pseudomyxoma peritoneii
DESCRIPTION
Pseudomyxoma peritoneii is a rare entity. It is good for medical students as tutorial sessionTRANSCRIPT
![Page 1: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/1.jpg)
PSEUDOMYXOMA PERITONEII
‘jelly belly’—a case
Dr Rekha KhareMD Radiology
![Page 2: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/2.jpg)
It is a clinical condition caused by cancerous cells that produce diffuse intra peritoneal gelatinous ASCITIS in abdomen and pelvis
What is PMP ?
![Page 3: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/3.jpg)
Ascites is recurrent, voluminous and mucinous
Ascites is due to surface growth on the peritoneum without invading the underlying tissue
contd…..
![Page 4: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/4.jpg)
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
History of PMP…..
![Page 5: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/5.jpg)
Over all incidence- 1-2/million/year
Male :Female ratio= 9:11
Median age at presentation is about 50years (range 20-25years)
Epidemiology…..
![Page 6: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/6.jpg)
Ruptured mucinous tumour of appendix/ appendiceal mucocele
Most common cause…..
![Page 7: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/7.jpg)
Mucinous tumour of large & small bowel, Lung, Breast, Pancreas, Stomach, Bile duct, Gall bladder and Fallopian tube / Ovary, urachal tumour are implicated
Other uncommon causes…..
![Page 8: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/8.jpg)
Patient may present with:
-abdominal or pelvic pain -bloating/ distension -digestive disorder -weight loss -increasing abdominal girth -infertility
Clinical Presentation…..
![Page 9: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/9.jpg)
In male: patient may come with Inguinal hernia
In female: presentation could be with uni/ bilateral ovarian disease
Clinical presentation…..
![Page 10: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/10.jpg)
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
How to diagnose PMP?
![Page 11: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/11.jpg)
PET scan may be used to evaluate high grade mucinous adenocarcinoma
New MRI procedures are being developed for disease monitoring
Recent modality…..
![Page 12: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/12.jpg)
Non mobile Ascites with septations or loculated ascites with echogenic particle
Scalloping of liver, spleen & other organs
Ultrasound findings…..
![Page 13: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/13.jpg)
Loculated low attenuated ascites
Multiple complex cystic masses of fat density or variable density
CT findings.....modality of choice
![Page 14: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/14.jpg)
Scalloping of visceral surface of liver, spleen & other organs
Compression or central displacement of small bowels
CT findings…..
![Page 15: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/15.jpg)
Any of the above finding with:
- mass in Rt. lower quadrant/appendicial mucocele
-pelvic mass/ mucinous ovarian mass
- any other underlying cause of PMP
CT findings…..
![Page 16: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/16.jpg)
Peritoneal carcinomatosis without mucinous ascites
Peritoneal sarcomatosis
Peritonitis
Differential Diagnosis…..
![Page 17: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/17.jpg)
Peritoneal Adenomucinosis Primary tumour: ADENOMA
Peritoneal mucinous carcinoma Primary tumour: MUCINOUS ADENOCARCINOMA Intermediate or discordant feature
Pathological subtypes…..
![Page 18: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/18.jpg)
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
Complications…..
![Page 19: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/19.jpg)
Good with treatment
Lethal if untreated with death by -cachexia, -renal failure -other types of complication
Prognosis…..
![Page 20: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/20.jpg)
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
Case to present…..
![Page 21: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/21.jpg)
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)
Ultrasound exam…..
![Page 22: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/22.jpg)
Multi loculated ascites with well enhanced rim of peritoneum
Pocket of fluid in right iliac fossa, pelvic cavity and para colic gutter
CECT findings…..
![Page 23: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/23.jpg)
Scalloping effect over the border of liver and spleen
Small bowel seems to be gathered in the center
Right pleural effusion r
CT findings….. Contd.
![Page 24: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/24.jpg)
![Page 25: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/25.jpg)
![Page 26: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/26.jpg)
![Page 27: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/27.jpg)
![Page 28: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/28.jpg)
![Page 29: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/29.jpg)
![Page 30: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/30.jpg)
![Page 31: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/31.jpg)
![Page 32: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/32.jpg)
![Page 33: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/33.jpg)
![Page 34: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/34.jpg)
![Page 35: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/35.jpg)
![Page 36: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/36.jpg)
![Page 37: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/37.jpg)
![Page 38: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/38.jpg)
![Page 39: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/39.jpg)
![Page 40: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/40.jpg)
![Page 41: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/41.jpg)
![Page 42: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/42.jpg)
![Page 43: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/43.jpg)
![Page 44: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/44.jpg)
Finally…..
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
![Page 45: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/45.jpg)
Conclusion…..
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
![Page 46: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/46.jpg)
References…..
Pseudomyxoma Peritoneii, Alexandra Stanislavsky. Radiology Reference article
Radiopaedia.org
Pseudomyxoma peritoneii(PMP), Diagnosis and Imaging finding www.medscape.com/view article/506509_2
![Page 47: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/47.jpg)
Pseudomyxoma peritoneii. Submitted by Paurush shah MSIV www.learning radiology.com
Peritoneum & Mesentery PartII Pathology Angela Levy, The Radiology Assistant
References contd…..
![Page 48: Pseudomyxoma Peritoneii](https://reader036.vdocument.in/reader036/viewer/2022062705/55654d28d8b42a9b4c8b4edc/html5/thumbnails/48.jpg)
Gray-scale sonographic finding in a patient with pseudomyxoma , C Lersch etal Journal of Clinical ultrasound vol 29 Issue3 page186-191March/April 2001
References contd…..