Pseudomyxoma final slideshare

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Information about Pseudomyxoma final slideshare
Health & Medicine

Published on March 11, 2014




Pseudomyxoma peritoneii is a rare entity. It is good for medical students as tutorial session

Dr Rekha Khare MD Radiology

 It is a clinical condition caused by cancerous cells that produce diffuse intra peritoneal gelatinous ASCITIS in abdomen and pelvis

 Ascites is recurrent, voluminous and mucinous  Ascites is due to surface growth on the peritoneum without invading the underlying tissue

 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

 Over all incidence- 1-2/million/year  Male :Female ratio= 9:11  Median age at presentation is about 50years (range 20-25years)

 Ruptured mucinous tumour of appendix/ appendiceal mucocele

 Mucinous tumour of large & small bowel, Lung, Breast, Pancreas, Stomach, Bile duct, Gall bladder and Fallopian tube / Ovary, urachal tumour are implicated

 Patient may present with: -abdominal or pelvic pain -bloating/ distension -digestive disorder -weight loss -increasing abdominal girth -infertility

 In male: patient may come with Inguinal hernia  In female: presentation could be with uni/ bilateral ovarian disease

 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

 PET scan may be used to evaluate high grade mucinous adenocarcinoma  New MRI procedures are being developed for disease monitoring

 Non mobile Ascites with septations or loculated ascites with echogenic particle  Scalloping of liver, spleen & other organs

 Loculated low attenuated ascites  Multiple complex cystic masses of fat density or variable density

 Scalloping of visceral surface of liver, spleen & other organs  Compression or central displacement of small bowels

 Any of the above finding with: - mass in Rt. lower quadrant/appendicial mucocele -pelvic mass/ mucinous ovarian mass - any other underlying cause of PMP

 Peritoneal carcinomatosis without mucinous ascites  Peritoneal sarcomatosis  Peritonitis

 Peritoneal Adenomucinosis Primary tumour: ADENOMA  Peritoneal mucinous carcinoma Primary tumour: MUCINOUS ADENOCARCINOMA  Intermediate or discordant feature

 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

 Good with treatment  Lethal if untreated with death by -cachexia, -renal failure -other types of complication

 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

 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)

 Multi loculated ascites with well enhanced rim of peritoneum  Pocket of fluid in right iliac fossa, pelvic cavity and para colic gutter

 Scalloping effect over the border of liver and spleen  Small bowel seems to be gathered in the center  Right pleural effusion r

 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

 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

 Pseudomyxoma Peritoneii, Alexandra Stanislavsky. Radiology Reference article  Pseudomyxoma peritoneii(PMP), Diagnosis and Imaging finding article/506509_2

 Pseudomyxoma peritoneii. Submitted by Paurush shah MSIV www.learning  Peritoneum & Mesentery PartII Pathology Angela Levy, The Radiology Assistant

 Gray-scale sonographic finding in a patient with pseudomyxoma , C Lersch etal Journal of Clinical ultrasound vol 29 Issue3 page186-191March/April 2001

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