Pseudomyxoma peritonei accompanied by intraductal papillary mucinous neoplasm of the pancreas.
We describe a case of pseudomyxoma peritonei (PMP) successfully managed with intraperitoneal hyperthermic chemoperfusion. This case is unique due to the concurrent presence of intraductal papillary mucinous neoplasm (IPMN) of the pancreas. The patient presented with abdominal fullness. Abdominal computed tomography revealed massive ascites, thickened peritoneum, and a cystic lesion of the pancreas. Cytological examination of ascitic fluid sample showed mucin-rich atypical cells. Endoscopic retrograde pancreatography revealed a cystic lesion with the defect probably due to mural nodule and mucin, communicating with the pancreatic duct. At exploratory laparotomy, massive ascites and multiple nodules were identified within the peritoneal cavity. No primary tumour, including mucinous neoplasm of the appendix, was found. Histopathological examination of the omentum showed mucinous adenocarcinoma in pools of mucoid material, consistent with PMP. The relation between PMP and IPMN of the pancreas was possible, but not conclusive. The patient received intraperitoneal perfusion of saline heated to 42 degrees C containing cisplatin, etoposide, and mitomycin C, followed by 24 courses of postoperative chemotherapy with gemcitabine. The patient remains in good general condition with no signs of progression of PMP for 2 years, but with a gradual and progressive enlargement of the pancreatic cystic lesion.
Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan. ymizuta@net.nagasaki-u.ac.jp
Yohei
Y
Mizuta
Yuko
Y
Akazawa
Ken
K
Shiozawa
Hiroshi
H
Ohara
Kazuo
K
Ohba
Ken
K
Ohnita
Hajime
H
Isomoto
Fuminao
F
Takeshima
Katsuhisa
K
Omagari
Kenji
K
Tanaka
Tohru
T
Yasutake
Tohru
T
Nakagoe
Kenji
K
Shirono
Shigeru
S
Kohno
D002288:Adenocarcinoma, Mucinous / Q000473:pathology* / Q000628:therapy; D000231:Adenocarcinoma, Papillary / Q000473:pathology* / Q000628:therapy; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001201:Ascites / Q000473:pathology; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology* / Q000628:therapy; D010478:Chemotherapy, Cancer, Regional Perfusion; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000031:analogs & derivatives; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D006979:Hyperthermia, Induced; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009378:Neoplasms, Multiple Primary; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000628:therapy; D010534:Peritoneal Neoplasms / Q000473:pathology* / Q000628:therapy; D011553:Pseudomyxoma Peritonei / Q000473:pathology* / Q000628:therapy; D000093542:Gemcitabine
D003841:Deoxycytidine; D016685:Mitomycin; D005047:Etoposide; D002945:Cisplatin; D000093542:Gemcitabine