Pseudomyxoma peritonei is seen with
|B||Mucin secreting ovarian carcinoma|
a. Pseudomyxoma peritonei is a rare malignant process of the peritoneal cavity that characteristically arises from a ruptured ovarian or appendiceal adenocarcinoma.
b. In this disease, the peritoneum becomes coated with a mucus-secreting tumor that fills the peritoneal cavity with tenacious, semisolid mucus and large loculated cystic masses.
c. Pseudomyxoma peritonei is most prevalent in women between 50 and 70 years of age.
d. It is often asymptomatic until very late in its course, and patients often experience a global deterioration in their health long before the diagnosis of pseudomyxoma peritonei is made.
e. Symptoms include abdominal pain and distention as well as numerous nonspecific symptoms.
f. Physical examination reveals a distended abdomen with nonshifting dullness.
g. On occasion, a palpable abdominal mass may be present, especially in tumors of appendiceal origin.
h. CT may demonstrate posterior displacement of the small intestine, loculated collections of fluid-density material, and scalloping of intra-abdominal organs due to extrinsic compression by adjacent peritoneal implants.
j. Ovarian malignancies are treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy as well as cytoreduction. In the setting of an indeterminate site of origin, a right colectomy and resection of the omentum along with bilateral oophorectomy and cytoreduction surgery are performed.
k. Postoperative adjuvant therapy has included the use of intraperitoneal 5-fluorouracil, mitomycin C, and oxiliplatin, as well as intraperitoneal mucolytics, such as dextran sulfate and plasminogen activator (urokinase).