ABSTRACT
Primary appendiceal carcinoma is extremely rare and is found in approximately 1% of
appendectomy specimens. When cancer is present, the most frequent histology is mucinous
adenocarcinoma. Neoplasms of the appendix that secrete mucin such as adenocarcinoma
may rupture, leading to intraperitoneal seeding of the peritoneum and producing the
clinical picture of pseudomyxoma peritonei (PMP). PMP is characterized by mucin-producing
neoplastic cells that have seeded the peritoneum from the ruptured viscous and continue
to secrete copious amounts of gelatinous material that accumulates in the abdomen
producing the characteristic “jelly belly.” A review of the medical literature revealed
no cases of PMP diagnosed at time of cesarean section. A previously healthy gravida
5, para 3 underwent cesarean section. Upon opening of the peritoneum, copious amounts
of gelatinous, yellow-tinged mucoid material was noted. A general surgeon was consulted,
and grossly necrotic-appearing appendix was noted. The patient underwent appendectomy
with right hemicolectomy. Pathology showed well-differentiated mucinous adenocarcinoma
of the appendix. PMP is associated with gastrointestinal and ovarian carcinomas. Although
somewhat rare, these cancers may occur in pregnancy. Because nonspecific abdominal
pain and increasing abdominal girth are common in pregnancy, patients' complaints
may go ignored. Early diagnosis of a potentially life-threatening disease requires
that clinicians expand the differential diagnosis and consider the possibility of
a malignant neoplasm presenting in the pregnant female.
KEYWORDS
Pseudomyxoma peritonei - mucinous adenocarcinoma of the appendix - pregnancy complications
- cancer
REFERENCES
- 1
Jivan S, Bahal V.
Pseudomyxoma peritonei.
Postgrad Med J.
2002;
78
170-172
- 2
Donnenfeld A E, Roberts N S, Losure T A, Mellen A W.
Perforated adenocarcinoma of the appendix during pregnancy.
Am J Obstet Gynecol.
1986;
154
637-638
- 3
Morgan D R, Fernandez C O, DeSarno C et al..
Adenocarcinoma of the appendix in pregnancy: a case report.
J Reprod Med.
2004;
49
753-755
- 4
Lang H, Jahne J, Flemming P, Meyer H J, Pichlmayr R.
Pseudomyxoma peritonei of appendiceal origin—a report of seven cases and a review
of published reports.
Eur J Surg.
1995;
161
355-360
- 5
Sugarbaker P H.
Pseudomyxoma peritonei.
Cancer Treat Res.
1996;
81
105-119
- 6
Yeh H C, Shafir M K, Slater G et al..
Ultrasonography and computed tomography in pseudomyxoma peritonei.
Radiology.
1984;
153
507-510
- 7
Caspi B, Cassif E, Auslender R.
The onion skin sign: a specific sonographic marker of appendiceal mucocele.
J Ultrasound Med.
2004;
23
117-121
- 8
Varona J F, Guerra J M, Salamanca J, Colina F, Lopez G, Morales M.
Pseudomyxoma peritonei: a clinicopathologic analysis and follow-up of 21 patients.
Hepatogastroenterology.
2005;
52
812-816
- 9
Prayson R A, Hart W R, Petras R E.
Pseudomyxoma peritonei: a clinicopathologic study of 19 cases with emphasis on site
of origin and nature of associated ovarian tumors.
Am J Surg Pathol.
1994;
18
591-603
- 10
Pranesh N, Menasce L P, Wilson M S, O'Dwyer S T.
Pseudomyxoma peritonei: unusual origin from an ovarian mature cystic teratoma.
J Clin Pathol.
2005;
58
1115-1117
- 11
Ronnett B M, Seidman J D.
Mucinous tumors arising in ovarian mature cystic teratomas: relationship to the clinical
syndrome of pseudomyxoma peritonei.
Am J Surg Pathol.
2003;
27
650-657
- 12
Sugarbaker P H.
Cytoreductive surgery and perioperative intraperitoneal chemotherapy as a curative
approach to pseudomyxoma peritonei syndrome.
Tumori.
2001;
87
S3-5
- 13
Kalu E, Croucher C.
Appendiceal mucocele: a rare differential diagnosis of a cystic right adnexal mass.
Arch Gynecol Obstet.
2005;
271
86-88
- 14
Beller F K, Zimmerman R E, Nienhaus H.
Biochemical identification of mucus of pseudomyxoma peritonei as the basis of mucolytic
treatment.
Am J Obstet Gynecol.
1986;
155
970-973
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