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Recurrence of pseudomyxoma peritonei within the inguinal canal
Jacobo Cabanas1, Rodrigo Gomes da Silva, Paulo Goldstein
1Hospital Universitario Ramkón y Cajal, Madrid, Spain.
Aim And Background:
Tumor appearing in an inguinal hernia sac indicates widespread carcinomatosis with ascites. A new onset hernia is a common clinical presentation of pseudomyxoma peritonei syndrome arising in an appendiceal mucinous tumor. Recurrence of pseudomyxoma peritonei within the inguinal region was previously reported in only a single patient. We present five patients with a recurrence of pseudomyxoma peritonei tumor nodules in the inguinal region following cytoreductive surgery and attempt to understand the etiology of this treatment failure.
Methods And Study Design:
From a database of 910 patients with mucinous appendiceal tumors with peritoneal dissemination who had definitive treatment, five patients who had disease recurrence within the inguinal region were identified. The clinical histories were studied and presented in order to make future recommendations regarding the management of these patients.
Results:
Five patients with ages ranging 39 to 67 years had a mucinous tumor in the inguinal region as a recurrence after a previous cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. One of them had separate recurrence in both right and left inguinal regions. All these patients were made disease-free by the reoperative surgery with a sacrifice of the testicle in four. None have evidence of a recurrence of an inguinal hernia despite the lack of formal repair.
Conclusion:
At the time of initial cytoreductive surgery the surgeon should be aware of the inguinal region as a possible site of relapse. This may be more problematic in patients who have had prior surgery with mucoid fluid in a hernia as the presenting sign of pseudomyxoma peritonei. Inguinal recurrences should be removed with clear margins even if orchiectomy is required.
Insights
Recurrence of pseudomyxoma peritonei in the inguinal region after cytoreductive surgery is uncommon. This study identified five patients with inguinal recurrence, highlighting the need for awareness and complete surgical removal, even if orchiectomy is required.
Area of Science:
- Surgical Oncology
- Gastrointestinal Oncology
- Abdominal Wall Surgery
Background:
- Pseudomyxoma peritonei syndrome, often arising from appendiceal mucinous tumors, can present as inguinal hernias.
- Inguinal recurrence of pseudomyxoma peritonei after cytoreductive surgery is rare, with only one prior report.
- This study investigates the etiology of treatment failure in patients experiencing inguinal recurrence.
Observation:
- Five patients (ages 39-67) presented with recurrent mucinous tumors in the inguinal region post-cytoreductive surgery and intraperitoneal chemotherapy.
- One patient had bilateral inguinal recurrence.
- All patients achieved disease-free status after reoperative surgery, with four requiring orchiectomy.
Findings:
- Complete surgical resection of inguinal recurrences was achieved.
- No evidence of inguinal hernia recurrence was observed post-operatively, despite the absence of formal hernia repair.
- Orchiectomy was necessary in four out of five patients for complete tumor removal.
Implications:
- The inguinal region should be considered a potential site for pseudomyxoma peritonei relapse during initial cytoreductive surgery.
- Awareness is crucial, especially in patients with prior surgery and mucoid fluid in a hernia.
- Complete excision of inguinal recurrences with clear margins, potentially including orchiectomy, is recommended to prevent further relapse.
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