Synchronous Ovarian and Appendiceal Mucinous Neoplasms in the Absence of Pseudomyxoma Peritonei Ovarian Cancer and Us OVARIAN CANCER and US Ovarian Cancer and Us

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Tuesday, November 22, 2016

Synchronous Ovarian and Appendiceal Mucinous Neoplasms in the Absence of Pseudomyxoma Peritonei



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What is Pseudomyxoma Peritonei (“PMP”)?
The term Pseudomyxoma Peritonei has been and still is used to mean a number of different things. This has created much confusion for patients and physicians. Efforts are underway to better define PMP in the medical literature so that there is a better understanding of the term and communication between physicians and patients. Generally speaking, PMP is a rare condition characterized by the presence of mucin in the abdominal cavity. A number of types of tumors can cause PMP, but the most common cause is appendix cancer – including low grade mucinous neoplasms of the appendix.
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abstract
 

BACKGROUND:

Synchronous (existing or occurring at the same time) ovarian/appendiceal mucinous neoplasms sometimes occur in the absence of clinical pseudomyxoma peritonei (PMP), which raises a question about whether the 2 tumors could be independent.

METHODS:

We identified 11 cases of synchronous ovarian/appendiceal mucinous neoplasms without PMP and subclassified them into groups 1 and 2 based on the presence or absence of microscopic peritoneal/ovarian surface mucin deposits. A 7-marker panel (CK7, CK20, CDX2, PAX8, MUC1, MUC2, and MUC5AC) immunohistochemistry was performed on both tumors.

RESULTS:

Between the 2 groups, there were no significant differences in age, laterality, size, and histology of ovarian/appendiceal tumors. In group 1, 2 of 4 cases developed PMP later, and both had ovarian surface and contralateral ovarian involvement and appendiceal perforation with microscopic mucin deposits on the peritoneum. No patients in group 2 developed PMP. All group 1 cases showed a high degree of concordance of immunoprofile between the synchronous tumors, with an identical expression of appendiceal pattern in greater than 90% of the markers. In group 2, only 1 of 7 cases showed concordance in all markers.

CONCLUSIONS:

If peritoneal mucin deposits present, even microscopic and acellular, the synchronous tumors are most likely of a single appendiceal origin. Otherwise, they are more heterogeneous, and some may be truly dual primaries.

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