Pseudomyxoma peritonei differential diagnosis: Difference between revisions

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* Elevated serum CA 125 level  
* Elevated serum CA 125 level  


* Normal serum CA 19-9, and CEA associated with lymphocyte predominant benign ascites  
* Normal serum CA 19-9, and CEA associated with lymphocyte predominant benign ascites<ref name="pmid21912057">{{cite journal |vauthors=Kaya M, Kaplan MA, Isikdogan A, Celik Y |title=Differentiation of tuberculous peritonitis from peritonitis carcinomatosa without surgical intervention |journal=Saudi J Gastroenterol |volume=17 |issue=5 |pages=312–7 |date=2011 |pmid=21912057 |pmc=3178918 |doi=10.4103/1319-3767.84484 |url=}}</ref>
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* Miliary microabscesses in the liver or spleen  
* Miliary microabscesses in the liver or spleen  
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* Caseating granuloma with central area of necrotic acellular debris surrounded by histiocytes
* Caseating granuloma with central area of necrotic acellular debris surrounded by histiocytes
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* Laparoscopy and peritoneal biopsy  
* Laparoscopy and peritoneal biopsy<ref name="pmid21912057">{{cite journal |vauthors=Kaya M, Kaplan MA, Isikdogan A, Celik Y |title=Differentiation of tuberculous peritonitis from peritonitis carcinomatosa without surgical intervention |journal=Saudi J Gastroenterol |volume=17 |issue=5 |pages=312–7 |date=2011 |pmid=21912057 |pmc=3178918 |doi=10.4103/1319-3767.84484 |url=}}</ref>
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Revision as of 20:48, 15 January 2019

Pseudomyxoma peritonei Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[2]Parminder Dhingra, M.D. [3]

Overview

Pseudomyxoma peritonei must be differentiated from peritoneal carcinomatosis without mucinous ascites, peritoneal sarcomatosis, and peritonitis.

Differential Diagnosis

Pseudomyxoma peritonei must be differentiated from:[1][2]

  • Peritoneal carcinomatosis without mucinous ascites
  • Peritoneal sarcomatosis
  • Peritonitis

Differentiating pseudomyxoma peritonei from other diseases on the basis of [symptom 1], [symptom 2], and [symptom 3]

On the basis bloating, abdominal distention, infertility and hernia , must be differentiated from [disease 1], [disease 2], [disease 3], [disease 4], [disease 5], and [disease 6].

Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging Histopathology
Symptom 1 Physical exam 1 Lab 1 Imaging 1

CT Scan

Imaging

2

Imaging 3
Pseudomyxoma peritonei
  • Bloating
  • Abdominal distention
  • Abdominal tenderness
  • Low-attenuation
  • Scalloping of the visceral surfaces
Peritoneal carcinomatosis without mucinous ascites
  • Pleural effusion and/or masses in chest
  • Mesenteric or retroperitoneal lymphadenopathy
  • Omental caking, and invasion into parenchymal organs
Peritoneal sarcomatosis
  • Abdominal mass
  • Heterogeneous bulky masses
  • Hypervascularity with or without
  • Hemoperitoneum Variable presence of ascites.
Lymphomatosis
  • Fever
  • Night sweat
  • Weight loss
  • CD20,
  • CD79a,
  • CD10
  • Thickened peritoneal surfaces.
  • Multifocal nodules and masses
  • Atypical lymphoid cells
  • Associated with Herpes virus 8 (HHV-8), which is also associated with Kaposi sarcoma, and Epstein-Barr virus
Tuberclousis Peritonitis
  • Fever
  • Night sweat
  • Abdominal pain
  • Elevated serum CA 125 level
  • Normal serum CA 19-9, and CEA associated with lymphocyte predominant benign ascites[3]
  • Miliary microabscesses in the liver or spleen
  • lymph node calcification
  • Inflammatory thickening of the terminal ileum and cecum
  • low-attenuation lymphadenopathy
  • Caseating granuloma with central area of necrotic acellular debris surrounded by histiocytes
  • Laparoscopy and peritoneal biopsy[3]
Endometriosis
  • Menstrual cramps[4]
  • Painful bowel movements
  • Painful urination during menstrual periods
  • Heavy menstrual periods
  • Pain during or after sex
  • Immobile uterine
  • Cervical motion tenderness
  • Fixed and retroverted uterus
  • Tender adnexal mass
  • Tender uterosacral nodularity
  • Thomsen-Friedenreich (T) antigen (Gal beta1-3GalNAc)[5]
  • Endometrial-type glands and stroma, as well as hemosiderin-laden macrophages
  • Hemorrhagic, reddish brown or blue nodules or cysts on the peritoneal surfaces
  • Visual inspection with laparascopy[6]
Sclerosing encapsulating peritonitis
Gliomatosis Peritonei
  • Association with solid or immature ovarian teratomas, but it has also been reported to occur in association with ventriculoperitoneal shunts
Osseous metaplasia
  • Multiple, high-attenuation, linear-branching structures within the mesentery that extend to the peritoneal surfaces
Splenosis
Melanosis
  • Pigment-laden macrophages within the mucosa on PAS staining
Inflammatory Pseudotumor
  • Fever
  • Weight loss
  • Anemia
  • Anemia
  • Thrombocytosis
  • Polyclonal hypergammaglobulinemia
  • Stain positive for ALK with immunohistochemistry
  • Loose myxoid areas with interspersed spindle cells,
  • Variable vascularity
  • Areas of dense collagen, and dense spindled myofibroblasts admixed with inflammatory cells to include plasma cells and lymphocytes.
  • Chromosomal translocations involving the ALK gene

References

  1. Harmon RL, Sugarbaker PH (February 2005). "Prognostic indicators in peritoneal carcinomatosis from gastrointestinal cancer". Int Semin Surg Oncol. 2 (1): 3. doi:10.1186/1477-7800-2-3. PMC 549516. PMID 15701175.
  2. Carr NJ, Bibeau F, Bradley RF, Dartigues P, Feakins RM, Geisinger KR, Gui X, Isaac S, Milione M, Misdraji J, Pai RK, Rodriguez-Justo M, Sobin LH, van Velthuysen MF, Yantiss RK (December 2017). "The histopathological classification, diagnosis and differential diagnosis of mucinous appendiceal neoplasms, appendiceal adenocarcinomas and pseudomyxoma peritonei". Histopathology. 71 (6): 847–858. doi:10.1111/his.13324. PMID 28746986.
  3. 3.0 3.1 Kaya M, Kaplan MA, Isikdogan A, Celik Y (2011). "Differentiation of tuberculous peritonitis from peritonitis carcinomatosa without surgical intervention". Saudi J Gastroenterol. 17 (5): 312–7. doi:10.4103/1319-3767.84484. PMC 3178918. PMID 21912057.
  4. DiVasta AD, Vitonis AF, Laufer MR, Missmer SA (March 2018). "Spectrum of symptoms in women diagnosed with endometriosis during adolescence vs adulthood". Am. J. Obstet. Gynecol. 218 (3): 324.e1–324.e11. doi:10.1016/j.ajog.2017.12.007. PMID 29247637.
  5. Yeaman GR, Collins JE, Lang GA (March 2002). "Autoantibody responses to carbohydrate epitopes in endometriosis". Ann. N. Y. Acad. Sci. 955: 174–82, discussion 199–200, 396–406. PMID 11949946.
  6. Kennedy S, Bergqvist A, Chapron C, D'Hooghe T, Dunselman G, Greb R, Hummelshoj L, Prentice A, Saridogan E (October 2005). "ESHRE guideline for the diagnosis and treatment of endometriosis". Hum. Reprod. 20 (10): 2698–704. doi:10.1093/humrep/dei135. PMID 15980014.

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