Diagnosis of Pseudomyxoma peritonei via endoscopic ultrasound guided fine needle aspiration: a case report and review of literature.
BACKGROUND
Pseudomyxoma peritonei (PMP) is a rare condition caused by mucinous adenocarcinoma cancerous cells that produce abundance of mucin or gelatinous ascites. This cancer can cause tissue fibrosis and can impair normal organ function. Diagnosis can involve multiple imaging modalities including CT scan. There have been few cases of endoscopic ultrasound (EUS) being used as a means for diagnosis of this condition. Here we report a second case of PMP with a previous history of appendectomy diagnosed with EUS guided fine needle aspiration (FNA) biopsy.


METHODS
A 66-year-old male with a history of an appendectomy presented with intermittent abdominal pain for two years and weight loss of 40 pounds over two months. EGD and colonoscopy performed at an outside hospital was unremarkable. CT abdomen revealed perigastric ascities and lesions of the liver. ESR was elevated at 75. At our facility, EUS was performed revealing a peri-gastric and omental mass measuring 36.6 mm × 25.5 mm. FNA performed of both mass and ascetic fluid revealed low grade mucinous adenocarcinoma with mucinous deposits in the peritoneum consistent with PMP.


CONCLUSIONS
Endoscopic ultrasound guided FNA, although very rarely used, can be a reliable and safe technique in diagnosis of PMP.
a Department of Internal Medicine , University of Toledo Medical Center , Toledo , OH , USA.
Umar
U
Darr
a Department of Internal Medicine , University of Toledo Medical Center , Toledo , OH , USA.
Anas
A
Renno
a Department of Internal Medicine , University of Toledo Medical Center , Toledo , OH , USA.
Turki
T
Alkully
a Department of Internal Medicine , University of Toledo Medical Center , Toledo , OH , USA.
Zubair
Z
Khan
a Department of Internal Medicine , University of Toledo Medical Center , Toledo , OH , USA.
Abhinav
A
Tiwari
a Department of Internal Medicine , University of Toledo Medical Center , Toledo , OH , USA.
Waleed
W
Zeb
a Department of Internal Medicine , University of Toledo Medical Center , Toledo , OH , USA.
Jenna
J
Purdy
a Department of Internal Medicine , University of Toledo Medical Center , Toledo , OH , USA.|b Division of Gastroenterology , University of Toledo , Toledo , OH , USA.
Ali
A
Nawras
D002288:Adenocarcinoma, Mucinous / Q000473:pathology*; D000368:Aged; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006801:Humans; D008297:Male; D010534:Peritoneal Neoplasms / Q000175:diagnosis* / Q000473:pathology; D011553:Pseudomyxoma Peritonei / Q000175:diagnosis* / Q000473:pathology; D014057:Tomography, X-Ray Computed
Pseudomyxoma peritonei; endoscopic ultrasound (EUS); endoscopy; fine needle aspiration (FNA)