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

1. Dr Rekha Khare
MD Radiology

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

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

4.  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

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

6.  Ruptured mucinous tumour of
appendix/ appendiceal mucocele

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

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

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

10.  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

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

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

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

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

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

16.  Peritoneal carcinomatosis without
mucinous ascites
 Peritoneal sarcomatosis
 Peritonitis

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

18.  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

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

20.  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

21.  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)

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

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

44.  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

45.  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

46.  Pseudomyxoma Peritoneii, Alexandra
Stanislavsky. Radiology Reference article
Radiopaedia.org
 Pseudomyxoma peritoneii(PMP), Diagnosis
and Imaging finding
www.medscape.com/view article/506509_2

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

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