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Case Reports
. 2008 Nov 11;6:118.
doi: 10.1186/1477-7819-6-118.

Experience With Adjuvant Chemotherapy for Pseudomyxoma Peritonei Secondary to Mucinous Adenocarcinoma of the Appendix With Oxaliplatin/Fluorouracil/Leucovorin (FOLFOX4)

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Free PMC article
Case Reports

Experience With Adjuvant Chemotherapy for Pseudomyxoma Peritonei Secondary to Mucinous Adenocarcinoma of the Appendix With Oxaliplatin/Fluorouracil/Leucovorin (FOLFOX4)

Chin-Fan Chen et al. World J Surg Oncol. .
Free PMC article

Abstract

Background: Pseudomyxoma peritonei (PMP) is a rare condition characterized by mucinous tumors, disseminated intra-peritoneal implants, and mucinous ascites. So far its diagnosis remains challenging to most clinicians.

Case presentation: A 55-year-old male patient had suffered from acute onset of abdominal pain and abdominal distension for one day prior to his admission. Physical examination revealed tenderness over the right lower quadrant of the abdomen without diffuse muscle guarding. A large amount of ascites was identified by abdominal computed tomography (CT) scan. Paracentesis showed the appearance of sticky mucinous ascites. He underwent laparotomy under the impression of pseudomyxoma peritonei. There was a lot of mucinous ascites, one appendiceal tumor and multiple peritoneal implants disseminated from the subphrenic space to the recto-vesicle pouch. Pseudomyxoma Peritonei caused by mucinous adenocarcinoma of appendiceal origin, was confirmed by histopathology. We performed an excision of the appendiceal tumor combined with copious irrigation and debridement. After the operation, he received 10 cycles of systemic chemotherapy with FOLFOX4 regimen, without specific morbidity. Follow-up of abdominal CT and colonoscopy at post-operative 17 months showed excellent response without evidence of local recurrence or distal metastasis. He made an uneventful recovery (up to the present) for 21 months after the operation.

Conclusion: This case report emphasizes the possible new role of systemic chemotherapy in the treatment of patients with this rare clinical syndrome.

Figures

Figure 1
Figure 1
CT scan of abdomen showing pseudomyxoma peritonei with mucin septations (arrows).
Figure 2
Figure 2
CT scan of abdomen showing pseudomyxoma peritonei with scalloping of hepatic margin (arrows).
Figure 3
Figure 3
Multiple peritoneal implants (arrows) over visceral peritoneum. Mucinous ascites with yellowish-greenish materials (arrow head) in peritoneal cavity.
Figure 4
Figure 4
The pathological findings of the resected appendix. Mucinous adenocarcinoma (arrows) exhibiting abundant acellular mucin pooling (arrow head), with scarce well-differentiated mucin producing epithelium embedded in a fibrous matrix or as lining epithelium.
Figure 5
Figure 5
The pathological findings of the resected appendix extra-cellular mucinous materials (arrow) showing light blue in color distributed in fibrous stroma.
Figure 6
Figure 6
CT scan of abdomen – postoperative 17 months, compared with Fig 1. No local recurrence or metastatic lesion is identified.
Figure 7
Figure 7
CT scan of abdomen – postoperative 17 months, compared with Fig 2. No local recurrence or metastatic lesion is identified.

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