Pseudomyxoma Peritoneii
- 1. Dr Rekha Khare MD Radiology
- 2. It is a clinical condition caused by cancerous cells that produce diffuse intra peritoneal gelatinous ASCITIS in abdomen and pelvis
- 3. Ascites is recurrent, voluminous and mucinous Ascites is due to surface growth on the peritoneum without invading the underlying tissue
- 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. Over all incidence- 1-2/million/year Male :Female ratio= 9:11 Median age at presentation is about 50years (range 20-25years)
- 6. Ruptured mucinous tumour of appendix/ appendiceal mucocele
- 7. Mucinous tumour of large & small bowel, Lung, Breast, Pancreas, Stomach, Bile duct, Gall bladder and Fallopian tube / Ovary, urachal tumour are implicated
- 8. Patient may present with: -abdominal or pelvic pain -bloating/ distension -digestive disorder -weight loss -increasing abdominal girth -infertility
- 9. In male: patient may come with Inguinal hernia In female: presentation could be with uni/ bilateral ovarian disease
- 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. PET scan may be used to evaluate high grade mucinous adenocarcinoma New MRI procedures are being developed for disease monitoring
- 12. Non mobile Ascites with septations or loculated ascites with echogenic particle Scalloping of liver, spleen & other organs
- 13. Loculated low attenuated ascites Multiple complex cystic masses of fat density or variable density
- 14. Scalloping of visceral surface of liver, spleen & other organs Compression or central displacement of small bowels
- 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. Peritoneal carcinomatosis without mucinous ascites Peritoneal sarcomatosis Peritonitis
- 17. Peritoneal Adenomucinosis Primary tumour: ADENOMA Peritoneal mucinous carcinoma Primary tumour: MUCINOUS ADENOCARCINOMA Intermediate or discordant feature
- 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. Good with treatment Lethal if untreated with death by -cachexia, -renal failure -other types of complication
- 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. 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. Multi loculated ascites with well enhanced rim of peritoneum Pocket of fluid in right iliac fossa, pelvic cavity and para colic gutter
- 23. Scalloping effect over the border of liver and spleen Small bowel seems to be gathered in the center Right pleural effusion r
- 44. 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
- 45. 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
- 46. Pseudomyxoma Peritoneii, Alexandra Stanislavsky. Radiology Reference article Radiopaedia.org Pseudomyxoma peritoneii(PMP), Diagnosis and Imaging finding www.medscape.com/view article/506509_2
- 47. Pseudomyxoma peritoneii. Submitted by Paurush shah MSIV www.learning radiology.com Peritoneum & Mesentery PartII Pathology Angela Levy, The Radiology Assistant
- 48. Gray-scale sonographic finding in a patient with pseudomyxoma , C Lersch etal Journal of Clinical ultrasound vol 29 Issue3 page186-191March/April 2001