2. It is a clinical condition caused by
cancerous cells that produce diffuse
intra peritoneal gelatinous
ASCITIS in abdomen and pelvis
3. Ascites is recurrent, voluminous and
mucinous
Ascites is due to surface growth on
the peritoneum without invading the
underlying tissue
4. Carl F. Rokitansky reported first case in 1842
Werth coined the term pseudomyxoma
peritoneii in 1884, that was in association
with mucinous ovarian tumour
Frankel reported first case of PMP in 1901
that was in association with cyst of appendix
5. Over all incidence- 1-2/million/year
Male :Female ratio= 9:11
Median age at presentation is about
50years (range 20-25years)
7. Mucinous tumour of large &
small bowel, Lung, Breast, Pancreas,
Stomach, Bile duct, Gall bladder and
Fallopian tube / Ovary, urachal
tumour are implicated
8. Patient may present with:
-abdominal or pelvic pain
-bloating/ distension
-digestive disorder
-weight loss
-increasing abdominal girth
-infertility
9. In male: patient may come with
Inguinal hernia
In female: presentation could be
with uni/ bilateral ovarian disease
10. Ultrasound
CT scan
History, clinical exam. & imaging studies often
lead to the diagnosis
Sometimes diagnostic paracentesis under U/S
confirmation by cytological exam.
Often discovered during surgery
11. PET scan may be used to evaluate
high grade mucinous adenocarcinoma
New MRI procedures are being
developed for disease monitoring
12. Non mobile Ascites with septations or
loculated ascites with echogenic
particle
Scalloping of liver, spleen & other
organs
13. Loculated low attenuated ascites
Multiple complex cystic masses of
fat density or variable density
14. Scalloping of visceral surface of liver,
spleen & other organs
Compression or central displacement
of small bowels
15. Any of the above finding with:
- mass in Rt. lower quadrant/appendicial
mucocele
-pelvic mass/ mucinous ovarian mass
- any other underlying cause of PMP
18. Recurrent bowel obstruction
due to fibrosis or adhesion
Mucus build up, filling the abdominal
cavity, compression of organ will impede
digestive or organ function
Increased abdominal pressure
19. Good with treatment
Lethal if untreated with death by
-cachexia,
-renal failure
-other types of complication
20. A middle aged lady was referred to
Deptt. Of Radiology for ultrasound exam.
She had problem of progressively
increasing abdominal girth, pain in
abdomen and digestive disorders
21. Multiloculated ascites with no
particles (not moving like blood or pus)
Scalloping effect over the border of
liver and spleen
(spleen is significantly reduced in size)
22. Multi loculated ascites with well
enhanced rim of peritoneum
Pocket of fluid in right iliac fossa,
pelvic cavity and para colic gutter
23. Scalloping effect over the border of
liver and spleen
Small bowel seems to be gathered
in the center
Right pleural effusion
r
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44. Long history of slow growing illness,
clinical exam. and Imaging findings
lead to the diagnosis of:
Pseudomyxoma -Peritoneii
Nothing much could be done for her, as
she has left the hospital against medical
advice
45. PMP is rare, slow growing disease & may
recur after surgery or chemotherapy
It is important to obtain an accurate
diagnosis as treatment ranges from
watchful waiting to:
-debulking
-hyper thermic intraperitoneal chemotherapy
-cytoreductive surgery
46. Pseudomyxoma Peritoneii, Alexandra
Stanislavsky. Radiology Reference article
Radiopaedia.org
Pseudomyxoma peritoneii(PMP), Diagnosis
and Imaging finding
www.medscape.com/view article/506509_2
47. Pseudomyxoma peritoneii. Submitted by
Paurush shah MSIV
www.learning radiology.com
Peritoneum & Mesentery PartII Pathology
Angela Levy, The Radiology Assistant
48. Gray-scale sonographic finding in a patient
with pseudomyxoma , C Lersch etal
Journal of Clinical ultrasound
vol 29 Issue3 page186-191March/April 2001