title: Progression of peritoneal adenomucinosis to the scrotum: a rare occurrence treated with cytoreductive surgery and hyperthermic chemoperfusion of the scrotum in two patients.
abstract: BACKGROUND
  Disseminated Peritoneal Adenomucinosis (DPAM) is an infrequent presentation of appendiceal cancer. Infrequently, umbilical or inguinal hernias could be the first clinical manifestation of this condition; DPAM extension to the scrotum may be anatomically viable. Treatment with cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the standard of treatment for DPAM. We hypothesize that these same treatment principles, consisting of CRS with hyperthermic chemoperfusion of the scrotum (HCS), could be applied to the scrotal dissemination of DPAM.
  
  
  METHODS
  We reviewed our Institution's prospective cancer database and identified two cases of DPAM with extension to the scrotum. Their medical records were examined, and close follow-up was performed. Tumor histopathology and cytoreduction scores were evaluated. Tumor progression was monitored on follow-up by physical examination, tumor markers (CEA, CA 125, CA 19.9) and abdomino-pelvic CT scan.
  
  
  RESULTS
  Two patients who previously had CRS/ HIPEC for DPAM were successfully treated with HSC. Both patients are alive and free of disease at 88 and 57 months following initial CRS/HIPEC, and 50 and 32 months following CRS/HCS, respectively.
  
  
  CONCLUSIONS
  Increased awareness by surgeons to the coexistence of inguinal hernia with peritoneal neoplasm and the need for a surgical repair is raised. CRS/HCS may be employed to treat patients with DPAM extension to the scrotum. Successful outcome is dependent on complete cytoreduction of metastatic tumor.
authors.affiliation: Division of Surgical Oncology. The Institute for Cancer Care - Mercy Medical Center. Baltimore, Maryland, USA.
authors.forename: Armando
authors.initials: A
authors.lastname: Sardi
authors.affiliation: Division of Surgical Oncology. The Institute for Cancer Care - Mercy Medical Center. Baltimore, Maryland, USA.
authors.forename: William Andrés
authors.initials: WA
authors.lastname: Jiménez
authors.affiliation: Division of Surgical Oncology. The Institute for Cancer Care - Mercy Medical Center. Baltimore, Maryland, USA.
authors.forename: Chukwuemeka
authors.initials: C
authors.lastname: Wosu
mesh_terms: D000368:Aged; D001063:Appendiceal Neoplasms / Q000473:pathology / Q000628:therapy*; D014408:Biomarkers, Tumor / Q000378:metabolism; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures / Q000379:methods*; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods; D008297:Male; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000473:pathology / Q000628:therapy*; D011553:Pseudomyxoma Peritonei / Q000473:pathology / Q000628:therapy; D012611:Scrotum / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: CRS; DPAM; HIPEC; Hyperthermic chemoperfusion; cytoreductive surgery; scrotum
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