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Federación Mexicana de Ginecología y Obstetricia, A.C.

2022, Number 08

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Ginecol Obstet Mex 2022; 90 (08)

Primary pseudomyxoma peritonei originated from ovaries

Gallardo-Martínez J, Palomo-Rodríguez MF, Brenner- Anidjar RD, Márquez-Maraver F, Pantoja-Garrido M, Gutiérrez-Domingo Á

Language: Spanish
References: 25
Page: 706-712
PDF size: 318.06 Kb.


ABSTRACT

Background: Pseudomyxoma peritonei is very rare; it is characterized by mucinous ascites and peritoneal implants related to rupture and dissemination of the contents of a mucinous tumor. In 80 to 90% of cases the primary tumor is appendicular and the ovary is a truly exceptional location.
Clinical case:A 49 year old female patient presented for consultation due to abdominal pain. Imaging tests showed a left adnexal tumor and findings suggestive of pseudomyxoma peritonei. At surgery, the ovarian mass was partially fragmented, with an enlarged appendix and extensive peritoneal implants; in addition to a large amount of free mucin in the peritoneal cavity. The anatomopathological analysis determined the existence of a mucinous adenocarcinoma in the affected ovary, with positive immunohistochemistry for CK7+ and CK20+, multiple mucin implants and an undamaged appendix. Therefore, a diagnosis was made: pseudomyxoma peritoneum of ovarian origin. After two surgical interventions she did not achieve complete cytoreduction. The patient remained stable for seven years, at which time the symptoms of the disease became evident and led to her death.
Conclusion: Determining the origin of a pseudomyxoma peritonei remains a challenge as often both the appendix and ovaries are affected simultaneously. Therefore, appendectomy and bilateral ovarian exploration should be routine practice. Extensive specimen analysis and immunohistochemistry can facilitate cataloging of these infrequent tumors.


REFERENCES

  1. Mittal R, Chandramohan A, Moran B. Pseudomyxomaperitonei: natural history and treatment. Int J Hyperthermia 2017; 33 (5): 511-19. doi: 10.1080/02656736.2017.1310938

  2. Werth. Klinische und anatomische Untersuchungen zurLehre von den Bauchgeschwülsten und der Laparatomie.Arch Für Gynäkol 1884; 24 (1): 100-18.

  3. Smeenk RM, van Velthuysen ML, Verwaal VJ, ZoetmulderFA. Appendiceal neoplasms and pseudomyxoma peritonei:a population based study. Eur J Surg Oncol 2008; 34: 196-201. doi: 10.1016/j.ejso.2007.04.002

  4. Bignell M, Carr NJ, Mohamed F. Pathophysiology andclassification of pseudomyxoma peritonei. Pleura Peritoneum2016; 11 (1): 3-13. doi: 10.1515/pp-2016-0008

  5. Sugarbaker PH. Pseudomyxoma peritonei. Cancer TreatRes 1996; 81: 105-19.

  6. Carr NJ, Cecil TD, Mohamed F, Sobin LH, Sugarbaker PH,González-Moreno S, et al. A Consensus for Classificationand Pathologic Reporting of Pseudomyxoma Peritoneiand Associated Appendiceal Neoplasia: The Results ofthe Peritoneal Surface Oncology Group International(PSOGI). Modified Delphi Process. Am J Surg Pathol 2016;40 (1): 14-26.

  7. Esquivel J, Sugabaker PH. Clinical presentation of thepseudomyxoma peritonei syndrome. Br J Surg 2000; 87:1414-18. doi: 10.1046/j.1365-2168.2000.01553

  8. Krishnamurthy SR. Role of imaging in peritoneal surfacemalignancies. Indian J Surg Oncol 2016; 7 (4): 441-52.doi: 10.1007/s13193-016-0539-8

  9. Tirumani SH, Fraser-Hill M, Auer R, Shabana W, Walsh C,Lee F, et al. Mucinous neoplasms of the appendix: a currentcomprehensive clinicopathologic and imaging review.Cancer Imaging Off Publ Int Cancer Imaging Soc 2013; 22(13): 14-25. doi: 10.1102/1470-7330.2013.0003

  10. Cotton F, Pellet O, Gilly F-N, Granier A, Sournac L, GlehenO. MRI evaluation of bulky tumor masses in the mesenteryand bladder involvement in peritoneal carcinomatosis.Eur J Surg Oncol 2006; 32 (10): 1212-16. doi: 10.1016/j.ejso.2006.04.013

  11. Passot G, Glehen O, Pellet O, Isaac S, Tychyj C, MohamedF, et al. Pseudomyxoma peritonei: role of 18F-FDG PET inpreoperative evaluation of pathological grade and potentialfor complete cytoreduction. Eur J Surg Oncol 2010; 36 (3):315-23. doi: 10.1016/j.ejso.2009.09.001

  12. Wagner P, Austin F, Sathaiah M, Magge D, Maduekwe U,Ramalingam L, et al. Significance of serum tumour markerlevels in peritoneal carcinomatosis of appendiceal origin.Ann Surg Oncol 2013; 20 (2): 506-14. doi: 10.1245/s10434-012-2627-5

  13. Alexander-Sefre F, Chandrakumaran K, Banerjee S, SextonR, Thomas JM, Moran B. Elevated tumour markers priorto complete tumour removal in patients with pseudomyxomaperitonei predict early recurrence. ColorectalDisease 2005; 7 (4): 382-6. https://doi.org/10.1111/j.1463-1318.2005.00773.x

  14. Kusamura S, Baratti D, Hutanu I, Gavazzi C, Morelli D,Iusco DR, et al. The role of baseline inflammatory-basedscores and serum tumor markers to risk stratify pseudomyxomaperitonei patients treated with cytoreduction.Eur J Surg Oncol 2015; 41 (8): 1097-105. doi: 10.1016/j.ejso.2015.04.005

  15. Kusamura S, Hutanu I, Baratti D, Deraco M. Circulatingtumor markers: predictors of incomplete cytoreductionand powerful determinants of outcome in pseudomyxomaperitonei. J Surg Oncol 2013; 108 (1): 1-8. doi: 10.1002/jso.23329

  16. O’Connell JT, Hacker CM, Barsky SH. MUC2 is a molecularmarker for pseudomyxoma. Mod Pathol 2002; 15: 958-72.doi:10.1097/01.MP.0000026617.52466.9F

  17. Wang J, El-Bahrawy MA. Expression profile of mucins inovarian mucinous tumours: distinguishing primary ovarianfrom metastatic tumours. Int J Gynecol Pathol 2014; 33 (2):166-75. doi:10.1097/PGP.0b013e318288b384

  18. Chu P, Wu E, Weiss LM. Cytokeratin 7 and Cytokeratin20 expression in epithelial neoplasms: a survey of 435cases. Mod Pathol 2000; 13 (9): 962-72. doi: 10.1038/modpathol.3880175

  19. Vang R, Gown AM, Barry TS. Cytokeratins 7 and 20 in primaryand secondary mucinous tumors of the ovary: analysis ofcoordinate immunohistochemical expression profiles andstaining distribution in 179 cases. Am J Surg Pathol 2006;30 (9): 1130-9. doi: 10.1097/01.pas.0000213281.43036.bb

  20. Saluja M, Kenwright DN, Keating JP. Pseudomyxomaperitonei arising from a mucinous borderline ovarian tumour:Case report and literature review. Aust N Z J ObstetGynaecol 2010; 50 (4): 399-403. doi: 10.1111/j.1479-828X.2010.01189.x

  21. Yan F, Shi F, Li X, Yu C, Lin Y, Li Y, et al. ClinicopathologicalCharacteristics of Pseudomyxoma Peritonei Originatedfrom Ovaries. Cancer Manag Res 2020; 12: 7569-78.doi: 10.2147/CMAR.S264474

  22. Dayal S, Taflampas P, Riss S, Chandrakumaran K, CecilTD, Mohamed F, et al. Complete cytoreduction for pseudomyxomaperitonei is optimal but maximal tumor debulkingmay be beneficial in patients in whom complete tumorremoval cannot be achieved. Dis Colon Rectum 2013; 56(12): 1366-72. doi: 10.1097/DCR.0b013e3182a62b0d

  23. Chua TC, Moran BJ, Sugarbaker PH, Levine EA, GlehenO, Gilly FN, et al. Early- and long-term outcome data ofpatients with pseudomyxoma peritonei from appendicealorigin treated by a strategy of cytoreductive surgery andhyperthermic intraperitoneal chemotherapy. J Clin Oncol2012; 30 (20): 2449-56. doi: 10.1200/JCO.2011.39.7166

  24. Omohwo C, Nieroda CA, Studeman KD, Thieme H, KostuikP, Ross AS, et al. Complete cytoreduction offers longtermsurvival in patients with peritoneal carcinomatosis fromappendiceal tumors of unfavorable histology. J Am CollSurg 2009; 209 (3): 308-12.

  25. Elias D, Gilly F, Quenet F, Bereder JM, Sidéris L, MansveltB, et al. Pseudomyxoma peritonei: a French multicentricstudy of 301 patients treated with cytoreductive surgeryand intraperitoneal chemotherapy. EJSO 2010; 36 (5): 456-62. doi: 10.1016/j.ejso.2010.01.006.




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