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Gelatinous ascites: a cytohistologic study of pseudomyxoma peritonei in 67 patients
S L Jackson1, R A Fleming, B W Loggie
1Department of Pathology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA.
Background:
Pseudomyxoma peritonei (PMP) is a rare condition characterized by gelatinous ascites. Although the histologic attributes of PMP have been well studied, the cytologic features remain ill defined.
Methods:
We reviewed the peritoneal washings (PW) in 67 patients with PMP to identify cytomorphologic features useful in classifying cases as either disseminated peritoneal adenomucinosis (DPAM) or peritoneal mucinous carcinomatosis (PMCA). Histologic specimens were correlated with the cytologic diagnoses. Correlation between cytologic diagnosis and patient outcome was investigated.
Results:
Neoplastic epithelial cells were identified in 63 of 67 PW (94%). Concordance with the histologic diagnosis was obtained in 61 of 63 cases. Of these 36.5% were cytologically classified as DPAM with primary appendiceal neoplasms in 19 cases. Thirty-four of 63 cases (53.9%) were cytologically diagnosed as PMCA based on PW cytology. Most were of appendiceal or colonic origin. Four cases displayed cytologic features of both DPAM and PMCA. Two discordant cases each with a cytologic diagnosis of PMCA had an appendiceal adenoma. Acellular mucin alone was identified in the PW in four cases. Analysis of follow-up data revealed that cases diagnosed as DPAM had a better prognosis than those diagnosed as PMCA.
Conclusions:
Cytomorphologic features of epithelial cells in PW material can accurately categorize cases of PMP as either DPAM or PMCA. Furthermore, this categorization appears to have important prognostic implications.
Insights
Cytologic analysis of peritoneal washings accurately classifies pseudomyxoma peritonei (PMP) into disseminated peritoneal adenomucinosis (DPAM) or peritoneal mucinous carcinomatosis (PMCA), aiding prognosis.
Area of Science:
- Gastroenterology
- Pathology
- Oncology
Background:
- Pseudomyxoma peritonei (PMP) is a rare condition with gelatinous ascites.
- Histologic features of PMP are well-documented, but cytologic characteristics are less defined.
Purpose of the Study:
- To identify cytomorphologic features in peritoneal washings (PW) for classifying PMP.
- To differentiate between disseminated peritoneal adenomucinosis (DPAM) and peritoneal mucinous carcinomatosis (PMCA).
- To correlate cytologic diagnosis with patient outcomes.
Main Methods:
- Review of peritoneal washings from 67 PMP patients.
- Correlation of cytologic findings with histologic specimens.
- Analysis of patient follow-up data.
Main Results:
- Neoplastic epithelial cells found in 94% of PW samples.
- Cytologic classification achieved high concordance with histologic diagnosis (95%).
- DPAM cases (36.5%) showed a better prognosis than PMCA cases (53.9%).
Conclusions:
- Cytomorphologic analysis of PW accurately categorizes PMP subtypes (DPAM vs. PMCA).
- This classification has significant prognostic implications for patient outcomes.
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