Title : Case study: Pseudomyxoma peritonei secondary to rectal mass adenocarcinoma: A rare clinical presentation
Abstract:
Pseudomyxoma peritonei (PMP) is a rare malignant disease, involving the peritoneum, characterized by the production of large quantities of mucinous ascites. PMP has a low incidence of 2-4 per million people, it’s challenging to diagnose, and has a limited prognosis. Normally, it’s extremely rare but the most common presentation is PMP induced by low-grade appendiceal mucinous neoplasm. This reports a case of a 76-year-old female who presented to the Emergency Department due to abdominal pain, rectal mass with bleeding of several months of evolution. The patient has poor medical follow-up and has never had a colonoscopy before. A colonoscopy was performed on admission alongside a biopsy of the rectal mass that resulted with adenomatous colon mucosa with positive immunostain (CK-20). Pathology from ultrasound-guided biopsy results came back positive with PMP primarily from adenocarcinoma from the rectum. CEA resulted elevated. The patient presented with pulmonary embolism (PE) occluding the right-upper-lobe (RUL) with bilateral lower extremities deep vein thrombosis (DVT). Due to a hypercoagulable state, an inferior vena cava (IVC) filter was placed. Diagnostic laparoscopy was performed and resulted with carcinomatosis in the peritoneal cavity. An attempt to do a colostomy for the palliative process was not possible due to extension of tumor to bowel. Cytoreductive Surgery (CRS) associated with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) is the optimal treatment for PMP. However, in patients with an extensive or recurrent disease, few therapeutic opportunities are available. In this case, tumor marker elevations correlate with worse prognosis and increased recurrence rates.
Keywords: Pseudomyxoma peritonei, rectal cancer, adenocarcinoma
Audience Take away:
• Management of a rare cause of cancer as pseudomyxoma peritonei
• Known about its rare presentation and the importance of early diagnosis
• Is this research that other faculty could use to expand their research or teaching? yes
