Introduction: PMP is a rare disease with a slow but progressive course leading to death. According to the literature PMP encompass wide variety of conditions. To avoid the confusion and to facilitate the treatment and comparison of the results several authors suggested that the term `PMP` should include only the cases with appendiceal origin.
Case report: We report two cases with low-grade paseudomyxoma peritonei. The first case was managed by debulking surgery alone with survival 2 years. The second case underwent complete cytoreduction plus HIPEC and 3 years later is still alive and free of disease. There was one patient with a benign appendiceal mucocele treated by appendectomy, who is free of disease 3 years later.
Introduction: PMP is a rare disease with a slow but progressive course leading to death. According to the literature PMP encompass wide variety of conditions. To avoid confusion and to facilitate treatment and comparison of the results several authors suggested that the term `PMP` should include only the cases with appendiceal origin.
Case report: We report two cases with low-grade paseudomyxoma peritonei. The first case was managed by debulking surgery alone with survival 2 years. The second case underwent complete cytoreduction plus HIPEC and 3 years later is still alive and free of disease. There was one patient with a benign appendiceal mucocele treated by appendectomy, who is free of disease 3 years later.
Conclusion: Despite the high complication rate, cytoreductive surgery with HIPEC remains the gold standard in the treatment of pseudomyxoma peritonei. The tumor grade and completeness of cytoreduction are the main prognostic factors. Due to the rarity of the condition most of the surgeons are not experienced enough to manage these patients. Additionally, the incomplete cytoreduction is associated with poorer prognosis and significantly hampers the subsequent interventions. Thus, in the cases when it is found incidentally, the best strategy is the taking of biopsy, appendectomy and subsequent referral to a specialized center for a treatment by multidisciplinary team.
Jarvinen P. Diagnosis and treatment of pseudomyxoma peritonei. PhD Thesis. 2014, Helsinki, Finland.
Smeenk RM, van Velthhuysen ML, Verwaal VJ, Zoetmulder FA. Appendiceal neoplasms and pseudomyxoma peritonei: a population based study. Eur. J. Surg. Oncol. 2008;34(2):196-201.
Bevan K, Mohamed F, Moran B. Pseudomyxoma peritonei. World J. Gastrointest. Oncol. 2010; 2(1):44-50.
Ronnett BM, Yan H, Kurman RJ, Shmookler BM, Wu L, Sugarbaker PH. Patients with pseudomyxoma peritonei associated with disseminated peritoneal adenomucinosis have a significantly more favourable prognosis than patients with peritoneal mucinosis carcinomatosis. Cancer 2001;92:85-91.
Sugarbaker PH. Appendiceal epithelial neoplasms and pseudomyxoma peritonei, a distinct clinical entity with distinct treatmnets. Polski Przeglad Chir. 2007;79(9):618-28.
Ronnet BM, Kurman RJ, Zahn CM, Shmookler BM, Jablonski KA, Kass ME, Sugarbaker PH. Pseudomyxoma peritonei in women : a clicopathologic analysis of 30 cases with emphasis on site of origin, prognosis, and relationship to ovarian mucinous tumors of low malignant potential. Hum. Pathol. 1995;26:509-24.
Szych C, Staebler A, Connolly D, Wu R, Cho KR, Ronnett BM. Molecular genetic evidence supporting the clonality and appendiceal origin of Pseudomyxoma peritonei in women. The Am. J. Pathol. 1999;154(6):1849-55.
Mukherjee A, Parvaiz A, Cecil T, Moran B. Pseudomyxoma peritonei usually originates from the appendix: a review of the evidence. Eur. J. Gynecol. Oncol. 2004;25(4):411-14.
Ronnet BM, Zahn CM, Kurman RJ, Sugarbaker PH, Shmookler BM. Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to `pseudomyxoma peritonei`. Am. J. Surg. Pathol. 1995;19:1390-1408.
Carr N. In: WHO Classification of Tumours of the Digestive System. 4th Ed.; 2010:122-124.
Sulkin T, O'Neill H, Amin A, Moran B. CT in pseudomyxoma peritonei: a review of 17 cases. Clin. Radiol. 2002;57:608-13.
Van Ruth S, Hart AA, Bonfrer JM, Verwaal VJ, Zoetmulder FA. Prognostic value of baseline and serial carcinoembryonic antigen and carbohydrate antigen, 19.9 measurements in patients with pseudomyxoma peritonei treated with cytoreduction and hyperthermic intraperitoneal chemotherapy. Ann. Surg. Oncol. 2002;9:961-7.
Glehen O, Mohamed F, Sugarbaker P. Incomplete cytoreduction in 174 patients with peritoneal carcinomatosis from appendiceal malignancy. Ann. Surg. 2004;240:278-85.
Stephens A, Alderman R, Chang D, et al. Morbidity and mortality analysis of 200 treatments with cytoreductive surgery and hyperthermic intraoperative intraperitoneal chemotherapy using the coliseum technique. Ann. Surg. Oncol. 1999;6(8):790-6.
Elias D, Bonnay M, Puizillou J, et al. Heated intraoperative intraperitoneal oxaliplatine after complete resection of peritoneal carcinomatosis:pharmacokinetiks and tissue distribution. Ann. Oncol. 2002;13(2):267-72.
Elias D, Honore C, Ciuchendea R, et al. Peritoneal pseudomyxoma: results of a systematic policy of complete cytoreductive surgey and hyperthermic intraperitoneal chemotherapy. Br. J. Surg. 2008;95(9):1164-71.
Smith J, Kemeny N, Caldwell C, Banner P, Sigurdson E, Huvos A. Pseudomyxoma peritonei of appendiceal origin. The Memorial Sloan-Kettering Cancer Center experience. Cancer 1992;70:396-401.
Gough D, Donohue J, Schutt A, Gonchoroff N, Goeliner JR, Wilson TO, et al. Pseudimyxoma peritonei. Long-term patient survival with an aggressive regional approach. Ann. Surg. 1994;219(2):112-9.
Sugarbaker P, Chang D: Results of treatment of 385 patients with peritoneal surface spread of appendiceal malignancy. Ann. Surg. Oncol. 1999;6:727-31.
Piso P, Bektas H, Werner U, Schlitt HJ, Kubicka S, Bornscheuer A, et al. Improved prognosis following peritonectomy procedures and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis from appendiceal carcinoma. EJSO. 2001;27:286-90.
van Ruth S, Acherman Y, van de Vijver M, Hart AA, Verwaal VJ, Zoetmulder FA. Pseudomyxoma peritonei: a review of 62 cases. Eur. J. Surg. Oncol. 2003;29:682-8.
Misdraji J, Yantiss R, Graeme-Cook F, Graeme-Cook FM, Balis UJ, Young RH. Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases. Am. J. Surg. Pathol. 2003;27:1089-103.
Guner Z, Schmidt U, Dahlke M, Schlitt HJ, Klempnauer J, Piso P. Cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei. Int. J. Colorectal Dis. 2005;20(2):155-60.
Baratti D, Kusamura S, Nonaka D, Langer M, Andreola S, Favaro M, et al. Pseudomyxoma peritonei: clinical pathological and biological prognostic factors in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Ann. Surg. Oncol. 2007;15(2):526-34.
Vaira M, Cioppa T, de Marco G, Bing C, D`Amico S, D`Alessandro M, et al. Management of pseudomyxoma peritonei by Cytoreduction+HIPEC (Hyperthermic Intraperitoneal Chemotherapy): results analysis of a twelve-year experience. In vivo 2009;23:639-44.
Elias D, Gilly F, Quenet F, Bereder JM, Sideris L, Mansvelt B, et al. Pseudomyxoma peritonei: a French multicentric study of 301 patients treated with cytoreductive surgery and intraperitoneal chemotherapy. Eur. J. Surg. Oncol. 2010;36(5):456-62.
Youssef H, Newman C, Chandrakumaran K, Mohamed F, Cecil TD, Moran BJ. Operative findings, early complications, and long-term survival in 456 patients with pseudomyxoma peritonei syndrome of appendiceal origin. Dis. Col. Rectum. 2011;54(3):293-99.
Andreasson H, Graf W, Nygren P, Glimelius B, Mahteme H. Outcome difference between debulking surgery and cytoreductive surgery in patients with pseudomyxoma peritonei. Eur. J. Surg. Oncol. 2012;38(10):962-968.
Sorensen O, Flatmark K, Reed W, Wiig JN, Dueland S, Giercksky KE, et al. Evaluation of complete cytoreductive surgery and two intraperitoneal chemotherapy techniques in pseudomyxoma peritonei. Eur. J. Surg. Oncol. 2012;38(10):969-76.
Chua T, Moran B, Sugarbaker P, Levien EA, Glehen O, Gilly FN, et al. Early- and long-term outcome data of patients with pseudomyxoma peritonei from appendiceal origin treated by a strategy of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J. Clin. Oncol. 2012;30(20):2449-56.
Iversen L, Rasmussen P, Hageman-Madsen R, Laurberg S. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis: the Danish experience. Colorectal Dis. 2013;15(7):365-72.
Kuijpers A, Mirck B, Aalbers A, Nienhuijs SW, de Hingh I, Wiezer M, et al. Cytoreduction and HIPEC in the Netherlands: Nationwide Long-term Outcome Following Dutch Protocol. Ann. Surg. Oncol. 2013;20:4224-30.
Lord AC, Shihab O, Chandrakumaran K, Mohamed F, Cecil TD, Moran BJ. Recurrence and outcome after complete tumour removal and hyperthermic intraperitoneal chemotherapy in 612 patients with pseudomyxoma peritonei from perforated appendiceal mucinous tumours. Eur. J. Surg. Oncol. 2015;41(3):396-9.
Wheeler B, Reddy S, Kenwright D, Keating JP. Treating pseudomyxoma peritonei without heated intraperitoneal chemoradiotherapy - a first look in New Zealand. NZMJ. 2014;127(1389):31-39.
Miner T, Shia J, Jaques D, Klimstra D, Brennan M, Coit D. Long-term survival following treatment of pseudomyxoma peritonei. Ann. Surg. 2005;241:300-8.