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Organizing mucinous ascitis masquerading as pseudomyxoma peritonei: a process possibly caused by metaplasia but not

Ravindra K Saran1, Kaushik Majumdar, Sukhpreet Kaur

  • 1Department of Pathology, G B Pant Hospital, Jawaharlal Nehru Marg, New Delhi, India.

Journal of Surgical Education
|June 24, 2008
PubMed

Insights

This report details a case of organizing mucinous ascitis, distinct from pseudomyxoma peritonei, in a young woman. The condition was linked to chronic appendicitis and peritoneal metaplasia, successfully managed surgically.

Area of Science:

  • Gastroenterology and Hepatology
  • Surgical Pathology
  • Oncology

Background:

  • Differentiating mucinous ascitis from pseudomyxoma peritonei is crucial for patient management.
  • Pseudomyxoma peritonei is a rare malignancy characterized by mucin accumulation and epithelial cells.
  • Mucinous ascitis, while less ominous, requires careful diagnosis to exclude neoplastic conditions.

Observation:

  • A 34-year-old woman presented with recurrent right iliac fossa pain and imaging suggestive of mucocele.
  • Surgical intervention included appendectomy and removal of mucinous adhesions.
  • Histopathology revealed chronic appendicitis with mucin pools and reactive mesothelial cells, but no neoplastic epithelial cells.

Findings:

  • The case presented as organizing mucinous ascitis, confirmed by the absence of neoplastic epithelial cells in mucin pools.
  • Immunohistochemistry was essential to distinguish reactive mesothelial cells from true epithelial cells.
  • The etiology was suspected to be mucinous metaplasia of peritoneal mesothelial cells secondary to recurrent appendicitis.

Implications:

  • Accurate microscopic differentiation is key to avoiding misdiagnosis between mucinous ascitis and pseudomyxoma peritonei.
  • This case highlights a potential non-neoplastic origin of localized mucinous ascitis.
  • Understanding the role of appendicitis in peritoneal changes can guide clinical and diagnostic approaches.

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