[Pseudomyxoma peritonei spread into the right inguinal hernia sac--a case report]

Area of Science:

• Oncology
• Surgical Oncology
• Gastroenterology

Background:

• Pseudomyxoma peritonei (PMP) is a rare, progressive malignancy originating typically from the appendix or ovaries.
• PMP diagnosis is challenging due to vague symptoms and potential asymptomatic presentation, leading to delayed detection.
• The estimated incidence of PMP is exceptionally low, approximately 1-2 per 100,000,000 individuals annually.

Observation:

• A 68-year-old patient presented with chronic hypertension, leading to an incidental diagnosis of PMP.
• The patient's reported symptoms did not indicate a neoplastic process within the peritoneal cavity.
• Myxoid cells, characteristic of PMP, were discovered within an inguinal hernia sac during surgical intervention.

Findings:

• Standard systemic chemotherapy demonstrated no significant response in the PMP patient.
• Cytoreductive surgery followed by hyperthermic intraperitoneal chemotherapy (HIPEC) was initiated due to chemotherapy inefficacy.
• The presence of PMP cells within the hernia sac was identified as a likely cause of the patient's clinical presentation.

Implications:

• This case underscores the importance of thorough diagnostic evaluation, even with non-specific symptoms, for rare conditions like PMP.
• HIPEC offers a potential treatment avenue for PMP refractory to systemic chemotherapy.
• Hernia sac examination during surgery may reveal unexpected neoplastic implants, aiding in PMP diagnosis and management.