Presentation
Macroscopic hematuria.
Patient Data
Normal kidneys, ureters and empty bladder. No obvious cause for hematuria.
Incidental widespread abdomino-pelvic fluid with loculations. Scalloping of the left hepatic lobe.
Omental thickening and nodularity.
Distended appendix with peripheral calcification.
Case Discussion
Ultrasound-guided omental biopsy report:
Microscopy revealed mucin pools containing sparse strips of mucinous epithelium. The histological features correspond to the proffered clinical details of pseudomyxoma peritonei (PMP). In approximately 95% of cases, PMP is due to an appendiceal neoplasm. Immunohistochemistry has a limited role in distinguishing between mucinous tumors of the gynecological and gastrointestinal tract but the immunoprofile in this case is consistent with a GI tract origin, in the correct clinical and imaging context.
The final diagnosis was pseudomyxoma peritonei secondary to a mucinous appendiceal neoplasm. The patient then went to have extensive cytoreductive surgery at a specialized peritoneal malignancy center.