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Zhao XY, Li CQ, Zhang SY, Liu G. Case Report: An Unusual Case of Pulmonary Metastatic Adenocarcinoma From Low-Grade Appendiceal Mucinous Neoplasms. Front Oncol 2022; 12:906344. [PMID: 35912193 PMCID: PMC9327614 DOI: 10.3389/fonc.2022.906344] [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: 03/28/2022] [Accepted: 06/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Low-grade appendiceal mucinous neoplasms (LAMNs) are indolent tumors with low-grade cytology. Although peritoneal dissemination is common due to tumor rupture and mucinous deposits on the visceral peritoneal surface, distant involvement, such as lung, is rarely seen due to lack of invasiveness. Case Presentation A 70-year-old woman presented to the hospital due to continuously elevated carcinoembryonic antigen (CEA) levels for 10 months without any symptoms. PET/CT revealed two lesions located in the left lung and appendix. The postoperative pathology results revealed pulmonary mucinous adenocarcinoma and LAMN. Then we performed next-generation sequencing (NGS) to clarify the relationship between the two tumors. The sequencing result showed that both tumors harbored the common tumor mutations, KRAS (p.G12D), GNAS (p.R201H), and BRAF (p.R735Q), which indicated that the pulmonary tumor was a metastasis of LAMN. Conclusion This case is unusual in that the primary LAMN and the pulmonary metastasis are present at the time of diagnosis. This study reported the first pulmonary metastasis from LAMN verified by NGS.
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Azzakhmam M, Zouaidia F, Jahid A, Znati K, Bernoussi Z, Mahassini N. [Recurrence of pseudomyxoma peritonei with liver and splenic metastases: about a case and literature review]. Pan Afr Med J 2018; 30:225. [PMID: 30574243 PMCID: PMC6295300 DOI: 10.11604/pamj.2018.30.225.15484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/06/2018] [Indexed: 11/11/2022] Open
Abstract
Le pseudo myxome péritonéal (PMP), est un syndrome clinicopathologique caractérisé par une ascite mucineuse et des pools de mucine comportant un épithélium mucineux néoplasique dans la cavité péritonéale. Le PMP est peu fréquent, et se présente avec des manifestations cliniques et pathologiques inhabituelles posant des problèmes diagnostic et thérapeutiques. L'atteinte des viscères abdominaux et les métastases ganglionnaires sont rares et se limitent à des cas sporadiques rapportes dans la littérature. Nous rapportons ici le cas d'un patient de 56 ans opéré à deux reprises pour PMP d'origine appendiculaire, et qui a consulté pour douleurs abdominales évolutives, cinque ans après sa dernière cure. Le scanner avait objective une récidive de pseudo myxome péritonéal, avec présence de lésions intraparenchymateuses spléniques et hépatique .l 'étude anatomopathologique avait objective la récidive d'un pseudo myxome péritonéal de bas grade avec la localisation intrasplénique et hépatique des mêmes lésions histologiques confirmant les métastases.
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Affiliation(s)
- Mustapha Azzakhmam
- Laboratoire d'Anatomie Pathologique, Hôpital Militaire d'Instruction Mohamed V, Rabat, Faculté de Médecine et de Pharmacie de Rabat, Maroc
| | - Fouad Zouaidia
- Laboratoire d'Anatomie Pathologique, Centre Hospitalier Universitaire Avicenne, Rabat, Maroc
| | - Ahmed Jahid
- Laboratoire d'Anatomie Pathologique, Centre Hospitalier Universitaire Avicenne, Rabat, Maroc
| | - Kaoutar Znati
- Laboratoire d'Anatomie Pathologique, Centre Hospitalier Universitaire Avicenne, Rabat, Maroc
| | - Zakia Bernoussi
- Laboratoire d'Anatomie Pathologique, Centre Hospitalier Universitaire Avicenne, Rabat, Maroc
| | - Najat Mahassini
- Laboratoire d'Anatomie Pathologique, Centre Hospitalier Universitaire Avicenne, Rabat, Maroc
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Pulmonary metastasis from pseudomyxoma peritonei. Gastroenterol Res Pract 2012; 2012:690256. [PMID: 22844275 PMCID: PMC3403384 DOI: 10.1155/2012/690256] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 04/19/2012] [Indexed: 12/18/2022] Open
Abstract
Pseudomyxoma peritonei (PMP) is a rare clinical condition, where copious mucinous ascites accumulate in the peritoneal cavity due to dissemination of mucin-producing tumor. Because of this disseminating, yet nonmetastasizing, behavior, PMP attracts much interest from surgical oncologists in that aggressive locoregional therapy can give the opportunity of long survival and even cure. Although extra-abdominal metastasis is exceptionally rare, the lung is the most likely site in such a case. In this paper, the clinical findings and treatment of eleven cases with pulmonary metastasis from PMP were reviewed, including ten cases in the literature and one case which we experienced. The clinical features of PMP cases with pulmonary metastasis were similar to cases without pulmonary metastasis. The histological type was low-grade mucinous neoplasm in most cases. Pulmonary lesions were resected in seven cases in which abdominal lesions were controlled by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy or another therapeutic modality. Disease-free state was maintained in five cases at the end of the follow-up period. However, it should be noted that rapid progression after resection was seen in two cases, suggesting that biological features may have changed by surgical intervention.
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Geisinger KR, Levine EA, Shen P, Bradley RF. Pleuropulmonary involvement in pseudomyxoma peritonei: morphologic assessment and literature review. Am J Clin Pathol 2007; 127:135-43. [PMID: 17145619 DOI: 10.1309/601k2l2t7cr5u7g1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Intrathoracic spread in patients with pseudomyxoma peritonei (PP) is rare. We reviewed 101 patients uniformly treated at our institution for PP of appendiceal origin. In that study, we suggested mucinous carcinoma peritonei (MCP) as the pathologic terminology for all cases of PP. Four patients had pathologically documented pleuropulmonary involvement. We subsequently examined another patient with pleural invasion. Of 5 patients, 3 had low-grade histologic features in the peritoneum; these showed variably proliferative, bland-appearing neoplastic cells arising from low-grade appendiceal mucinous neoplasms. In 2 cases, 1 or more pulmonary parenchymal metastases of low histologic grade developed. The lack of pleural involvement argued against transdiaphragmatic tumor extension. The third patient with low-grade MCP had direct extension through the left diaphragm involving the left pleural and pericardial spaces without pulmonary parenchymal involvement. In the 2 patients with high-grade MCP, right-sided pleural effusions developed. Neither patient had documented injury to the diaphragm. Pleural cytologic examination revealed high-grade adenocarcinoma cells singly, in small clusters, and in large spheres. The smear backgrounds contained wispy mucin. None of the 5 patients developed thoracic lymph nodal metastases. Although rare, mucinous neoplasms from PP may involve the thorax.
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Affiliation(s)
- Kim R Geisinger
- Department of Pathology, Wake Forest University School of Medicine and the North Carolina Baptist Hospital, Winston-Salem, NC 27157-1072, USA
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Lee BY, Kim HS, Lee SH, Moon HS, Cho SM, Lee KH, Song KS, Min KO, Seo EJ, Lee JM. Pseudomyxoma peritonei: extraperitoneal spread to the pleural cavity and lung. J Thorac Imaging 2004; 19:123-6. [PMID: 15071333 DOI: 10.1097/00005382-200404000-00013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abdominal and pelvic recurrence of pseudomyxoma peritonei after the surgery is occasionally seen but extraperitoneal spread and hematogeneous metastases are rare. This case of pseudomyxoma peritonei provides interesting radiologic findings of extraperitoneal spread, which occurred after an extremely long interval from initial diagnosis.
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Affiliation(s)
- Bae Young Lee
- Department of Radiology, St. Paul's Hospital, Medical College, The Catholic University of Korea, Seoul, Korea
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Shimoyama S, Kuramoto S, Kawahara M, Yamasaki K, Endo H, Murakami T, Kaminishi M. A rare case of pseudomyxoma peritonei presenting an unusual inguinal hernia and splenic metastasis. J Gastroenterol Hepatol 2001; 16:825-9. [PMID: 11446896 DOI: 10.1046/j.1440-1746.2001.02401.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Pseudomyxoma peritonei (PMP) is a rare clinical entity in which a diffuse collection of intraperitoneal gelatinous fluid is associated with gelatinous implants on the peritoneal surfaces and omentum. Hematogenic or lymphatic metastasis is extremely rare. In addition, an inguinal mass as an initial presentation is also relatively rare. This is a case report of a PMP patient who had splenic metastasis and showed an inguinal tumor as an initial presentation. A 59-year-old female patient, who had undergone bilateral oophorectomy because of a ruptured ovarian mucinous tumor of boderline malignancy 12 years previously, presented a presumptive diagnosis of a left inguinal irreducible hernia. Computed tomography revealed a low density mass in the pelvic cavity and in the inguinal lesion, as well as in the spleen without any diseases around the organ. The preoperative serum carcinoembryonic antigen (CEA) level was elevated. The patient underwent a resection of gelatinous tumor in the pelvic cavity, splenectomy, and appendectomy, as well as left inguinal herniorrhaphy. Histological examinations revealed a splenic metastasis of PMP originating from the ovarian low-grade mucinous tumor. She received postoperative intraperitoneal lavage as well as chemotherapy, and has survived for over 7 years postoperatively without any evidence of recurrence, as confirmed by repeated follow-up CT examinations and CEA determination. Splenic metastasis of PMP is extremely rare; this represents only the third reported case of its kind in the literature. Furthermore, it should be noted that an inguinal tumor can sometimes be an initial presentation of PMP.
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Affiliation(s)
- S Shimoyama
- Department of Gastrointestinal Surgery, University of Tokyo, Tokyo, Japan.
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Abstract
PURPOSE Pseudomyxoma peritonei is a rare disease characterized by mucinous ascites and associated with ruptured mucocele, cystadenoma, and low-grade carcinoma arising from the appendix, ovaries, or colon. Metastases and extraperitoneal involvement are extremely rare events. METHOD This is a case report of a patient with pseudomyxoma peritonei with pleural involvement. RESULTS A 38-year-old male patient with a pseudomyxoma peritonei from appendiceal origin underwent an extensive cytoreduction procedure. During the operation pleural involvement was noted. This was later confirmed by thoracoscopy. An expectant policy was followed until the patient became symptomatic with progressive disease in the abdomen and both pleural cavities. With systemic chemotherapy (5-fluorouracil and leucovorin), a good clinical response was obtained, and the patient was alive with stable disease 2.5 years after the first diagnosis. CONCLUSIONS Involvement of the pleural cavity by pseudomyxoma peritonei is rare and carries an unfavorable prognosis. Whenever possible, the same guidelines as for intra-abdominal disease should be followed: extensive cytoreductive procedures with local and/or systemic chemotherapy. In our patient we hope to achieve a prolonged palliation with systemic chemotherapy.
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Affiliation(s)
- D F Peek
- Department of Surgery, University Hospital Maastricht, The Netherlands
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Mortman KD, Sugarbaker PA, Shmookler BM, DeGuzman VC, Soberman MS. Pulmonary metastases in pseudomyxoma peritonei syndrome. Ann Thorac Surg 1997; 64:1434-6. [PMID: 9386716 DOI: 10.1016/s0003-4975(97)00806-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pseudomyxoma peritonei (PMP) is a rare disease arising from a mucinous cystadenoma of appendiceal origin. The syndrome has been characterized by progressive growth of mucinous tumors, tense mucinous ascites, and ultimately death. Abdominal and pelvic recurrence after resection of intraperitoneal disease occurs in all patients unless adjunctive measures are taken. Local spread of PMP by direct extension to the pleural or pericardial space is uncommon but has been reported in the literature. Here we report development of pulmonary parenchymal metastases after treatment for PMP. METHODS The charts of 3 patients were retrospectively reviewed for the presentation and management of metastatic PMP. RESULTS Three patients underwent resection for pulmonary parenchymal metastases of PMP. All patients recovered uneventfully. The continue to do well after 2 to 8 years of follow-up. CONCLUSIONS Pulmonary metastasectomy for PMP is safe and effective after treatment of intraperitoneal disease.
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Affiliation(s)
- K D Mortman
- Department of Surgery, Washington Cancer Institute, Washington Hospital Center, Washington, DC 20010, USA
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Smith JW, Kemeny N, Caldwell C, Banner P, Sigurdson E, Huvos A. Pseudomyxoma peritonei of appendiceal origin. The Memorial Sloan-Kettering Cancer Center experience. Cancer 1992; 70:396-401. [PMID: 1319813 DOI: 10.1002/1097-0142(19920715)70:2<396::aid-cncr2820700205>3.0.co;2-a] [Citation(s) in RCA: 126] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
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.
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Affiliation(s)
- J W Smith
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021
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Masaryk TJ, Chilcote WA. CT of pseudomyxoma peritonei: case report. COMPUTERIZED RADIOLOGY : OFFICIAL JOURNAL OF THE COMPUTERIZED TOMOGRAPHY SOCIETY 1984; 8:43-7. [PMID: 6697707 DOI: 10.1016/0730-4862(84)90010-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Pseudomyxoma peritonei is an uncommon disorder, which is usually the sequelae of mucocele of the appendix or mucinous ovarian cystadenocarcinoma. The characteristic CT findings of massive ascites, loculated fluid collections, hepatic and mesenteric scalloping caused by low attenuation tumor masses, without lymphadenopathy and in the presence of intrinsically normal viscera strongly suggest the diagnosis.
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Mets T, Van Hove W, Louis H. Pseudomyxoma peritonei. Report of a case with extraperitoneal metastasis and invasion of the spleen. Chest 1977; 72:792-4. [PMID: 923321 DOI: 10.1378/chest.72.6.792] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The findings in a patient with pseudomyxoma peritonei, probably of appendicular origin, are reported. As a rule, pseudomyxoma peritonei remains limited to the peritoneal cavity, but in this case, dissemination occurred to the right pleural cavity and to the pericardium. In addition, invasion of the spleen (to our knowledge, nor previously described) was noted.
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Abstract
Primary adenocarcinoma of the appendix is rare and less than 200 cases are on record. The present material consisted of 20 cases collected from different hospitals. The cases are described in respect of sex and age-distribution, symptoms, treatment and prognosis. Of 7 patients with malignant mucocele, 6 subjected to appendectomy only, were still alive 5 years after the operation. Of 12 patients with colonic type of adenocarcinoma, 3 had been treated with appendectomy only. Of these, 2 were still alive 5 years after the operation. The remaining 9 patients had undergone right hemicolectomy. Only one of them was alive 5 years after the operation. A compilation of a further 39 cases garnered from the literature, however, showed that 60% had survived at least 5 years after right hemicolectomy, compared with 46% after appendectomy alone. Appendectomy alone is probably a sufficiently radical operation for malignant mucocele provided the tumor has not grown through the submucosa and that it is confined to the tip of the appendix. Right hemicolectomy is indicated for the colonic type of adenocarcinoma.
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Higa E, Rosai J, Pizzimbono CA, Wise L. Mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma of the appendix. A re-evaluation of appendiceal "mucocele". Cancer 1973; 32:1525-41. [PMID: 4757938 DOI: 10.1002/1097-0142(197312)32:6<1525::aid-cncr2820320632>3.0.co;2-c] [Citation(s) in RCA: 238] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Long RT, Spratt JS, Dowling E. Pseudomyxoma peritonei. New concepts in management with a report of seventeen patients. Am J Surg 1969; 117:162-9. [PMID: 5773930 DOI: 10.1016/0002-9610(69)90300-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Georgsson G. [Mucocele of the appendix and pseudomyxoma peritonei]. LANGENBECKS ARCHIV FUR CHIRURGIE 1966; 315:300-9. [PMID: 5986124 DOI: 10.1007/bf01439601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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