Dynamic observation of pseudomyxoma peritonei: a clinical case

Abstract

INTRODUCTION: Pseudomyxoma peritonei (PMP) is a rare pathology without specific clinical symptoms, predominantly asymptomatic in the early stages and can be difficult to diagnose; leads to extensive surgical procedures and reduced quality of life of the patient. PMB in most cases occurs due to invasion or perforation of a mucinous tumor of the appendix.OBJECTIVE: To perform a dynamic follow-up of a patient with pseudomyxoma peritoneum of appendicular origin with asymptomatic course.MATERIALS AND METHODS: A dynamic follow-up (from 2018 to 2024) of a 64-year-old female patient was performed. At the annual routine ultrasonography (USG) a moderate accumulation of fluid in the pelvic cavity was detected, which increased in dynamics. Computed tomography (CT) of the abdominal cavity and retroperitoneum was performed, and the results showed extended infiltrates, enlargement of the appendix lumen, and ascitic fluid in the peritoneal cavity. According to the histological study, a lowgrade appendicular mucinous neoplasms (LAMN) and pseudomyxoma of the peritoneum (low-grade mucinous carcinoma peritonei (LGMCP)) were verified. The patient underwent incomplete cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). MRI or CT studies of the abdominal cavity and retroperitoneum were performed during dynamic follow-up.RESULTS: The presence of a large volume of tumor masses, including those localized in the area of the liver gate, mesentery of the small intestine, did not allow to perform complete cytoreductive surgery with HIPEC. During dynamic observation, an increase in the size of peritoneal pseudomyxoma was noted.CONCLUSION: A comprehensive approach, up-to-date diagnosis and identification of affected area help to determine the tactics of patient management.