Kostov Stoyan, Kornovski Yavor, Slavchev Stanislav, Ivanova Yonka, Dzhenkov Deyan, Yordanov Angel, Slavcheva Svetoslava
Department of Gynecology, UMHAT "Saint Anna", Varna, Bulgaria.
Department of Gynecology, Medical University Varna "Prof. Dr. Paraskev Stoyanov", Varna, Bulgaria.
Prz Menopauzalny. 2021 Sep;20(3):148-153. doi: 10.5114/pm.2021.109120. Epub 2021 Sep 13.
Pseudomyxoma peritonei (PMP) is a rare and uncommon condition, characterized by the presence of mucinous ascites in the abdominal cavity. The most common cause of PMP is mucinous adenocarcinoma of the appendix, followed by neoplasms of the ovary, endocervix, fallopian tube, alimentary organs, urachus, urinary bladder, lung, mucinous cyst of the spleen, and breast. Herein, we report a case of a 64-year-old postmenopausal woman (gravida 2, para 2) who presented at the department of gynecology with a short history of nausea and abdominal distention. Abdominal and vaginal ultrasonography showed a large amount of free fluid in the pelvis with hyperechoic echogenicity and right pelvic tumor with mixed echogenicity. Computed tomography demonstrated the presence of a heterogeneous, hypodense mass, without contrast enhancement, located on the right side of the pelvis, near the right ovary. Laparotomy was performed. Revision of the abdominal cavity revealed a large amount of yellow gelatinous mucinous ascites - approximately 1.5 l. A tumor (6 x 7 cm in diameter), arising from the appendix and located in the pouch of Douglas near the right ovary, was observed. Histopathology examination revealed poorly differentiated mucinous appendiceal adenocarcinoma, comprising up to 50% signet ring cells. Gastrointestinal tumors such as appendiceal neoplasms combined with PMP may mimic ovarian carcinomas. Computed tomography, abdominal/vaginal ultrasonography and tumor marker levels (carcino-embryonic antigen, carbohydrate antigen 19.9, carbohydrate antigen Ca-125) may establish the diagnosis. A differential diagnosis with appendiceal tumors should be considered for patients with right pelvic masses.
腹膜假黏液瘤(PMP)是一种罕见病症,其特征为腹腔内出现黏液性腹水。PMP最常见的病因是阑尾黏液腺癌,其次是卵巢、子宫颈、输卵管、消化器官、脐尿管、膀胱、肺、脾脏黏液囊肿及乳腺的肿瘤。在此,我们报告一例64岁绝经后女性(孕2产2),因恶心和腹胀病史较短就诊于妇科。腹部及阴道超声检查显示盆腔内有大量高回声的游离液体,右侧盆腔有混合回声肿瘤。计算机断层扫描显示盆腔右侧靠近右卵巢处有一个不均匀的低密度肿块,无对比增强。遂行剖腹手术。术中见腹腔内有大量黄色胶冻样黏液性腹水——约1.5升。观察到一个直径6×7厘米的肿瘤,起源于阑尾,位于右卵巢附近的Douglas陷凹。组织病理学检查显示为低分化黏液性阑尾腺癌,印戒细胞占比高达50%。胃肠道肿瘤如阑尾肿瘤合并PMP可能会酷似卵巢癌。计算机断层扫描、腹部/阴道超声检查及肿瘤标志物水平(癌胚抗原、糖类抗原19.9、糖类抗原Ca-125)有助于确诊。对于右盆腔肿块患者,应考虑与阑尾肿瘤进行鉴别诊断。