![]() The patient returned 2 years later with abdominal distension, deposits on the intestinal wall, highly suspicious for a recurrent malignancy. A history of appendectomy was not recovered from the medical records, nor was the specimen of appendix received therefore, the status of the appendix was unknown. This was consistent with a diagnosis of PMP. The omentum and uterine serosa had mucinous deposits with epithelial cells. Total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy was performed after an intraoperative frozen section biopsy which revealed borderline mucinous ovarian tumors of both ovaries. Ultrasonogram revealed bilateral ovarian cystic masses. The postoperative period was uneventful, and the patient was put on adjuvant chemotherapy.Ī 54-year female presented with loss of appetite and abdominal distension. The uterine cervix, endometrium and right ovary showed no mucin, although the parametria, serosal aspect of the uterus and right fallopian tube showed mucoid material with inflammation. The retroperitoneal lymph nodes showed no metastasis. ![]() This was called diffuse peritoneal adenomucinosis of appendiceal origin, according to the earlier classification by Ronnett et al. Hence, a diagnosis of low-grade mucinous adenocarcinoma of the omentum, secondary to a low-grade mucinous neoplasm of the appendix along with borderline mucinous tumor of the left ovary, was rendered. The omentum showed mucin pools with scanty epithelial fragments (Fig. The mucin was dissecting between muscularis propria and extending up to the serosa, suggestive of rupture (Fig. The sections of the appendix revealed a mucinous neoplasm with minimal atypia. The cut surface of the appendix revealed mucinous material. The intervening fibroblastic stroma showed dissecting pools of mucin (Fig. ![]() There was no evidence of atypia or invasion. Histopathology of the left ovarian mass revealed a mucinous tumor with borderline features composed of multiple mucin filled cysts lined by multilayered mucinous epithelium. The samples were sent for histopathological examination. Total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy, retro peritoneal lymph node dissection was done along with appendectomy. Intraoperatively, the peritoneal cavity was filled with gelatinous material, a large mucinous tumor (with ruptured capsule) replacing the left ovary and an enlarged appendix. Investigations revealed an elevated CEA (923 ng/ml) and mildly elevated CA 125 (51 U/ml). On ultrasonography, a large, multiloculated cystic lesion measuring 15 × 12 × 16 cm was noted in the pelvis. Ī 75-year female presented with abdominal distension and loss of appetite for 2 months. The treatment options range from cytoreductive surgery to hyperthermic intraperitoneal chemotherapy (HIPEC) with varied prognosis. This can be further classified as invasive, low grade or high grade, based on the WHO AJCC 2010 classification. According to the current AJCC and WHO classification, any neoplastic mucinous epithelium in the appendiceal wall and beyond is a mucinous adenocarcinoma. It was classified into disseminated peritoneal adenomucinosis (DPAM) and peritoneal mucinous carcinomatosis (PMCA) based on cellularity, epithelial atypia and mitotic activity which presented much subjective ambiguity. The pathological diagnosis and classification of PMP has posed much debate. The ovaries usually represent secondary involvement. It may also originate from other mucinous neoplasms throughout the gastrointestinal tract. The primary neoplasms producing PMP may be benign or malignant and their origin has been debated, until recent studies have attributed it to primary appendiceal mucinous neoplasms. PMP is a clinical terminology rather than a pathological diagnosis. Pseudomyxoma peritonei (PMP) is an enigmatic intra-abdominal disease characterized by epithelial implants secreting extracellular mucin resulting in dissecting gelatinous ascites.
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