A Case of Pseudomyxoma Peritonei with Splenic Metastasis from Mucinous Cystadenocarcinoma of the Appendix

Hideo Miyamoto, Kouichi Okita, Ritsu Kusama, Yoshirou Fujimori, Kiyofumi Yamagishi, Hiroyuki Nishimura and Naohiro Shinohara*

Department of Surgery and Department of Pathology*, Hokushin General Hospital

Pseudomyxoma peritonei is a clinical entity resulting from low-grade-malignancy tumor-cell implantation. Distant metastasis in these cases is very rare. We report a case of pseudomyxoma peritonei with splenic metastasis from mucinous cystadenocarcinoma of the appendix. A 65-year-old man undergoing surgery for an inguinal hernia was found interperioperatively to have a nodular region on the peritoneum of the hernial sac. Histopathology results suggested psedomyxoma peritonei. Abdominal CT scan and MRI showed a multilocular 13×11×16 cm cystic mass involving the spleen necessitating surgery in February 2004. Laparotomy revealed jelly-like mucinous materials filling the abdominal cavity and countless mucinous nodules scattered through the intestinal tract, the mesentery, and the omentum. The appendix was slightly swollen. We conducted splenectomy, partial omentectomy, and appendectomy, removing as much of the mucinous materials as possible. We irrigated abdominal cavity with warm saline and distilled water. The histopathological diagnosis was mucinous cystadenocarcinoma of the appendix and splenic metastasis from the appendix. When we encounter a case of cystic mass of the spleen, we should examine the appendix considering a possibility of this disease.

Key words
pseudomyxoma peritonei, splenic metastasis, mucinous cystadenocarcinoma of the appendix

Reprint requests
Hideo Miyamoto Department of Surgery, Shinonoi General Hospital
666-1 Shinonoi-Ai, Nagano, 388-8004 JAPAN

Accepted
September 28, 2005

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