A Case Report of Pseudomyxoma Peritonei Arising From Primary Mucinous Ovarian Neoplasms

Abstract

Pseudomyxoma peritonei (PMP) is a rare manifestation of primary mucinous neoplasms. We report two rare cases of PMP originating from mucinous primary ovarian neoplasms. The case series discusses the cases of female patients aged 86 and 52 years who presented with worsening dyspepsia, abdominal distension, pelvic pain, and altered bowel habits. Both of the patients underwent evaluation comprising cancer antigen-125 (CA-125) levels, ultrasound (US) examination of the abdomen and the pelvis, tumor markers, cytological evaluation, and contrast-enhanced computed tomography (CECT) of the pelvis and abdomen. Patients were diagnosed to have pseudomyxoma peritonei arising from mucinous ovarian tumors. Patients were referred to the surgical department and were successfully managed with repeated removal of mucinous material. The present case report highlights the significant radio-pathologic characteristics of PMP, which originated from mucinous ovarian tumors.

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“…Our patient's presentation primarily involved a two-year history of abdominal distension and vague abdominal pain. This feature aligns with the case reported by Joseph et al, which described worsening indigestion and abdominal distension within a two- to three-month timeframe [ 8 ]. In contrast, the case reported by Sarpietro et al presented with infertility and pelvic pain, while Pantiora et al described a patient with changing bowel habits over a year [ 7 , 9 ].…”

“…This finding aligns with the cases by Pantiora et al, both males in their late 50s [7]. However, our case diverges from Joseph et al who reported an 86-year-old female patient with PMP [8], and Sarpietro et al who described a 37-year-old female diagnosis [9]. These age discrepancies highlight the variable presentation of PMP, extending beyond middle age, as seen in Joseph et al's [8] study, and encompassing younger individuals, as noted by Sarpietro et al [9].…”

“…Pantiora et al similarly described an elevated CEA (210 ng/mL) but unremarkable CA 19-9, further illustrating the variability of marker expression [7]. Conversely, Joseph et al reported normal CEA and CA 19-9 in their case, highlighting the potential for normal levels even in advanced disease [8]. These discrepancies underscore the unreliable nature of tumor markers for definitive PMP diagnosis, necessitating a multi-modal approach incorporating clinical features, imaging, and tissue biopsy.…”