EP-138 Pseudomyxoma peritoni induced by appendiceal mucinous adenocarcinoma- a case report

Abstract

Abstract Introduction Appendiceal tumours are rare and mucinous tumours account for 58% of the malignant tumours of appendix according to SEER data base, with remaining being carcinoid tumors. Mucinous tumours of appendix have a potential of peritoneal spread in the form of gelatinous material, resulting in pseudomyxoma peritoni (PMP). We report a case of mucinous adenocarcinoma of appendix inducing pseudomyxoma peritoni in a 37 year old male. Case summary A 37 year old male presented with generalised abdominal pain for 2 months and gradually increasing abdominal distension over a period of one month. On examination, abdomen was tense, distended and mildly tender. Rest of systemic examination was unremarkable. Biochemical investigations revealed normal blood complete picture. AST was mildly raised. ALP was 330 (normal upto 130 U/L. Bilirubin, total proteins and renal function tests were within normal limits. CECT abdomen and pelvis showed omental caking and moderate ascites with no overt bowel mass lesion. Diagnostic laparoscopy was done which showed extensive mucinous deposits over peritoneum. Biopsy was taken which revealed metastatic mucinous adenocarcinoma with appendix as primary organ of origin on immunohistochemistry (CK 7 -/CK 20 +, CDX 2 positive). CEA levels were done which were 220 ng/ml (normal upto 10 ng/ml). Patient was referred to oncology centre for further management. Discussion PMP occurs in 7th decade of life and more common in females with a M: F ratio of 1:4 and is almost always of appendiceal in origin. Conclusion PMP is rare tumour with negligible incidence in younger population.