J Korean Soc Radiol.  2014 May;70(5):359-362. 10.3348/jksr.2014.70.5.359.

Pseudomyxoma Peritonei Caused by Ruptured Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Case Report

• Huh S
• Lee HK
• Lee MH
• Yi BH
• Kim HK
• Jung JC
• Cha JG

• KMID: 1941782
• DOI: http://doi.org/10.3348/jksr.2014.70.5.359

Abstract

Pseudomyxoma peritonei (PMP) is an uncommon disease characterized by the seeding of mucin-secreting tumor cells throughout the abdomen and accumulation of mucin in the abdominal and pelvic cavities. Intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are defined as pancreatic neoplasms that accumulate mucin within dilated ducts. Only a few cases of pancreatic IPMNs are associated with extra-pancreatic mucin and lead to PMP. This manuscript describes an unusual case of PMP caused by ruptured pancreatic IPMN.

MeSH Terms

Abdomen
Mucins*
Pancreas*
Pancreatic Neoplasms
Pseudomyxoma Peritonei*
Mucins

Figure

• 

  Fig. 1 An 83-year-old female with pseudomyxoma peritonei caused by a ruptured intraductal papillary mucinous neoplasm. Multidetector computed tomography of abdomen axial (A, B), curved multiplanar reconstruction (C) and coronal reformatted (D) images showed multiloculated cystic lesions in the lesser sac (*) extending to the low attenuated fluid collection in perigastric (**) region. Additionally, a large amount of low-density materials, which exhibited a slightly higher density than that of urine, was present in the abdomen and pelvic cavities. The main pancreatic duct (arrowhead) in the pancreatic tail was markedly dilated and continued to the cystic lesion in the lesser sac (*). Additionally, a large defect in the cystic wall that directly communicated to the fluid collection in the perigastric space was observed at the anterior portion (thin arrow). During the surgery, a large amount of yellowish fluid and multiple gelatinous nodules attached to the omentum were observed (E). Additionally, a large cystic mass originating from the pancreas tail (F) was noted, and the mucinous materials spilled incidentally (thick arrow) due to traumatic rupture during surgery. On pathologic examination, the pancreatic cystic mass was filled with various complex papillary projections lined by tall columnar epithelial cells [hematoxylin and eosin (H&E) staining; magnification, × 20] (G). The lining epithelium showed architectural complexity with cribriforming and micropapillary formation, and the nuclei were round and lacked significant pseudostratification (H&E staining; magnification, × 200) (H). Additionally, the omentum revealed abundant pools of mucoid material with collections of inflammatory cells and hemorrhagic foci (H&E staining; magnification, × 40) (I).

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