Mary Grace O Cheng
FEU-NRMF Medical Center, Philippines
Posters & Accepted Abstracts: Gynecol Obstet
Correct pre-operative diagnosis is difficult to make in rare cases such as Pseudomyxoma Peritonei. This is a case of a 74 year-old, gravida 10 para 8 presenting with abdominal enlargement and postmenopausal bleeding. Imaging studies pointed to an ovarian malignancy. Tumor markers CA-125 and CA-199 were elevated. Due to the presence of post-menopausal bleeding, endometrial curettage with frozen section was done revealing Leiomyosarcoma. Exploratory laparotomy revealed gelatinous material in the peritoneum with seeding into the omentum, ovaries and appendix. The uterus was adherent to the colon hence the surgical intervention done were BSO with frozen section of the ovary revealing atypical proliferative mucinous tumor (APMT), appendectomy and omentectomy instead of EHBSO. Final histopathology result of the ovaries, appendix and omentum were consistent with disseminated peritoneal adenomucinosis (DPAM). Final histopath result of the endometrial curetting revealed adenomatoid tumor. Due to the discrepancy, immunohistochemical staining with desmin and caldesmon were negative implicating absence of leiomyosarcoma. To determine the primary organ of origin, staining with CK20 was positive and CK7 was negative consistent with metastases from the GIT. Recent literatures confirmed our finding that the appendix is the primary site of origin in such cases. Chemotherapy with FOLFOX regimen followed by cytoreductive surgery was contemplated. However, patient was lost to follow up. Currently, it has been 3 years from the time she underwent surgery. On inquiry, she is well with her quality of life restored. Pseudomyxoma peritonei is rare and difficult to diagnose pre-operatively due to its multi-organ involvement. Our patient has low-grade type which has better prognosis even with incomplete treatment. Despite the low grade potential for malignancy and high survival rates, cytoreductive surgery is still the recommended treatment. This is possibly due to the insufficient studies done in terms of management because of its rarity.
E-mail: thegracecheng@gmail.com
