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. 2019 Apr 25;19(1):42.
doi: 10.1186/s12893-019-0508-6.

Pseudomyxoma Peritonei Induced by Low-Grade Appendiceal Mucinous Neoplasm Accompanied by Rectal Cancer: A Case Report and Literature Review

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Pseudomyxoma Peritonei Induced by Low-Grade Appendiceal Mucinous Neoplasm Accompanied by Rectal Cancer: A Case Report and Literature Review

Shili Ning et al. BMC Surg. .
Free PMC article


Background: Pseudomyxoma peritonei (PMP) is a disease involving the peritoneum characterized by the production of large quantities of mucinous ascites. PMP has a low incidence, is difficult to diagnose, and has a guarded prognosis. PMP induced by low-grade appendiceal mucinous neoplasm is extremely rare, and PMP accompanied by rectal cancer is even rarer.

Case presentation: We present a unique case of a 70-year-old male with PMP induced by low-grade appendiceal mucinous neoplasm accompanied by rectal cancer. The patient's clinical, surgical, and histologic data were reviewed. The patient had persistent distended abdominal pain without radiating lower back pain, abdominal distension for 1 month, and no exhaustion or defecation for 4 days. A transabdominal ultrasound-guided biopsy was performed on the first day. The patient received an emergency exploratory laparotomy because of increased abdominal pressure. We performed cytoreductive surgery, enterolysis, intestinal decompression, special tumour treatment and radical resection of rectal carcinoma. The postoperative course was uneventful. The postoperative histological diagnoses were PMP, low-grade appendiceal mucinous neoplasm and rectal medium differentiated adenocarcinoma. At the 1-year follow-up visit, no tumour recurrence was observed by computed tomography (CT). We also performed a literature review.

Conclusions: We should be aware that PMP can rarely be accompanied by rectal cancer, which represents an easily missed diagnosis and increases the difficulty of diagnosis and treatment. Additionally, there are some typical characteristics of PMP with respect to diagnosis and treatment.

Keywords: Appendiceal mucinous neoplasm; Diagnosis; Pseudomyxoma peritonei; Rectal cancer; Treatment.

Conflict of interest statement

Ethics approval and consent to participate

The study protocols were approved by the Ethical Committee of the Second Affiliated Hospital of Dalian Medical University.

Consent for publication

Written informed consent for the publication of relevant medical information was obtained from the patient. A copy of the consent form is available for review by the Editor of this journal.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


Fig. 1
Fig. 1
Physical examination and abdominal computed tomography scans. Physical examination revealed abdominal distension (a). Abdominal computed tomography images of the patient revealed peritoneal effusion (arrow 1) and bowel dilatation (arrow 2) (b)
Fig. 2
Fig. 2
Transabdominal ultrasound-guided biopsy of the patient and microscopic appearance of the mucus. Yellow, jelly-like mucus was extracted via transabdominal ultrasound-guided biopsy (a). Mesothelial cells, fibrous tissue and lymphocytes with mild atypia were noted (b, c)
Fig. 3
Fig. 3
Findings of laparotomy. Large quantities of yellow, jelly-like mucus (a). The patient’s small intestine and colon were expanded (b). A hard mass (arrow) was identified on the ileocecal junction (c). Appendiceal tumour with gangrenous rupture and rectal tumour (d)
Fig. 4
Fig. 4
Postoperative histological pathologic diagnoses were appendiceal mucinous neoplasm, rectal cancer and PMP. The rectal cancer was medium differentiated adenocarcinoma (a). The appendiceal mass was low-grade appendiceal mucinous neoplasm (b). Large quantities of cavities containing mucus were observed in the fibrous tissue (c). Immunohistochemical staining of the rectal tumour revealed the following staining results: PTEN (++), ERRCC1 (++), VEGF (++), TS (−), EGFR (++), HER2 (0), PMS2 (+), MLH1 (++), MSH2 (+++), MSH6 (+++), and MGMT (+) (d)

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