Pseudomyxoma Peritonei Originating from Gynecological Diseases: An Incidental Pathological Diagnosis

Abstract

Psuedomyxoma peritonei is an uncommon disease characterized by the presence and accumulation of gelatinous material in the pelvis and abdominal cavity. It is an unusual manifestation of mucinous ascites of controversial origin, though often associated with a primary tumour of the appendix. Diagnosis of pseudomyxoma peritonei is often incidental during exploratory laparotomy because there are no specific diagnostic clinical symptoms. We report three females with gynaecological diseases with incidental finding of pseudomyxoma peritonei in the absence of appendiceal or gastrointestinal tumour. Tissue biopsies were fixed in 10% formalin and processed in paraffin wax. Representative sections were stained with haematoxylin & eosin, periodic acid Schiff, diastase and mucicarmine. Three females aged 25years, 42years and 50years presented respectively with a year, 5years and 12years history of abdominal swelling and abdominal mass. The older female also complained of vaginal protrusion with significant weight loss. Clinical diagnosis in the two younger females was advanced ovarian carcinoma, while the older female was diagnosed with third degree utero vaginal prolapse. All three had exploratory laparotomy which revealed unilateral multi-lobulated left ovarian masses, with extensive mucinous peritoneal and omental deposits. There were no obvious gastrointestinal lesions and the appendices had no gross pathology. Two of the patients had oophorectomy with peritoneal and omental clearance of mucinous materials while the third patient had vaginal hysterectomy and peritoneal clearance of gelatinous deposits. The gelatinous materials showed papillary and multi locular cystic masses containing gelatinous fluid. Histopathological diagnosis of pseudomyxoma peritonei in a background of mucinous ovarian cystadenoma, and utero vaginal prolapse with epidermialization of the cervical lining epithelium was made. Pseudomyxoma peritonei occurs in the absence of a primary appendiceal disease and there are no specific diagnostic clinical symptoms. Definitive diagnosis requires histopathological analysis however, clinicians should entertain a high index of suspicion during laparotomy when mucin pools are present in the absence of gross pathology particularly in females with benign gynaecological diseases. Our cases were classed histologically into the benign disseminated peritoneal adenomucinosis type.