is also provided.
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Comparison of serial debulking and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy in pseudomyxoma peritonei of appendiceal origin. Int J Colorectal Dis 2014; 29:999-1007. [PMID: 24965858 DOI: 10.1007/s00384-014-1933-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE Patients with pseudomyxoma peritonei (PMP) benefit from cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Reports on this modality usually have included only patients with successful HIPEC treatment, which can potentially cause biased results. We report the survival of a PMP population treated by CRS and HIPEC, including patients who were not eligible for HIPEC. METHODS The outcome of the whole population of 87 patients with PMP treated by CRS and HIPEC in Helsinki University Central Hospital between 2008 and 2011 was evaluated. The results of treatment were compared with 33 patients treated by serial debulking in our unit between 1984 and 2008. RESULTS Of the 87 patients in the HIPEC-era group, 56 received HIPEC, 12 were treated non-radically in an attempt at HIPEC, 9 were debulked and 10 were referred back or transferred to palliative care without surgery. The 5-year overall survival for the debulking-era group and the HIPEC-era group were 67 and 69 %, respectively. The number of patients with no evidence of disease was higher in the HIPEC-era group (47/87) than that in the debulking-era group (8/33) at the end of the follow-up. Overall survival for patients who underwent successful CRS and HIPEC at 2 and 5 years was 95 and 93 %, respectively. CONCLUSIONS The improved survival from using the CRS and HIPEC was not apparent after 5-year follow-up, when the whole patient population was included in the analysis. Even so, patients successfully treated by CRS and HIPEC manage well.
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Amini A, Masoumi-Moghaddam S, Ehteda A, Morris DL. Secreted mucins in pseudomyxoma peritonei: pathophysiological significance and potential therapeutic prospects. Orphanet J Rare Dis 2014; 9:71. [PMID: 24886459 PMCID: PMC4013295 DOI: 10.1186/1750-1172-9-71] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 04/22/2014] [Indexed: 12/22/2022] Open
Abstract
Pseudomyxoma peritonei (PMP, ORPHA26790) is a clinical syndrome characterized by progressive dissemination of mucinous tumors and mucinous ascites in the abdomen and pelvis. PMP is a rare disease with an estimated incidence of 1-2 out of a million. Clinically, PMP usually presents with a variety of unspecific signs and symptoms, including abdominal pain and distention, ascites or even bowel obstruction. It is also diagnosed incidentally at surgical or non-surgical investigations of the abdominopelvic viscera. PMP is a neoplastic disease originating from a primary mucinous tumor of the appendix with a distinctive pattern of the peritoneal spread. Computed tomography and histopathology are the most reliable diagnostic modalities. The differential diagnosis of the disease includes secondary peritoneal carcinomatoses and some rare peritoneal conditions. Optimal elimination of mucin and the mucin-secreting tumor comprises the current standard of care for PMP offered in specialized centers as visceral resections and peritonectomy combined with intraperitoneal chemotherapy. This multidisciplinary approach has reportedly provided a median survival rate of 16.3 years, a median progression-free survival rate of 8.2 years and 10- and 15-year survival rates of 63% and 59%, respectively. Despite its indolent, bland nature as a neoplasm, PMP is a debilitating condition that severely impacts quality of life. It tends to be diagnosed at advanced stages and frequently recurs after treatment. Being ignored in research, however, PMP remains a challenging, enigmatic entity. Clinicopathological features of the PMP syndrome and its morbid complications closely correspond with the multifocal distribution of the secreted mucin collections and mucin-secreting implants. Novel strategies are thus required to facilitate macroscopic, as well as microscopic, elimination of mucin and its source as the key components of the disease. In this regard, MUC2, MUC5AC and MUC5B have been found as the secreted mucins of relevance in PMP. Development of mucin-targeted therapies could be a promising avenue for future research which is addressed in this article.
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Affiliation(s)
- Afshin Amini
- Department of Surgery, St George Hospital, The University of New South Wales, Level 3, Clinical Sciences (WR Pitney) Building, Gray Street, Kogarah, Sydney, NSW 2217, Australia
| | - Samar Masoumi-Moghaddam
- Department of Surgery, St George Hospital, The University of New South Wales, Level 3, Clinical Sciences (WR Pitney) Building, Gray Street, Kogarah, Sydney, NSW 2217, Australia
| | - Anahid Ehteda
- Department of Surgery, St George Hospital, The University of New South Wales, Level 3, Clinical Sciences (WR Pitney) Building, Gray Street, Kogarah, Sydney, NSW 2217, Australia
| | - David Lawson Morris
- Department of Surgery, St George Hospital, The University of New South Wales, Level 3, Clinical Sciences (WR Pitney) Building, Gray Street, Kogarah, Sydney, NSW 2217, Australia
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Baleato-González S, García-Figueiras R, Trujillo-Ariza MV, Carrera-Álvarez JJ. Malignant glomus tumor of the peritoneum: case report. Korean J Radiol 2014; 15:61-5. [PMID: 24497793 PMCID: PMC3909863 DOI: 10.3348/kjr.2014.15.1.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 10/10/2013] [Indexed: 11/25/2022] Open
Abstract
Glomus tumors are usually benign tumors that occur in the skin and soft tissues of the extremities. Visceral locations, such as stomach, intestines or lung, are extremely rare because glomus bodies are rare or absent in these organs. This report describes our experience in a 47-year-old woman diagnosed with a peritoneal malignant glomus tumor. This finding has not been previously reported.
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Affiliation(s)
- Sandra Baleato-González
- Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela, Choupana s/n, 15701 Santiago de Compostela (A Coruña), Spain
| | - Roberto García-Figueiras
- Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela, Choupana s/n, 15701 Santiago de Compostela (A Coruña), Spain
| | - Maria Virginia Trujillo-Ariza
- Department of Radiology, Complexo Hospitalario Universitario de Santiago de Compostela, Choupana s/n, 15701 Santiago de Compostela (A Coruña), Spain
| | - Juan Jose Carrera-Álvarez
- Department of Pathology, Complexo Hospitalario Universitario de Santiago de Compostela, Choupana s/n, 15701 Santiago de Compostela (A Coruña), Spain
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Whole abdominopelvic radiotherapy in the palliative treatment of pseudomyxoma peritonei. Strahlenther Onkol 2013; 190:223-8. [PMID: 24306063 DOI: 10.1007/s00066-013-0470-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 09/16/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pseudomyxoma peritonei (PMP) is a rare clinical syndrome characterized by mucinous peritoneal disease arising from disseminated peritoneal adenomucinosis. Primary treatment involves a combination of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). There is no consensus on the proper treatment of recurrent PMP. In selected patients, repeated cytoreductive surgery with or without HIPEC might improve outcome. However, every repeated debulking procedure becomes less effective with increased morbidity. CASE REPORT We present a case of a patient with intestinal obstruction caused by recurrent pseudomyxoma peritonei. We treated the patient with whole abdominopelvic radiotherapy (WAPRT) using intensity-modulated arc therapy (IMAT) to a total dose of 33 Gy, delivered in 22 daily fractions. The treatment was well tolerated and resulted in resolution of the obstruction for a period of 24 months. CONCLUSION To the best of our knowledge, we present the first case report showing the possibility of resolving intestinal obstruction with WAPRT in a patient with recurrent PMP. It is our opinion that WAPRT delivered by IMAT, in analogy with ovarian cancer, should be considered as a palliative treatment option in managing patients with recurrent PMP especially in case of obstruction.
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van den Heuvel MGW, Lemmens VEPP, Verhoeven RHA, de Hingh IHJT. The incidence of mucinous appendiceal malignancies: a population-based study. Int J Colorectal Dis 2013; 28:1307-10. [PMID: 23695388 DOI: 10.1007/s00384-013-1714-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Mucinous appendiceal tumours were described already 180 years ago, but reliable data on the incidence of these tumours are sparse. The clinical importance of these tumours is increasing since they are now identified as the most common site of origin for pseudomyxoma peritonei (PMP), which is currently recognised as a treatable condition. METHODS Data on the incidence of mucinous appendiceal tumours were retrieved from the Eindhoven Cancer Registry, which collects data on all patients with newly diagnosed cancer in a large part of the southern Netherlands that comprises about 2.3 million inhabitants. From 1980 to 2010, all cases of primary adenocarcinomas of the appendix were included. RESULTS From 1980 to 2010, a mucinous adenocarcinoma was diagnosed in 78 patients being 48 % of all cases of appendiceal adenocarcinoma diagnosed during this period (n = 164). The incidence increased during the study period from 0.6 to 1.9 per 1,000,000 person-years for women and from 0.4 to 1.0 per 1,000,000 person-years for men. CONCLUSION The reported incidence of mucinous adenocarcinomas of the appendix shows an increasing trend. This is probably mainly explained by the increased awareness of this tumour and its relation with PMP, and better registration of this specific diagnosis.
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Affiliation(s)
- M G W van den Heuvel
- Department of Surgical Oncology, Catharina Hospital Eindhoven, P.O. Box 1350, 5602, ZA Eindhoven, The Netherlands
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Semino-Mora C, Testerman TL, Liu H, Whitmire JM, Studeman K, Jia Y, McAvoy TJ, Francis J, Nieroda C, Sardi A, Merrell DS, Dubois A. Antibiotic treatment decreases microbial burden associated with pseudomyxoma peritonei and affects β-catenin distribution. Clin Cancer Res 2013; 19:3966-76. [PMID: 23743566 DOI: 10.1158/1078-0432.ccr-13-0616] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE Pseudomyxoma peritonei is an understudied cancer in which an appendiceal neoplasm invades the peritoneum and forms tumor foci on abdominal organs. Previous studies have shown that bacteria reside within pseudomyxoma peritonei tumors and mucin. Thus, we sought to analyze the effect of antibiotics on bacterial density and β-catenin expression within pseudomyxoma peritonei samples. EXPERIMENTAL DESIGN The study included 48 patients: 19 with disseminated peritoneal adenomucinosis (DPAM) and 29 with peritoneal mucinous carcinomatosis (PMCA). Fourteen patients were given antibiotics (30 mg lansoprazole, 1 g amoxicillin, and 500 mg clarithromycin) twice a day for 14 days. One week after completion of therapy, surgery was conducted and specimens were harvested for pathology, bacterial culture, ISH, and immunohistochemistry. RESULTS ISH showed the presence of bacteria in 83% of the patient samples, with a higher Helicobacter pylori density observed in PMCA versus DPAM. PMCA patients treated with antibiotics had a significantly lower bacterial density and decreased β-catenin levels in the cytoplasm, the cell nuclei, and mucin-associated cells. Although not significant, similar trends were observed in DPAM patients. Cell membrane β-catenin was significantly increased in both DPAM and PMCA patients receiving antibiotics. CONCLUSIONS Bacteria play an important role in pseudomyxoma peritonei. Antibiotic treatment improved the histopathology of tissue, particularly in PMCA patients. In PMCA, antibiotics decreased bacterial density and were associated with a significant β-catenin decrease in the cytoplasm, cell nuclei, and mucin along with a small membrane increase. These results suggest that antibiotics offer potential protection against cell detachment, cellular invasion, and metastasis.
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Affiliation(s)
- Cristina Semino-Mora
- Uniformed Services University and United States Military Cancer Institute, Bethesda, Maryland 20814, USA
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Abstract
Pulmonary giant cell carcinoma is a rare subtype of sarcomatoid carcinoma. Pseudomyxoma peritonei (PMP) is a rare condition in which gelatinous material accumulates within the peritoneal cavity. It is believed PMP arises from a primary appendiceal mucinous neoplasm that perforates the gut, causing mucinous ascites. There are sporadic reports of PMP associated with neoplasms of other organs, rarely the lung. Here, we report on a 60-year-old woman with pulmonary giant cell carcinoma associated with PMP. She presented with progressive dyspnea and abdominal distention. Abdominal computed tomography revealed moderately dense ascites without an obvious mass. Chest computed tomography revealed a large, solitary right lower-lobe lung mass. She underwent transbronchial fine-needle aspiration of the mass, and was diagnosed with pulmonary giant cell carcinoma. The ascites showed scattered malignant cells in a background of mucin, confirming PMP. To our knowledge, this is the first report of pulmonary giant cell carcinoma associated with PMP.
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WANG GUOSHENG, YANG LIU, MA HAIFEN, GAO YUAN. Different medical expenses incurred by appendiceal cystadenoma in China: Report of three cases. Oncol Lett 2013; 5:1343-1346. [PMID: 23599791 PMCID: PMC3629171 DOI: 10.3892/ol.2013.1174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 01/28/2013] [Indexed: 11/06/2022] Open
Abstract
Appendiceal cystadenoma, the most common type of what has been generally termed 'mucocele' of the appendix, has unique clinical characteristics. In this study, three similar clinical manifestations of appendiceal cystadenoma are presented, with different subsequent management and diverse prognostic outcomes relating to the characteristics of the disease, the wishes of the patients, the medical workers and social factors. In this study, we provide details of three cases of appendiceal cystadenomas.
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Affiliation(s)
- GUO-SHENG WANG
- Department of Oncology, Beilun District People’s Hospital, The First Affiliated Hospital, College of Medicine, Beilun Branch of Zhejiang University, Ningbo, Zhejiang 315800;,Correspondence to: Dr Guo-Sheng Wang, Department of Oncology, The First Affiliated Hospital, Beilun Branch of Zhejiang University, College of Medicine, 1288 Lushan East Road, Ningbo, Zhejiang 315800, P.R. China, E-mail:
| | - LIU YANG
- Department of Oncology, College of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang 310009
| | - HAI-FEN MA
- Department of Pathology, Beilun District People’s Hospital, The First Affiliated Hospital, College of Medicine, Beilun Branch of Zhejiang University, Ningbo, Zhejiang 315806
| | - YUAN GAO
- Department of Surgery, Division of General Surgery, Beilun District People’s Hospital, The First Affiliated Hospital, College of Medicine, Beilun Branch of Zhejiang University, Ningbo, Zhejiang 315800,
P.R. China
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Que Y, Tao C, Wang X, Zhang Y, Chen B. Pseudomyxoma peritonei: some different sonographic findings. Abdom Radiol (NY) 2012; 37:843-8. [PMID: 22234650 DOI: 10.1007/s00261-012-9843-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of our study was to assess the sonographic features of pseudomyxoma peritonei (PMP). MATERIALS AND METHODS All records of peritoneal biopsies under the guidance of ultrasound in our institutional database from April 2007 to June 2011 were retrospectively reviewed. 19 cases of PMP and 279 cases of other peritoneal lesions were included in the study. The sonograms of peritoneum, ascites, and parenchymal organs involved by PMP were evaluated, respectively, and compared with sonograms of other peritoneal lesions. RESULTS Anechoic areas were found in 89.5% cases of PMP at high frequency of insonation and the sensitivity in indicating PMP was 100%. In the pelvic cavity, echogenic foci in ascites of PMP in 52.6% cases were mobile. The specificity of "starburst" appearance and sensitivity of scalloping of the liver margin were relatively high (82.3 and 88.1%), but the sensitivity and specificity (57.9 and 42.1%) of these two signs were relatively low. CONCLUSION Anechoic area in the thickened peritoneum was a specific sign in indicating the diagnosis of PMP and high-frequency transducer could reveal these tiny anechoic areas more explicitly. In the pelvic cavity, echogenic foci in ascites of PMP could be observed to be mobile and scalloping of the liver margin and "starburst" appearance also played a significant role in indicating PMP.
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Affiliation(s)
- Yanhong Que
- Department of Ultrasound, First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China.
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Zhong Y, Deng M, Xu R, Kokudo N, Tang W. Pseudomyxoma peritonei as an intractable disease and its preoperative assessment to help improve prognosis after surgery: A review of the literature. Intractable Rare Dis Res 2012; 1:115-21. [PMID: 25343082 PMCID: PMC4204597 DOI: 10.5582/irdr.2012.v1.3.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 07/29/2012] [Accepted: 08/01/2012] [Indexed: 01/05/2023] Open
Abstract
Pseudomyxoma peritonei (PMP) is a rare and intractable disease with an estimated incidence of one per million population per year. Many aspects of PMP need to be fully and precisely understood; these include its preoperative assessment, i.e. diagnosis, early diagnosis, pathologic classification, and staging according to the peritoneal cancer index, and its surgical treatment. This review focuses on elements of preoperative assessment and surgery using the Sugarbaker procedure to help improve the prognosis for patients with PMP. Accurate data on the incidence of PMP must be based on large populations rather than estimates, and much work needs to be done especially in China. Special attention should be paid to its preoperative assessment. Also proposed here are steps to manage PMP with an emphasis on preoperative assessment.
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Affiliation(s)
- Yuesi Zhong
- Department of Hepatobiliary Surgery, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Meihai Deng
- Department of Hepatobiliary Surgery, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ruiyun Xu
- Department of Hepatobiliary Surgery, Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Norihiro Kokudo
- Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Wei Tang
- Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Address correspondence to: Dr. Wei Tang, Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan. E-mail:
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Rohani P, Scotti SD, Shen P, Stewart JH, Russell GB, Cromer M, Levine EA. Use of FDG-PET Imaging for Patients with Disseminated Cancer of the Appendix. Am Surg 2010. [DOI: 10.1177/000313481007601217] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The goal of this study is to evaluate the use of positron emission tomography (PET) in evaluation of patients with peritoneal dissemination of carcinoma of appendiceal origin (PDA). Thirty-three patients with PDA, who had preoperative PET or PET/CT imaging, were analyzed. Using operative, pathology, and PET ± CT data, presence or absence of disease in each abdominal quadrant was noted and the use of 18fluoro-deoxy-glucose (FDG) PET for each quadrant was evaluated. The mean age was 52, and there were 17 males; 58 per cent had low-grade lesions. PET was positive in only 35 per cent of cases overall (30 and 41% sensitivity for low-grade and high-grade, respectively). PET without CT sensitivity for low-grade and high-grade lesions was 21 and 8 per cent, respectively. PET imaging has limited use for patients with PDA. We do not recommend the use of FDG-PET for patients with PDA from cancer of the appendix.
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Affiliation(s)
- Payam Rohani
- Surgical Oncology Service, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Stephen D. Scotti
- Department of Nuclear Medicine, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Perry Shen
- Surgical Oncology Service, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - John H. Stewart
- Surgical Oncology Service, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Gregory B. Russell
- Department of Public Health Sciences, Section on Biostatistics, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Mary Cromer
- Surgical Oncology Service, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Edward A. Levine
- Surgical Oncology Service, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
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Mavanur AA, Parimi V, O'Malley M, Nikiforova M, Bartlett DL, Davison JM. Establishment and characterization of a murine xenograft model of appendiceal mucinous adenocarcinoma. Int J Exp Pathol 2010; 91:357-67. [PMID: 20586814 DOI: 10.1111/j.1365-2613.2010.00721.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We describe the clinical, pathologic and molecular characteristics of a xenograft model of metastatic mucinous appendiceal adenocarcinoma. Tumours from patients with mucinous appendiceal neoplasms were implanted in nude mice and observed for evidence of intraperitoneal tumour growth. Morphologic and immunohistochemical features, temporal growth characteristics relative to controls, and loss of heterozygosity (LOH) at multiple chromosomal alleles were assessed in a successfully engrafted tumour. Two of seventeen implanted tumours successfully engrafted and only one mucinous adenocarcinoma propagated throughout the course of the study. The successful xenograft is morphologically similar to the original tumour, produces abundant extracellular mucin and exhibits non-invasive growth on peritoneal surfaces. The temporal growth characteristics of the xenograft tumour relative to controls reveal that tumour burden can be followed indirectly by measuring the weight or abdominal girth of engrafted animals. The cytokeratin, mucin core protein, CDX2, Ki-67 and p53 expression patterns are identical in the xenograft and resected tumour and are consistent with the expected pattern of protein expression for mucinous adenocarcinoma of the appendix. LOH was found in 1 of 10 informative chromosomal loci (chromosome 10p23) in xenograft tumour cells. Although we were unable to engraft a low-grade appendiceal mucinous neoplasm, the engrafted adenocarcinoma will be useful for future evaluation of novel therapeutic strategies directed at mucinous appendiceal adenocarcinoma and evaluation of strategies for treating widespread, bulky, mucinous peritoneal surface neoplasms. Xenograft tumour enrichment can facilitate molecular studies of appendiceal epithelial neoplasia.
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Affiliation(s)
- Arun A Mavanur
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Flatmark K, Davidson B, Kristian A, Stavnes HT, Førsund M, Reed W. Exploring the peritoneal surface malignancy phenotype--a pilot immunohistochemical study of human pseudomyxoma peritonei and derived animal models. Hum Pathol 2010; 41:1109-19. [PMID: 20338618 DOI: 10.1016/j.humpath.2009.12.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 12/17/2009] [Accepted: 12/29/2009] [Indexed: 11/26/2022]
Abstract
Peritoneal surface malignancies are characterized by the propensity for tumor growth on peritoneal surfaces without development of extraperitoneal metastases, but the molecular basis for this phenomenon is incompletely understood. Five human tumors and corresponding orthotopic animal models of human pseudomyxoma peritonei and peritoneal mucinous carcinomatosis from colorectal carcinoma were extensively characterized by immunohistochemical analysis of molecular markers of tissue differentiation (carcinoembryonal antigen, CK20, CK7, and vimentin), proliferation and metastasis (Ki-67, vascular endothelial growth factor, and S100A4), mucins (MUC1, MUC2, MUC4, MUC5AC), and adhesion molecules (E-cadherin, N-cadherin, P-cadherin, claudin 1, claudin 3, and claudin 4). Macro- and microscopic growth patterns of implanted human tissues were preserved through passages in the animals, as were with few exception immunohistochemical staining profiles, supporting the relevance of the models as tools for studying the human disease. Tissue differentiation marker expression was in accordance with previously published results and high Ki-67 score confirmed high proliferative capacity, whereas absence of metastatic capacity was supported by low expression levels of the studied metastasis markers. These mucinous tumors expressed high levels of MUC2 and MUC4, whereas MUC1 was not expressed and MUC5AC expression was variable. Similarly, specific adhesion molecules from the cadherin and claudin families were shown to be of relevance in the investigated samples. The results indicate that mucinous peritoneal surface malignancies of intestinal origin are characterized by the presence of specific molecular markers and represent a step toward understanding the complexity of this intriguing phenotypic entity.
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Affiliation(s)
- Kjersti Flatmark
- Department of Tumor Biology, Institute for Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, N-0310 Oslo, Norway.
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Bevan KE, Mohamed F, Moran BJ. Pseudomyxoma peritonei. World J Gastrointest Oncol 2010; 2:44-50. [PMID: 21160816 PMCID: PMC2999154 DOI: 10.4251/wjgo.v2.i1.44] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 12/24/2009] [Accepted: 12/31/2009] [Indexed: 02/05/2023] Open
Abstract
Pseudomyxoma peritonei (PMP) is an uncommon “borderline malignancy” generally arising from a perforated appendiceal epithelial tumour. Optimal treatment involves a combination of cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC). Controversy persists regarding the pathological classification and its prognostic value. Computed tomography scanning is the optimal preoperative staging technique. Tumour marker elevations correlate with worse prognosis and increased recurrence rates. Following CRS with HIPEC, 5-year survival ranges from 62.5% to 100% for low grade, and 0%-65% for high grade disease. Treatment related morbidity and mortality ranges from 12 to 67.6%, and 0 to 9%, respectively. Surgery and HIPEC are the optimal treatment for PMP which is at best a “borderline” peritoneal malignancy.
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Affiliation(s)
- Katharine E Bevan
- Katharine E Bevan, Faheez Mohamed, Brendan J Moran, Pseudomyxoma Peritonei Centre, Basingstoke and North Hampshire Hospital Foundation Trust, Aldermaston Road, Basingstoke, Hampshire RG24 9NA, United Kingdom
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50
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Mukherjee S, Weir C, Hammer H. Presumed fungal retinitis associated with pseudomyxoma peritonei. BMJ Case Rep 2009; 2009:bcr06.2008.0345. [PMID: 21686849 DOI: 10.1136/bcr.06.2008.0345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pseudomyxoma peritonei is a rare malignant growth characterised by the progressive accumulation of mucus-secreting (mucinous) tumour cells within the abdomen and pelvis.1 No previous ophthalmic associations have been reported with this condition. We present a case involving this rare cancer and fungal retinitis. Our patient developed a florid retinitis, which was thought to have a fungal aetiology, most likely because he was immunocompromised. Numerous factors are thought to have contributed to the development of ocular symptoms. He was treated appropriately and recovered his vision well. A holistic, multidisciplinary approach should be adopted when managing these patients.
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Affiliation(s)
- Sumona Mukherjee
- Department of Ophthalmology, Tennent Institute, Gartnavel General Hospital, Great Western Road, Glasgow G12 0YN, UK
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