Pseudomyxoma peritonei

Abstract

The authors report a case of a 60 years old Romanian male with peritoneal pseudomyxoma that was discovered to have a primary location in the greater omentum. Pseudomyxoma peritonei arising into the greater omentum is very rare. It is an original case report and the new data represents a well-balanced summary of a timely subject, with reference to the literature. This it is a significantly advance in our understanding of a particular disease etiology. Until now, only a few primary greater omentum pseudomyxoma peritonei have been described. Clinical and pathologic findings of this case are presented and the topic of primary location in the great omentum of pseudomyxoma peritonei was reviewed. Preoperative ultrasound examination showed the presence of an "eyes of net" tumoral-mass formation, in the greater omentum, and a fluid collection was found in the abdomen (Morrison space and the pouch of Douglas). Notwithstanding, diagnosis of pseudomyxoma was preoperatively considered less probable due to the rarity of the affection and the advanced age. During laparotomy, the presence of the large mass observed at the ultrasound examination was revealed. Mucinous ascites was present with invasive mucinous implants in the peritoneum and in the greater omentum. Operation consisted in the total removal of the mass followed by evacuation of the mucinous ascites. Histological examination confirmed the clinical diagnosis of pseudomyxoma peritonei.

Keywords: fibrous; peritoneum; pseudomyxoma; ultrasound examination.

Figure 1

Ultrasound examination of the abdomen revealed the presence of the fluid in peritoneal cavity and the presence of a “net’s eyes” tumoral formation without sings of the portal venous pressure.

Figure 2

Macroscopically, it was a round shaped formation of about 12 cm in diameter containing gelatinous substance like pseudomyxoma peritonei. Thus, we diagnosed it as retroperitoneal pseudomyxoma.

Figure 3

Pseudomyxoma peritonei characterized by pools of mucin containing very rare clusters of low-grade epithelium. (Hematoxylin-eosin, original magnification ×200)

Figure 4

Gelatinous aspect liquid (Hematoxylin-eosin, original magnification ×200)

Figure 5

Typical epithelium of a cyst adenoma with pseudo stratified, columnar cells containing elongated, crowded, hyper chromatic nuclei and scattered, well-defined goblet cells. (Hematoxylin-eosin, original magnification ×200).

Figure 6

Adenomatous epithelium within diverticulum with marked associated acute inflammation. (Hematoxylin-eosin, original magnification ×200).

Figure 7

Pools of acellular mucin infiltrate through fibro-vascular tissue (Hematoxylin-eosin, original magnification ×400).