Pseudomyxoma Peritoneii


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Pseudomyxoma peritoneii is a rare entity. It is good for medical students as tutorial session

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Pseudomyxoma Peritoneii

  1. 1. Dr Rekha Khare MD Radiology
  2. 2.  It is a clinical condition caused by cancerous cells that produce diffuse intra peritoneal gelatinous ASCITIS in abdomen and pelvis
  3. 3.  Ascites is recurrent, voluminous and mucinous  Ascites is due to surface growth on the peritoneum without invading the underlying tissue
  4. 4.  Carl F. Rokitansky reported first case in 1842  Werth coined the term pseudomyxoma peritoneii in 1884, that was in association with mucinous ovarian tumour  Frankel reported first case of PMP in 1901 that was in association with cyst of appendix
  5. 5.  Over all incidence- 1-2/million/year  Male :Female ratio= 9:11  Median age at presentation is about 50years (range 20-25years)
  6. 6.  Ruptured mucinous tumour of appendix/ appendiceal mucocele
  7. 7.  Mucinous tumour of large & small bowel, Lung, Breast, Pancreas, Stomach, Bile duct, Gall bladder and Fallopian tube / Ovary, urachal tumour are implicated
  8. 8.  Patient may present with: -abdominal or pelvic pain -bloating/ distension -digestive disorder -weight loss -increasing abdominal girth -infertility
  9. 9.  In male: patient may come with Inguinal hernia  In female: presentation could be with uni/ bilateral ovarian disease
  10. 10.  Ultrasound  CT scan History, clinical exam. & imaging studies often lead to the diagnosis  Sometimes diagnostic paracentesis under U/S confirmation by cytological exam.  Often discovered during surgery
  11. 11.  PET scan may be used to evaluate high grade mucinous adenocarcinoma  New MRI procedures are being developed for disease monitoring
  12. 12.  Non mobile Ascites with septations or loculated ascites with echogenic particle  Scalloping of liver, spleen & other organs
  13. 13.  Loculated low attenuated ascites  Multiple complex cystic masses of fat density or variable density
  14. 14.  Scalloping of visceral surface of liver, spleen & other organs  Compression or central displacement of small bowels
  15. 15.  Any of the above finding with: - mass in Rt. lower quadrant/appendicial mucocele -pelvic mass/ mucinous ovarian mass - any other underlying cause of PMP
  16. 16.  Peritoneal carcinomatosis without mucinous ascites  Peritoneal sarcomatosis  Peritonitis
  17. 17.  Peritoneal Adenomucinosis Primary tumour: ADENOMA  Peritoneal mucinous carcinoma Primary tumour: MUCINOUS ADENOCARCINOMA  Intermediate or discordant feature
  18. 18.  Recurrent bowel obstruction due to fibrosis or adhesion  Mucus build up, filling the abdominal cavity, compression of organ will impede digestive or organ function  Increased abdominal pressure
  19. 19.  Good with treatment  Lethal if untreated with death by -cachexia, -renal failure -other types of complication
  20. 20.  A middle aged lady was referred to Deptt. Of Radiology for ultrasound exam.  She had problem of progressively increasing abdominal girth, pain in abdomen and digestive disorders
  21. 21.  Multiloculated ascites with no particles (not moving like blood or pus)  Scalloping effect over the border of liver and spleen (spleen is significantly reduced in size)
  22. 22.  Multi loculated ascites with well enhanced rim of peritoneum  Pocket of fluid in right iliac fossa, pelvic cavity and para colic gutter
  23. 23.  Scalloping effect over the border of liver and spleen  Small bowel seems to be gathered in the center  Right pleural effusion r
  24. 24.  Long history of slow growing illness, clinical exam. and Imaging findings lead to the diagnosis of: Pseudomyxoma -Peritoneii  Nothing much could be done for her, as she has left the hospital against medical advice
  25. 25.  PMP is rare, slow growing disease & may recur after surgery or chemotherapy  It is important to obtain an accurate diagnosis as treatment ranges from watchful waiting to: -debulking -hyper thermic intraperitoneal chemotherapy -cytoreductive surgery
  26. 26.  Pseudomyxoma Peritoneii, Alexandra Stanislavsky. Radiology Reference article  Pseudomyxoma peritoneii(PMP), Diagnosis and Imaging finding article/506509_2
  27. 27.  Pseudomyxoma peritoneii. Submitted by Paurush shah MSIV www.learning  Peritoneum & Mesentery PartII Pathology Angela Levy, The Radiology Assistant
  28. 28.  Gray-scale sonographic finding in a patient with pseudomyxoma , C Lersch etal Journal of Clinical ultrasound vol 29 Issue3 page186-191March/April 2001