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A primary peritoneal pseudomyxoma peritonei arising from the Mullerian tissue: a case report
1Department of Surgery, Erasme University Hospital, Brussels, Belgium.
Abstract:
A primary Pseudomyxoma Peritonei is uncommon. For a long time, ovaries, colon and appendix were proposed like a site origin of these enigmatic lesions. Recent publications show that the majority of cases are due to a rupture of appendicle adenoma. We report a case of a pseudomyxoma peritonei arising in an elderly patient with a previous medical history of appendectomy undergone in infancy. The pseudomyxoma was misdiagnosed as an abdominal abscess related to colitis. In our opinion, metaplasia of the Müllerian system is a possible source of a primary peritoneal pseudomyxoma.
Insights
Pseudomyxoma peritonei is a rare condition. This case highlights the Müllerian system as a potential, overlooked origin for this enigmatic peritoneal disease, even after appendectomy.
Area of Science:
- Gastroenterology and Oncology
- Reproductive Medicine and Pathology
Background:
- Primary Pseudomyxoma Peritonei (PMP) is an uncommon malignancy.
- Historically, ovarian, colonic, and appendiceal origins were proposed for PMP.
- Recent evidence suggests appendiceal adenoma rupture as the predominant source.
Observation:
- A case of PMP occurred in an elderly patient with a history of childhood appendectomy.
- The patient's condition was initially misdiagnosed as an abdominal abscess secondary to colitis.
- This presentation challenges typical PMP origin theories.
Findings:
- The study presents a unique case of PMP in a patient lacking a typical appendiceal origin.
- The patient's prior appendectomy complicated the diagnostic pathway.
- The clinical presentation mimicked infectious colitis, delaying PMP diagnosis.
Implications:
- Metaplasia of the Müllerian system is proposed as a potential primary source for peritoneal pseudomyxoma.
- This finding expands the differential diagnosis for PMP, especially in appendectomized patients.
- Further research is needed to elucidate the role of Müllerian metaplasia in PMP pathogenesis.
