背景:腹膜假粘液瘤是一种罕见的疾病,全球每年的发病率仅为每百万人中1至2例。粘液性肿瘤,广泛的腹膜内植入物,粘液性腹水是它的特征。目前,大多数临床医生误诊了这种情况,导致管理延迟。
方法:一名44岁的北印度女性,有1.5个月的腹部肿块病史。体格检查显示在36周时有相当大的腹部盆腔肿块。对比增强计算机断层扫描显示大量多位置的右卵巢囊性肿块,大小为28×23×13cm,伴有轻度腹水和癌胚抗原水平升高(113.75ng/ml)。卵巢粘液性肿瘤的临时诊断,患者接受了剖腹手术。术中,有恶心的黏液性腹水,还有一个大的,受限制,右侧卵巢肿瘤破裂,充满凝胶状物质。阑尾肿块也与网膜一起充满粘液物质,升结肠,直肠的右侧,脾表面,和小肠系膜.与肿瘤外科医生一起进行了细胞减灭术,包括经腹全子宫切除术和双侧输卵管切除术,网膜切除术,右半结肠切除术,下部前切除术,回肠横向吻合术与近端回肠环分流造口,切除多个腹膜凝胶状植入物,和腹腔灌洗。组织病理学和免疫组织化学证实存在肠型粘液性癌。术后,患者接受了6个周期的化疗。她忍受了它,没有任何特定的发病率,并且恢复顺利。术后15个月随访显示肿瘤标志物水平正常,腹部计算机断层扫描结果正常,没有提示局部复发或远端转移的迹象。
结论:腹膜假粘液瘤是一种罕见的疾病,在术前经常被误诊。因此,放射科医师和临床医师应该对准确诊断和多学科管理保持高度怀疑.
BACKGROUND: Pseudomyxoma peritonei is an infrequent condition with a global annual incidence of only one to two cases per million people. Mucinous neoplasms, widespread intraperitoneal implants, and mucinous
ascites characterize it. Currently, most clinicians misdiagnose this condition, which leads to delayed management.
METHODS: A 44-year-old North Indian female presented with a 1.5-month history of an abdominal lump. Physical examination revealed a sizeable abdominopelvic mass at 36 weeks. Contrast-enhanced computed tomography showed a massive multiloculated right ovarian cystic mass measuring 28 × 23 × 13 cm with mild
ascites and elevated carcinoembryonic antigen levels (113.75 ng/ml). A provisional diagnosis of ovarian mucinous neoplasm was made, for which the patient underwent laparotomy. Intraoperatively, there were gross mucinous
ascites, along with a large, circumscribed, ruptured right ovarian tumor filled with gelatinous material. The appendicular lump was also filled with mucinous material along with the omentum, ascending colon, right lateral aspect of the rectum, splenic surface, and small bowel mesentery. Cytoreductive surgery was performed along with an oncosurgeon, including total abdominal hysterectomy with bilateral salpingoophorectomy, omentectomy, right hemicolectomy, lower anterior resection, ileo-transverse stapled anastomosis with proximal ileal loop diversion stoma, excision of multiple peritoneal gelatinous implants, and peritoneal lavage. Histopathology and immunohistochemistry confirmed the presence of intestinal-type mucinous carcinoma. Postoperatively, the patient was given six cycles of chemotherapy. She tolerated it without any specific morbidity and had an uneventful recovery. Postoperative follow-up at 15 months revealed normal tumor marker levels and abdominal computed tomography findings and no signs suggestive of local recurrence or distal metastases.
CONCLUSIONS: Pseudomyxoma peritonei is a rare disease that is frequently misdiagnosed in the preoperative phase. Therefore, radiologists and clinicians should maintain a high index of suspicion for accurate diagnosis and multidisciplinary management.