A Case Report of Pseudomyxoma Peritonei Arising From Primary Mucinous Ovarian Neoplasms

Abstract

Pseudomyxoma peritonei (PMP) is a rare manifestation of primary mucinous neoplasms. We report two rare cases of PMP originating from mucinous primary ovarian neoplasms. The case series discusses the cases of female patients aged 86 and 52 years who presented with worsening dyspepsia, abdominal distension, pelvic pain, and altered bowel habits. Both of the patients underwent evaluation comprising cancer antigen-125 (CA-125) levels, ultrasound (US) examination of the abdomen and the pelvis, tumor markers, cytological evaluation, and contrast-enhanced computed tomography (CECT) of the pelvis and abdomen. Patients were diagnosed to have pseudomyxoma peritonei arising from mucinous ovarian tumors. Patients were referred to the surgical department and were successfully managed with repeated removal of mucinous material. The present case report highlights the significant radio-pathologic characteristics of PMP, which originated from mucinous ovarian tumors.

Keywords: abdominal radiology; academic radiology; appendix; cystic mass; mucinous neoplasms; ovary; pseudomyxoma peritonei.

Figure 1. Contrast-enhanced computed tomography of abdomen and pelvis: (A) axial view and (B) coronal view

CECT of abdomen and pelvis showed (A) a large peripherally enhancing cystic mass arising from the right ovary with thin enhancing septae (arrowhead); (B) mucinous fluid within the peritoneal cavity (white arrow).

Figure 2. Aspirated ascitic fluid smear

Aspirated ascitic fluid showing mucinous epithelium totally lacking cytologic atypia consistent with pseudomyxoma peritonei (white arrow).

Figure 3. Mucinous ovarian cystadenoma

Ovarian lesion showing simple, non-stratified, mucinous epithelium with small basally located nuclei lacking cytological atypia consistent with benign mucinous ovarian cystadenoma (white arrow).

Figure 4. CT abdomen and pelvis: (A) axial view and (B) sagittal view

Mucinous appearing free fluid in peritoneal cavity (white arrow) and scalloping of liver and spleen (black arrow) (A). CT abdomen and pelvis showed (B) a complex cystic mass with multiple septations in the pelvis posterior to the bladder causing indentations on the bladder contour (arrowhead). There was mucinous appearing free fluid in the peritoneal cavity (white arrow).

Figure 5. Aspirated ascitic fluid

Ascitic fluid aspirated showed acellular pink proteinaceous mucus material with few RBCs in the background consistent with pseudomyxoma peritonei (white arrow). RBC: red blood cells.

Figure 6. Benign mucinous ovarian cystadenoma

Ovarian lesion showing a cyst wall lined by single layer of mucinous epithelium (white arrow) consistent with benign mucinous ovarian cystadenoma.