title: Recurrence of pseudomyxoma peritonei within the inguinal canal.
abstract: OBJECTIVE
  Tumor appearing in an inguinal hernia sac indicates widespread carcinomatosis with ascites. A new onset hernia is a common clinical presentation of pseudomyxoma peritonei syndrome arising in an appendiceal mucinous tumor. Recurrence of pseudomyxoma peritonei within the inguinal region was previously reported in only a single patient. We present five patients with a recurrence of pseudomyxoma peritonei tumor nodules in the inguinal region following cytoreductive surgery and attempt to understand the etiology of this treatment failure.
  
  
  METHODS
  From a database of 910 patients with mucinous appendiceal tumors with peritoneal dissemination who had definitive treatment, five patients who had disease recurrence within the inguinal region were identified. The clinical histories were studied and presented in order to make future recommendations regarding the management of these patients.
  
  
  RESULTS
  Five patients with ages ranging 39 to 67 years had a mucinous tumor in the inguinal region as a recurrence after a previous cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. One of them had separate recurrence in both right and left inguinal regions. All these patients were made disease-free by the reoperative surgery with a sacrifice of the testicle in four. None have evidence of a recurrence of an inguinal hernia despite the lack of formal repair.
  
  
  CONCLUSIONS
  At the time of initial cytoreductive surgery the surgeon should be aware of the inguinal region as a possible site of relapse. This may be more problematic in patients who have had prior surgery with mucoid fluid in a hernia as the presenting sign of pseudomyxoma peritonei. Inguinal recurrences should be removed with clear margins even if orchiectomy is required.
authors.affiliation: Hospital Universitario Ramkón y Cajal, Madrid, Spain.
authors.forename: Jacobo
authors.initials: J
authors.lastname: Cabanas
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Gomes da Silva
authors.forename: Paulo
authors.initials: P
authors.lastname: Goldstein
authors.forename: Mohan
authors.initials: M
authors.lastname: Verghese
authors.forename: Paul H
authors.initials: PH
authors.lastname: Sugarbaker
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000150:complications / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D006552:Hernia, Inguinal / Q000209:etiology*; D006801:Humans; D007264:Inguinal Canal / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000473:pathology / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D011553:Pseudomyxoma Peritonei / Q000150:complications / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed