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Letter to The Editor
Pseudomyxoma peritonei syndrome 12 months after an intact resection of malignant mucocele of the appendix: A case report
Leonardo Maciel da Fonseca, Antônio Lacerda-Filho, Rodrigo Gomes da Silva
Corresponding author
rodrigogsilva@uol.com.br

Email: Tel.: 55-31-32489403
Grupo de Coloproctologia e Intestino Delgado, Instituto Alfa de Gastroenterologia do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG) – Belo Horizonte/MG, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">Mucocele of the appendix &#40;MA&#41; is an obstructive dilatation of the appendix caused by either a benign or malignant process&#46; MAs are rare lesions found in only 0&#46;2&#37;&#8211;0&#46;3&#37; of appendectomies&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a> Malignant mucoceles are found even less frequently&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a></p><p id="para20" class="elsevierStylePara elsevierViewall">It is believed that an intact mucocele presents no risk for the patient&#46; Gonz&#225;lez Moreno et al&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a> has emphasized that peritoneal seeding should be preventable with atraumatic handling of the cancer specimen&#46; These authors also noted that peritoneal dissemination from a MA has not been regarded as a problem with open appendectomy&#46; The incidence of disseminated peritoneal mucinous tumors from an open appendectomy is extremely low&#44; and no reported cases were found in the literature&#46;</p><p id="para30" class="elsevierStylePara elsevierViewall">We report the case of a patient with no rupture of the MA during the primary surgery who presented after 12 months of follow-up with peritoneal dissemination typical of pseudomyxoma peritonei &#40;PP&#41;&#46; To the best of our knowledge&#44; no such case has previously been reported&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">Case Report</span><p id="para40" class="elsevierStylePara elsevierViewall">A 40-year-old female patient presented with abdominal pain lasting 3 months&#46; The patient underwent an abdominal CT scan that showed a 12-cm well-encapsulated cystic mass in the right lower quadrant &#40;<a class="elsevierStyleCrossRef" href="#fig1-cln_65p817">Figure 1A</a>&#41;&#46; However&#44; there was no mucinous ascites&#44; and MA of malignant origin was suspected&#46;</p><elsevierMultimedia ident="fig1-cln_65p817"></elsevierMultimedia><p id="para50" class="elsevierStylePara elsevierViewall">A median laparotomy&#44; rather than a laparoscopic approach&#44; was indicated to avoid rupturing the tumor&#46; A right hemicolectomy &#40;RHC&#41; was performed due to tumor size &#46; The surgical field was protected with pads to prevent the contamination of tumor cells into the peritoneal cavity&#46; The specimen was removed intact &#40;<a class="elsevierStyleCrossRef" href="#fig1-cln_65p817">Figure 1B</a>&#41;&#46; The pathologic exam showed mucinous cystadenocarcinoma of the appendix without rupture&#46; No metastases were found in 31 tested lymph nodes&#46;</p><p id="para60" class="elsevierStylePara elsevierViewall">One year later&#44; the patient was found to have an elevated serum carcinoembryonic antigen&#46; On the pelvic CT&#44; a tumor mass involving the right ovary and salpinx was discovered&#46; A cytoreductive surgery was indicated&#46; During laparotomy&#44; four-quadrant peritoneal dissemination of the tumor was observed along with a large tumor involving the right ovary&#46; An extensive 10-hour cytoreductive surgery&#44; as recommended by Sugarbaker&#44;<a class="elsevierStyleCrossRef" href="#bib4">4</a> was performed&#59; additionally&#44; the patient received 90 minutes of intraperitoneal chemotherapy with mitomycin C&#46; During the postoperative period&#44; the patient developed pneumonia in the ICU and died 30 days after the procedure&#46;</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">Discussion</span><p id="para70" class="elsevierStylePara elsevierViewall">During procedures involving mucoceles caused by mucinous cystadenomas and cystadenocarcinomas&#44; the most important concern for the surgeon is that a possible rupture of the mucocele&#44; either spontaneous or accidental&#44; may result in PP&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a></p><p id="para80" class="elsevierStylePara elsevierViewall">Considering these concerns&#44; an oncological RHC was performed to prevent both tumor cell spillage into the peritoneal cavity and rupture of the mucocele&#46; Unfortunately&#44; this patient presented with metastasis of malignant cells throughout the peritoneal cavity in the form of multiple mucinous deposits at 12 months after the initial surgery&#46;</p><p id="para90" class="elsevierStylePara elsevierViewall">MA of malignant origin may result in the PP syndrome even after an intact tumor resection has been performed&#46; We believe that intraperitoneal chemotherapy should be used in addition to the primary surgical treatment of MA even for intact tumor resections&#46;</p></span></span>"
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                              \t\t\t\t\t\t\t\t
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                            3 => """
                              D Herman \n
                              \t\t\t\t\t\t\t\t
                              """
                            4 => """
                              A Pourbaix \n
                              \t\t\t\t\t\t\t\t
                              """
                            5 => """
                              A de Neve \n
                              \t\t\t\t\t\t\t\t
                              """
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Article information
ISSN: 18075932
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos