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PubMed - Pseudomyxoma Peritonei (PMP) (16 unread)

Carcinoma involving the gallbladder: A retrospective review of 23 cases - pitfalls in diagnosis of gallbladder carcinoma.

Fetched: February 1st, 2012, 10:01pm MST

Carcinoma involving the gallbladder: A retrospective review of 23 cases - pitfalls in diagnosis of gallbladder carcinoma.

Diagn Pathol. 2012 Jan 27;7(1):10

Authors: Giang TH, Ngoc TT, Hassell LA

Abstract
ABSTRACT: BACKGROUND: Carcinoma of the gallbladder (GBC) clinically mimics benign gallbladder diseases and often escapes detection until advanced stage. Despite the frequency of cholecystectomy, diagnosis of GBC remains problematic in many situations. We sought to identify pathologic features that contribute to the difficulty in recognition of GBC. METHODS: We identified 23 patients (ranged from 45 to 86 years, male to female ratio 1:4.5) with carcinoma involving the gallbladder referred to an academic medical center over a period of 10 years for study. This includes 10 cases of primary GBC, 6 cases of metastatic tumor to gallbladder, 6 cases of directly invasive adenocarcinoma arising elsewhere in the biliary tree, and one case of unidentified origin adenocarcinoma. Primary tumors include adenocarcinoma not otherwise specified (NOS) in 6 cases, papillary adenocarcinoma in 2 cases, and single cases of undifferentiated carcinoma and combined adenocarcinoma and neuroendocrine carcinoma (NEC). Metastatic tumors to gallbladder were from a wide range of primary sites, predominantly the gastrointestinal tract. RESULTS: These cases illustrate seven potential pitfalls which can be encountered. These include: 1) mistakenly making a diagnosis of adenocarcinoma of gallbladder when only benign lesions such as deeply penetrating Rokitansky-Aschoff sinuses are present (overdiagnosis), 2) misdiagnosing well-differentiated invasive carcinoma with minimal disease as benign disease (underdiagnosis), 3) differentiating between primary NEC of gallbladder and metastasis, 4) confusing primary mucinous adenocarcinoma of gallbladder with pseudomyxoma peritonei from a low grade appendiceal neoplasm disseminated to gallbladder, 5) confusing gangrenous necrosis related to cholecystitis with geographic tumoral necrosis, 6) undersampling early, grossly occult disease, and 7) misinterpreting extracellular mucin pools. CONCLUSIONS: Clinical history and a high index of suspicion are prerequisite to detecting GBC. Detection of GBC at an early stage is difficult because the symptoms mimic benign gallbladder diseases. Misinterpretation of subtle microscopic abnormalities contributes diagnostic failures in early cases. Careful attention to any evidence of mural thickening, thorough sampling, particularly in older patients, and close examination of any deeply situated glandular structures are critical. Correlations with radiographic and clinical findings are important helps to avoid misdiagnosis in this commonly resected organ.

PMID: 22284391 [PubMed - as supplied by publisher]
Malignant Psoas abscess or pseudomyxoma extraperitonei.

Fetched: January 29th, 2012, 10:01pm MST

Malignant Psoas abscess or pseudomyxoma extraperitonei.

J Coll Physicians Surg Pak. 2011 Sep;21(9):567-8

Authors: Mehmood A, Ejaz K, Pishori TI

Abstract
Primary adenocarcinoma of appendix is an uncommon gastrointestinal malignancy. Similarly, Psoas abscess is an entity, which sometimes requires extensive work-up to reach a diagnosis. Combined presentation of these two rare conditions is not only exceptional, but also diagnostically challenging. We present a case of a lady who presented with recurrent UTI secondary to right sided ureteric obstruction, referred right hip joint pain resulting from a Psoas abscess, which eventually turned out to be a consequence of metastatic adenocarcinoma of appendix, causing pseudomyxoma extraperitonei, with simultaneous intraperitoneal deposits.

PMID: 21914418 [PubMed - indexed for MEDLINE]
Mucolysis by Ascorbic Acid and Hydrogen Peroxide on Compact Mucin Secreted in Pseudomyxoma Peritonei.

Fetched: January 22nd, 2012, 10:01pm MST

Mucolysis by Ascorbic Acid and Hydrogen Peroxide on Compact Mucin Secreted in Pseudomyxoma Peritonei.

J Surg Res. 2011 Nov 19;

Authors: Pillai K, Akhter J, Chua TC, Morris DL

Abstract
BACKGROUND: This study examines the potential efficacy of hydrogen peroxide and ascorbic acid in the dissolution of mucinous ascites from pseudomyxoma peritonei. METHODS: The mucolytic action of both ascorbic acid (0%-0.2%) and hydrogen peroxide (0%-3%) are investigated as single agent on mucin samples derived from patient. This was followed by examining the joint action of ascorbic acid (0.2%) and hydrogen peroxide (0%-3.0%) on mucin. To lower the concentration of hydrogen peroxide in the mixture, the action of equal concentration of ascorbic acid/hydrogen peroxide ranging from 0%-0.3% are then examined. Finally, the pH (4.5-7.0) effect on mucolytic properties of equal concentration (0.2%) of ascorbic acid/hydrogen peroxide was studied. RESULTS: At the concentrations examined (0%-0.2%), ascorbic acid showed highest mucolytic activity at 0.2%. Similarly, hydrogen peroxide as a single agent (0%-3.0%) showed highest mucolytic activity at 3.0%. The mucolytic action of hydrogen peroxide (0%-3.0%) containing 0.2% ascorbic acid demonstrated synergistic effects. At equal concentration of the two agents, ranging from 0%-0.5%, maximal mucolytic action was observed at 0.2%. The mucolytic property of the final mixture (0.2% ascorbic acid/0.2% hydrogen peroxide) was pH-dependant and showed maximal degradation at pH 4.5 and declined as it reached towards neutral pH. CONCLUSION: The current study introduces the potential applicability of a formulation that holds promise as a mucolytic agent in patients with mucinous ascites from pseudomyxoma peritonei.

PMID: 22261589 [PubMed - as supplied by publisher]
Single-incision Laparoscopic Surgery for Appendiceal Mucoceles: Safety and Feasibility in a Series of 16 Consecutive Cases.

Fetched: January 22nd, 2012, 10:01pm MST

Single-incision Laparoscopic Surgery for Appendiceal Mucoceles: Safety and Feasibility in a Series of 16 Consecutive Cases.

J Korean Soc Coloproctol. 2011 Dec;27(6):287-92

Authors: Park KB, Park JS, Choi GS, Kim HJ, Park SY, Ryuk JP, Choi WH, Jang YS

Abstract
PURPOSE: The aim of this study was to evaluate the technical feasibility, safety, and oncological outcomes of transumbilical single-incision laparoscopic surgery in patients with an uncomplicated appendiceal mucocele.
METHODS: A review of a prospectively collected database at the Kyungpook National University Hospital from January 2006 to September 2010 revealed that a series of 16 consecutive patients underwent single-incision laparoscopic surgery (SILS) for an appendiceal mucocele. Data regarding patient demographics, operating time, conversion, surgical morbidity, lateral lymph node status, and mid-term oncologic result were analyzed.
RESULTS: The reported series consisted of 7 women (50%) and 9 men with a mean age of 61.6 years (range, 41 to 88 years). The mean operative time was 66.8 minutes (range, 33 to 150 minutes). Perioperative mortality and morbidity were 0% and 6.2%, respectively. Recovery after the procedure was rapid, and the mean hospital stay was 6.8 days (range, 3 to 22 days). Pathology revealed 12 lesions compatible with a mucinous cystadenoma and four others compatible with benign cystic tumors. All surgical margins were clear. In one case, an extra port had to be placed, and another case required conversion from SILS to a standard open laparotomy immediately after identification of the tumor because of a micro-perforation with focal mucin collection. With a median follow-up of 28.7 months, no re-admission or tumor recurrence, such as pseudomyxoma peritonei, was noted in 14 patients.
CONCLUSION: A single-port laparoscopic mucocelectomy should be safe and feasible and has the advantage of being a minimally invasive approach. Prospective controlled studies comparing SILS and conventional open surgery, with long-term follow-up evaluation, are needed to confirm the author's initial experience.

PMID: 22259743 [PubMed - in process]
Intraductal Papillary Mucinous Neoplasm (IPMN) with Extra-Pancreatic Mucin: A Case Series and Review of the Literature.

Fetched: January 22nd, 2012, 10:01pm MST

Intraductal Papillary Mucinous Neoplasm (IPMN) with Extra-Pancreatic Mucin: A Case Series and Review of the Literature.

J Gastrointest Surg. 2012 Jan 19;

Authors: Rosenberger LH, Stein LH, Witkiewicz AK, Kennedy EP, Yeo CJ

Abstract
BACKGROUND: Intraductal papillary mucinous neoplasm (IPMN) is an increasingly recognized pancreatic neoplasm characterized by excessive mucin secretion by ductal epithelial cells resulting in a cystic dilation of the pancreatic duct. AIM: The objective of this study was to review Thomas Jefferson University's experience and the literature to determine the significance of extra-pancreatic mucin when associated with an IPMN. RESULTS: A retrospective analysis at our institution revealed only two cases of IPMN associated with extra-pancreatic mucin, which were classic IPMNs with rupture of the pancreatic duct and peritoneal mucin spillage. This specific finding is not previously described, although is assumed as five cases were reported in the literature with IPMN and mucin extension demonstrated by pseudomyxoma peritonei (PMP). We propose IPMN of the pancreas may be grossly compared to a mucocele of the appendix, as both are characterized by excessive secretion of mucin by ductal epithelial cells. A morbid complication of a mucocele is PMP. The presence of extra-pancreatic mucin with an IPMN could present a rare but important marker of the eventual seeding of tumor outside the primary IPMN. This has been documented with cases of iatrogenic spilling of pancreatic mucin, as well as multiple cases of IPMN associated with pseudomyxoma peritonei. CONCLUSIONS: At this time, there is scant reporting and consensus for the treatment of IPMN with extra-pancreatic mucin.

PMID: 22258877 [PubMed - as supplied by publisher]
A woman with a rare cause of ascites diagnosed on endoscopic ultrasonography.

Fetched: January 22nd, 2012, 10:01pm MST

A woman with a rare cause of ascites diagnosed on endoscopic ultrasonography.

Gastroenterology. 2011 Nov;141(5):1563-4, 1950

Authors: Rana SS, Bhasin DK, Gupta N

PMID: 21952087 [PubMed - indexed for MEDLINE]
Radiologic findings of urachal mucinous cystadenocarcinoma causing pseudomyxoma peritonei.

Fetched: January 19th, 2012, 10:01pm MST

Radiologic findings of urachal mucinous cystadenocarcinoma causing pseudomyxoma peritonei.

Jpn J Radiol. 2012 Jan 13;

Authors: Kebapçı M, Saylısoy S, Can C, Dündar E

Abstract
Urachal mucinous cystadenocarcinoma causing pseudomyxoma peritonei is very rare. We report a case of a 59-year-old man with urachal mucinous adenocarcinoma associated with pseudomyxoma peritonei, and our radiologic findings. Ultrasonography revealed a well delineated, large cystic tumor adjacent to the anterior wall of the abdomen. Computed tomography and magnetic resonance imaging revealed a tumor of which the left posterior wall was defective. A large amount of ascites was present in the peritoneal cavity. The ascites caused displacement of the intestinal structures toward the dorsal region. The tumor wall and septa in the ascites were well enhanced on contrast-enhanced images. Radiologically, pseudomyxoma peritonei due to rupture of urachal cystic tumor was considered. The pathologic diagnosis was mucinous adenocarcinoma and pseudomyxoma peritonei.

PMID: 22241451 [PubMed - as supplied by publisher]
Leptin, MUC2 and mTOR in Appendiceal Mucinous Neoplasms.

Fetched: January 14th, 2012, 10:01pm MST

Leptin, MUC2 and mTOR in Appendiceal Mucinous Neoplasms.

Pathobiology. 2012;79(1):45-53

Authors: Chang MS, Byeon SJ, Yoon SO, Kim BH, Lee HS, Kang GH, Kim WH, Park KJ

Abstract
Objective: Leptin contributes to mucin production in colonic epithelium and regulates carcinogenesis via various signalling pathways. We evaluated the proteins involved in mucin-producing carcinogenesis and putative targets for molecular therapy in appendiceal mucinous neoplasms. Methods: Immunohistochemistry and fluorescence in situ hybridization were performed in 22 cases of appendiceal mucinous adenoma, 20 mucinous neoplasms of uncertain malignant potential and 14 mucinous adenocarcinomas. Results: Leptin, MUC2, MUC5AC, mTOR and ERK were more frequently immunopositive in mucinous adenocarcinomas compared with mucinous adenomas or mucinous neoplasms of uncertain malignant potential (p < 0.05). STAT3 revealed immunopositivity in 82% of tumours, regardless of tumour category. MUC2 immunopositivity was associated with pseudomyxoma peritonei (p < 0.05). None of the tumours exhibited c-kitimmunoexpression, amplification of Her2 or EGFR, or translocation of ALK. The mTOR-immunopositive group of patients had a lower rate of disease-free survival compared with the mTOR-immunonegative group (p < 0.05). Conclusions: Leptin may collaborate with MUC2 and MUC5AC in mucin-producing carcinogenesis in an mTOR-, STAT3- and ERK-dependent manner. STAT3 may be activated early during tumorigenesis. MUC2 and mTOR (but not c-kit, Her2, EGFR and ALK) may represent targets for molecular therapy in pseudomyxoma peritonei and appendiceal mucinous adenocarcinoma, respectively.

PMID: 22236547 [PubMed - in process]
Pseudomyxoma peritonei: some different sonographic findings.

Fetched: January 14th, 2012, 10:01pm MST

Pseudomyxoma peritonei: some different sonographic findings.

Abdom Imaging. 2012 Jan 11;

Authors: Que Y, Tao C, Wang X, Zhang Y, Chen B

Abstract
OBJECTIVES: The purpose of our study was to assess the sonographic features of pseudomyxoma peritonei (PMP). MATERIALS AND METHODS: All records of peritoneal biopsies under the guidance of ultrasound in our institutional database from April 2007 to June 2011 were retrospectively reviewed. 19 cases of PMP and 279 cases of other peritoneal lesions were included in the study. The sonograms of peritoneum, ascites, and parenchymal organs involved by PMP were evaluated, respectively, and compared with sonograms of other peritoneal lesions. RESULTS: Anechoic areas were found in 89.5% cases of PMP at high frequency of insonation and the sensitivity in indicating PMP was 100%. In the pelvic cavity, echogenic foci in ascites of PMP in 52.6% cases were mobile. The specificity of "starburst" appearance and sensitivity of scalloping of the liver margin were relatively high (82.3 and 88.1%), but the sensitivity and specificity (57.9 and 42.1%) of these two signs were relatively low. CONCLUSION: Anechoic area in the thickened peritoneum was a specific sign in indicating the diagnosis of PMP and high-frequency transducer could reveal these tiny anechoic areas more explicitly. In the pelvic cavity, echogenic foci in ascites of PMP could be observed to be mobile and scalloping of the liver margin and "starburst" appearance also played a significant role in indicating PMP.

PMID: 22234650 [PubMed - as supplied by publisher]
Outcomes of cytoreduction with hyperthermic intraperitoneal chemotherapy: our experience at a Midwest community hospital.

Fetched: January 11th, 2012, 10:01pm MST

Outcomes of cytoreduction with hyperthermic intraperitoneal chemotherapy: our experience at a Midwest community hospital.

Am J Surg. 2012 Jan 5;

Authors: Goslin B, Sevak S, Siripong A, Onesti J, Wright GP, Melnik M, Chung M

Abstract
BACKGROUND: Most cytoreduction with hyperthermic intraperitoneal chemotherapy procedures are performed at academic tertiary referral centers with numerous surgical oncology faculty. The objective of this study was to review the postoperative morbidity and mortality data of our institution, a large community hospital. METHODS: This was a retrospective cohort study of patients who underwent cytoreduction with hyperthermic intraperitoneal chemotherapy at a single institution. Two surgical oncologists performed all the procedures between May 2005 and June 2011. RESULTS: We retrospectively analyzed 57 patients. The most common pathology being treated was pseudomyxoma peritonei (34 of 57; 59.6%), followed by colorectal cancer (9 of 57; 15.8%). Other types of cancer included peritoneal mesothelioma and gastric adenocarcinoma. The average surgery time was 6.9 hours. Approximately 51% of patients suffered grade 3 or 4 morbidity and there were no perioperative mortalities. CONCLUSIONS: Cytoreduction with hyperthermic intraperitoneal chemotherapy can be performed at our institution with comparable outcomes as academic referral centers.

PMID: 22226143 [PubMed - as supplied by publisher]
[A case of pleural extension of mucinous tumor with pseudomyxoma peritonei].

Fetched: January 2nd, 2012, 10:01pm MST

[A case of pleural extension of mucinous tumor with pseudomyxoma peritonei].

Gan To Kagaku Ryoho. 2011 Nov;38(12):2517-9

Authors: Fujisaki S, Takashina M, Tomita R, Sakurai K, Takayama T

Abstract
We report a case of pleural extension of mucinous tumor with pseudomyxoma peritonei. A 64-year-old man was diagnosed as pseudomyxoma peritonei according to the findings of abdominal CT scan and cytologic examination of the ascitic fluid. At laparotomy in November 2007, jelly-like ascites and a child-head size mutinous tumor involving the greater omentum, transverse colon, and ascending colon were found. Mucious nodules scattered on the undersurface of the right and left hemidiaphragms. In addition, transhiatal extension of mucinous tumors was also extended through the esophageal hiatus, suggesting that thoracic extension of pseudomyxoma peritonei. To avoid an excessive surgical stress, thracotomy was not performed. Cytoreduction surgery was conducted. Postoperative course was uneventful. Although systemic chemotherapy was performed after surgery, intra-abdominal tumor enlarged gradually. Cytoreduction surgery was performed again in September 2008. Thereafter, intra-abdomial tumor enlarged gradually and his physical condition deteriorated. He died 26 months after the first surgery.

PMID: 22202432 [PubMed - in process]
[Extraperitoneal presentation of pseudomyxoma peritonei as retroperitoneal invasion with skin fistula-a case report].

Fetched: January 2nd, 2012, 10:01pm MST

[Extraperitoneal presentation of pseudomyxoma peritonei as retroperitoneal invasion with skin fistula-a case report].

Gan To Kagaku Ryoho. 2011 Nov;38(12):1998-2001

Authors: Chang-Yun L

Abstract
Pseudomyxoma peritonei (PMP) is characterized by mucinous ascites and implants throughout the peritoneal cavity. The tumor rarely involves retroperitoneum. We present a patient of PMP with retroperitoneal presentation and spontaneous development of a skin fistula. There had been only 7 such cases reported.

PMID: 22202264 [PubMed - in process]
[Mucinous neoplasms of the vermiform appendix, Pseudomyxoma peritonei, and the new WHO classification.]

Fetched: December 21st, 2011, 10:01pm MST

[Mucinous neoplasms of the vermiform appendix, Pseudomyxoma peritonei, and the new WHO classification.]

Pathologe. 2011 Dec 18;

Authors: Reu S, Neumann J, Kirchner T

Abstract
Mucinous neoplasms of the appendix are rare tumors, some of them characterized by an enigmatic discrepancy between a benign morphologic appearance and an aggressive biologic potential, associated with a poor prognosis and high mortality. The clinical picture of pseudomyxoma peritonei is, with few exceptions, caused by mucinous appendiceal neoplasms and differs in many aspects from usual peritoneal carcinomatosis. The controversy regarding terminology, diagnostic criteria, classification and therapy of these tumors has lasted for decades. The revised edition of the World Health Organization Classification of Tumors of the Digestive System proposes a uniform reporting system for mucinous appendiceal neoplasms and the peritoneal disease associated with it, thereby creating a comparable basis for pathological diagnosis, clinical therapy and further scientific studies.

PMID: 22179200 [PubMed - as supplied by publisher]
Intussusception of the appendix secondary to mucinous cystadenoma: A rare cause of abdominal pain.

Fetched: November 21st, 2011, 10:00pm MST

Intussusception of the appendix secondary to mucinous cystadenoma: A rare cause of abdominal pain.

Int J Surg Case Rep. 2011;2(2):26-7

Authors: Ashrafi M, Joshi V, Zammit M, Telford K

Abstract
A 35-year-old woman was seen as an outpatient with a 3-month history of pain in the right iliac fossa. A CT scan of her abdomen revealed the presence of a mucocele of the appendix. Intra-operatively, an appendico-appendicular intussusception was found. Histology confirmed the presence of a mucinous cystadenoma with the presence of acellular mucin on the serosal surface of the appendix. This association has rarely been described in the literature. Prompt surgical intervention is advocated to prevent the subsequent development of pseudomyxoma peritonei. We present a case of intussusception of the appendix with a mucinous cystadenoma as its lead point.

PMID: 22096680 [PubMed - in process]
Pathology of primary and metastatic mucinous ovarian neoplasms.

Fetched: November 16th, 2011, 10:01pm MST

Pathology of primary and metastatic mucinous ovarian neoplasms.

J Clin Pathol. 2011 Nov 10;

Authors: Leen SL, Singh N

Abstract
Recent years have seen a dramatic change in the pathological approach to ovarian mucinous neoplasms. A substantial proportion of tumours previously considered to be ovarian primaries actually represent secondary ovarian involvement by tumours elsewhere in the body. Two major categories of tumour have completely disappeared from the diagnostic spectrum: ovarian 'borderline' mucinous tumour associated with pseudomyxoma peritonei, and widely disseminated mucinous carcinomas. The emergent picture of true ovarian primary carcinoma of pure mucinous morphology is that this is a rare malignancy that is low grade and low stage at presentation in the vast majority of cases, with a very low likelihood of aggressive clinical behaviour. A large volume of literature has appeared concerning the pathological distinction of primary from metastatic ovarian mucinous neoplasms in view of the dramatically different prognosis and treacherously similar morphology. Clinicopathological parameters useful in the distinction of primary from metastatic mucinous ovarian carcinomas are reviewed. Major features favouring metastases are bilaterality, size <10 cm, surface involvement, extensive intra-abdominal spread and an extensive infiltrative pattern with desmoplasia. Two morphological patterns essentially exclude ovarian origin: colloid and signet ring carcinomas. Features favouring primary ovarian origin are unilaterality, large size >12 cm, smooth external surface and association with other ovarian pathology. An admixture of benign, borderline and malignant patterns in the same tumour favour primary origin, but can be misleading as a 'maturation' pattern in metastases can result in the same appearance.

PMID: 22075188 [PubMed - as supplied by publisher]
Laparoscopic resection of a appendiceal mucocele.

Fetched: November 10th, 2011, 10:01pm MST

Laparoscopic resection of a appendiceal mucocele.

J Korean Surg Soc. 2011 Jun;80 Suppl 1:S21-5

Authors: Ju YT, Park ST, Ha WS, Hong SC, Lee YJ, Jung EJ, Jung CY, Jeong SH, Choi SK

Abstract
Laparoscopic resection of appendiceal mucoceles has recently been described, but the safety and efficacy are controversial. We present two cases of laparoscopic mucocelectomies involving 14 and 15 cm cystic masses originating from the appendix. The laparoscopic mucocelectomies were performed using four ports. From the beginning of the procedure, a laparoscopic bag was used to safely contain the mucocele, prevent rupture of the mucocele, and retract the mucocele. An endoscopic stapling device was used to transect the base of the cecum. Minimal handling was achieved by gravity and with the use of laparoscopic instruments. Laparoscopic appendectomies are widely performed for acute appendicitis, but laparoscopic resection is not routinely performed for an appendiceal mucocele because of the risk of perforation and subsequent pseudomyxoma peritonei. We report two cases of laparoscopic appendiceal mucocelectomies, which were performed safely with laparoscopic instruments and minimal manipulation.

PMID: 22066077 [PubMed - in process]

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PubMed - Pseudomyxoma Peritonei (PMP) (16 unread)

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