Pulmonary Pseudomyxoma Peritonei
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Publication Date
4-29-2026
Keywords
oregon, psvmc, psvmc gme, psvmc oaa
Disciplines
Medical Education
Abstract
Introduction: Pseudomyxoma peritonei (PMP) is an intra -abdominal cancer occurring in one to four out of one million patients. It begins as a mucinous adenocarcinoma of the appendix that implants on other peritoneal surfaces, spreading into gelatinous ascites. Treatment consists of hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS). Extra -abdominal metastases are rare. We present the case of a patient who underwent treatment for PMP and was found to have lung nodules over a decade later. Case Presentation: A 73 -year -old woman with pseudomyxoma peritonei presented to the emergency department with progressive dyspnea and unintentional weight loss. Twenty -eight years earlier she was found to have appendiceal pseudomyxoma peritonei with extension to her right ovary and underwent CRS, though she didn't receive HIPEC. Fifteen years later, she was noted to have lung nodules and underwent bronchoscopy with biopsy that revealed mucinous cystic lesions. Body -wide imaging was negative for recurrence or other metastases. She was monitored with serial imaging that showed stable sized nodules approximately 5 x 3.5 cm in the right lower lobe and 5 x 4 cm in the left upper lobe. She presented seven years later with twenty -pound weight loss, progressive dyspnea on exertion, and intermittent hemoptysis. She was borderline tachycardic without hypoxemia and newly anemic with a three -point hemoglobin drop to 8.9 g/dL. Computed tomography of the chest showed a right - sided mass 15.3 x 14.9 x 19 cm in size and a left -upper mass 12.9 x 11.3 x 11 cm in size with compression of adjacent bronchi and vasculature. Discussion: Extra -abdominal metastases of PMP are exceedingly rare. Within the metastatic cohort, the lungs accounted for 57.1% of cases, suggesting 3.7% of PMP cases developed pulmonary metastases. While it is unclear when our patient first developed pulmonary metastases, a case series suggests these are usually identified much earlier, with the longest time to discovery of lung metastasis being seven years. This is likely why our patient's masses grew to such a significant size, as none of the metastases identified in case series was even half the size of hers. Unfortunately, treatment of pulmonary metastases is usually accomplished with wedge resection or lobectomy, and our patient's masses had grown so large that this was unfeasible. While it is unclear whether systemic chemotherapy has a role in the treatment of metastatic PMP, the patient discussed a trial with oncology and elected to forego any further workup or treatment.
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Internal Medicine
