Pseudomyxoma peritonei. Radiologic features

CT in pseudomyxoma peritonei: a review of 17 cases

AIM

To describe the computed tomography (CT) findings in pseudomyxoma peritonei.

MATERIALS AND METHOD

Two observers independently and retrospectively reviewed the CT images of 17 consecutive patients (nine women, eight men, mean age 53 years) with histologically proven pseudomyxoma peritonei.

RESULTS

Six patients had small volume disease where pseudomyxoma peritonei was present in focal collections in the peritoneal cavity. Eleven had large volume disease that completely, or almost completely, filled the peritoneal cavity. Pseudomyxoma peritonei is characterized by low attenuation mucinous ascites on CT. Areas of high attenuation, septae and calcification are seen more commonly within it as the volume of disease increases. The pattern of accumulation of pseudomyxoma peritonei follows the normal flow of peritoneal fluid. It initially seeds at sites of relative stasis and as large volume disease develops it fills the remaining spaces in the peritoneal cavity and pressure effects dominate imaging. Pseudomyxoma peritonei may extend into hernial orifices or the pleural cavity.

CONCLUSION

Pseudomyxoma peritonei is difficult to diagnose clinically. However, the pattern of accumulation of disease is predictable and can be recognized on CT.

A clinical study on pseudomyxoma peritonei

To elucidate the clinical entity of pseudomyxoma peritonei, nine patients (male: female = 6:3) who had been treated in Chang Gung Memorial Hospital in the past 13 years were reviewed. The male patients with original appendiceal tumour were older than the male patients with original colon cancer or indefinite tumour (70, 67 and 67 years vs 42, 27 and 50 years). In addition, the former group survived in a disease-free status for 28 months on average, while the latter group died within 2 years. Echogenic ascites and diffuse low-attenuation intra-abdominal masses with scalloping on the surface of liver detected by ultrasonography and by computerized tomography, respectively, were found in most of the patients. Elevation of the serum carcinoembryonic antigen (CEA) during recurrence of the disease was also noted. This series suggested that: (i) the pre-operative diagnosis could be made with careful physical examination in conjunction with sonography or computerized tomography; (ii) the prognosis was better in patients with tumour of appendiceal origin; and (iii) serum CEA might be valuable for early detection of recurrence.

Pseudomyxoma peritonei due to adenocarcinoma of the lung: case report

A rare case of pseudomyxoma peritonei whose primary site was presumed to be the lung is reported. A 76-year-old woman was admitted to Hospital presenting with progressive abdominal distention. She had been admitted twice, 2 and 1 year previously for the evaluation of high plasma carcinoembryonic antigen (CEA) level, of 11.6 ng/ml. Chest computed tomography (CT) scan and chest X-ray film on the third admission revealed a nodular lesion in the left lower lung field, and transbronchial lung biopsy (TBLB) revealed mucus-producing tall columnar epithelial carcinoma. Paracentesis revealed gelatinous ascitic fluid. At laparotomy, appendix and ovary were normal, and there were many small cystic tumors on the peritoneal surface and omentum. The patient died 2 years later, after repeated episodes of dynamic ileus. The lung and abdominal tumors gradually increased in size during the 2-year period, but she developed no respiratory symptoms. Based on both the clinical and pathophysiological findings, the final diagnosis made was pseudomyxoma peritonei whose origin was a lung adenocarcinoma.

Pseudomyxoma peritonei associated with secondary infertility

In summary, we report a case of secondary infertility attributed to pseudomyxoma peritonei caused by ruptured appendiceal mucocele. Resection of the tumor and visible mucinous ascites resulted in spontaneous conception. We hypothesize secondary infertility was caused by significant peritoneal inflammation and inhibition of sperm-oocyte interaction from the ascites.

Pseudomyxoma peritonei of appendiceal origin. The Memorial Sloan-Kettering Cancer Center experience

BACKGROUND

Pseudomyxoma peritonei is a rare clinical entity in which the peritoneal surfaces and omentum are involved with diffuse gelatinous mucinous implants. It originates from ruptured mucinous tumors of the appendix or ovary.

METHODS

The authors examined the experience with 34 patients with pseudomyxoma peritonei seen at Memorial Sloan-Kettering Cancer Center from 1952-1989. Of these, 17 cases were identified to be of appendiceal origin.

RESULTS

All patients underwent celiotomy and cytoreduction. The median survival time from diagnosis was 75 months. It was found that long-term survival can be achieved by operation alone. When conditions do recur, chemotherapy may be valuable.

CONCLUSIONS

Pseudomyxoma peritonei of appendiceal origin is a rare low-grade malignancy. Initial treatment consists of cytoreduction in an attempt to render the patient locally disease-free. Long-term survival can be obtained by operation alone, even if gross disease is present at the end of the procedure. Systemic chemotherapy should be reserved for patients with proven recurrence.