Pseudomyxome péritonéal secondaire à une tumeur mucineuse de l’ovaire: à propos d’un cas

Abstract

Le pseudomyxome péritonéal (PMP) ou l'ascite gélatineuse est une entité rare, décrite pour la première fois par R. Wyerth en 1884. Il correspond à une atteinte péritonéale diffuse, composée d'une ascite mucineuse et d'implants épithéliaux mucineux multifocaux. Cette maladie touche essentiellement les femmes. Son incidence est estimée à 2 cas par un million d'habitants. Le pseudomyxome péritonéal peut rester asymptomatique, découvert lors d'une laparotomie. Le symptôme le plus fréquent est représenté par une distension abdominale associée à des douleurs abdominales diffuses. Le scanner abdominal constitue le moyen diagnostique le plus spécifique. Il met en évidence des signes pathognomoniques de l'ascite gélatineuse. Les tumeurs mucineuses de l'appendice sont la cause la plus fréquente du pseudomyxome péritonéal avec 90% des cas. L'origine ovarienne en constitue une cause très rare. Il existe essentiellement deux types de traitement du PMP: premièrement le « debulking » chirurgical multiple et deuxièmement la chirurgie de cytoréduction avec chimiothérapie intra-péritonéale péri-opératoire consistant en une chimiothérapie hyperthermique intrapéritonéale avec ou sans chimiothérapie intrapéritonéale post opératoire immédiate. Nous rapportons un cas de pseudomyxome péritonéal secondaire à une tumeur mucineuse de l'ovaire gauche.

Pseudomyxoma peritonei induced by a well-differentiated appendicular mucinous adenocarcinoma: An uncommon cause of isolated ascites in a young man patient

“…Although our case was male, PMP affects women 2 to 3 times more frequently than men. [1][2][3][4][5] Most tumors (90%) are of appendicular origin from low or high grade mucinous appendicular neoplasm and appendicular adenocarcinoma, associated with a mucocele, as in our patient's case. [1][2][3][4][5][6][7] Other tumors are mucinous adenocarcinomas of colonic, gastric, pancreatic, urachal, pulmonary, endocervical or mammary origin, or more rarely mucinous ovarian tumors, cystadenomas or cystadenocarcinomas.…”

“…[1][2][3][4][5] Most tumors (90%) are of appendicular origin from low or high grade mucinous appendicular neoplasm and appendicular adenocarcinoma, associated with a mucocele, as in our patient's case. [1][2][3][4][5][6][7] Other tumors are mucinous adenocarcinomas of colonic, gastric, pancreatic, urachal, pulmonary, endocervical or mammary origin, or more rarely mucinous ovarian tumors, cystadenomas or cystadenocarcinomas. 2,8 Some authors have reported nonneoplastic intraperitoneal mucinous deposits caused by alternative processes such as mucin retention due to a stercolith or diverticulum, or mucinous metaplasia of the fallopian tubes, but such situations are very rare and debatable.…”

“…6 The incidence of PMP was initially proposed to be approximately 1 per million population per year, but this estimate was not based on strong evidence. [1][2][3][4][5][6] Recent Dutch data from Smeenk et al estimated the incidence of mucinous epithelial neoplasms of the appendix to be approximately 0.3% and progression to PMP in approximately 20% of these patients. 1 Extrapolating the data, this places the incidence of PMP at approximately 2 per million per year.…”

“…PMP is often asymptomatic, discovered incidentally on imaging (ultrasound, abdominal CT scan, abdominal MRI) or during laparotomy. [1][2][3][4][5][6][7] It may be manifested by abdominal pain, increased abdominal volume, nausea, vomiting, altered general condition, signs related to the impact of the disease on the digestive tract and/or urinary tract. 2 Our patient had presented with increased abdominal volume with vague abdominal symptoms.…”

Pseudomyxoma peritonei induced by a well‐differentiated appendicular mucinous adenocarcinoma: An uncommon cause of isolated ascites in a young man patient

“…6 The incidence of PMP was initially proposed to be approximately 1 per million population per year, but this estimate was not based on strong evidence. [1][2][3][4][5][6] Recent Dutch data from Smeenk et al estimated the incidence of mucinous epithelial neoplasms of the appendix to be approximately 0.3% and progression to PMP in approximately 20% of these patients. 1 Extrapolating the data, this places the incidence of PMP at approximately two per million per year.…”