A RARE CASE PSEUDOMYXOMA PERITONEI AND FEMALE PELVIC MASS
Pseudomyxoma peritonei is a rare clinical entity with estimated incidence of one to two per million per year. It is characterized by diffuse intraabdominal gelatinous collections with mucinous implants on peritoneal surfaces and the omentum. PMP predominantly originates in the appendix in men, and synchronous ovarian and appendiceal disease in women.
We presented a rare case of PMP caused by primary mucinous adenocarcinoma of the appendix that spread to the right ovary in the 48-years female.
She complained to abdominal distension, abdominal pain in lower right quadrant and appearance umbilical hernia about two months duration. Expression levels of the tumor markers CA 125, CEA and CA 19-9 were elevated but HE 4 was in normal range.
She underwent gynecologic ultrasound, computed tomography scan and MRI which showed multiseptated cystic mass in her right lower quadrant and a large amount of ascites in all abdominal recess uses.
The presumed preoperative diagnosis was Ca ovarii with dissemination lesions into liver, splenic and peritonea. She underwent to exploratory laparoscopy.
Approximately 5000 ml of gelatinous fluid was aspirated from the pelvis and abdomen. The right adnexectomy and biopsio peritonei was done.
Surgical specimens were submitted for immunohistochemical examinations to distinguish the origin of the tumor and finally it showed low grade mucinous adenocarcinoma appendix.
In conclusion diagnosis of the adenocarcinoma appendix is difficult due to its lack of specific symptoms and signs. Adenocarcinoma appendix is an extremely rare disease in clinical practice. Until 2002, less than 250 cases had been reported in literature.
Milica Glusac was born in Niksic Montenegro in the year of 1981. Completed University School of Medicine in Podgorica at the age of 25 and specialization study of gynecology and obstetrician at University in Belgrade at the age 33. Nowadays works in general Hospital in Niksic.