Pseudomyxoma peritonei differential diagnosis: Difference between revisions

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Revision as of 20:32, 21 January 2019

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
Tuberclousis peritonitis
Peritoneal sarcomatosis
Endometriosis
Gliomatosis peritonei
Osseous metaplasia
Splenosis
Melanosis
Inflammatory pseudotumor
Sclerosis encapsulating peritonitis (Abdominal cocoon)

Differentiating pseudomyxoma peritonei from other diseases

On the basis of findings on CT scan such as visceral scalloping and histopathology, pseudomyxoma peritonei must be differentiated from other similar rare diseases such as Peritoneal carcinomatosis without muscinous ascites, Tubercluosis peritonitis, Sarcomatosis peritonei.

	Symptoms		Signs	Lab Findings	Imaging		Histopathology
Diseases	Clinical manifestations			Para-clinical findings				Gold standard	Additional findings
	Symptoms		Signs	Para-clinical findings
	Symptom	Constitutional symptoms	Physical exam	Other lab values	CT Scan	Ultrasound	Histopathology
Pseudomyxoma peritonei^[3]^[4]	Bloating Abdominal distention	Negative	Abdominal tenderness	Non specific	Low-attenuation Scalloping of the visceral surfaces differentiates pseudomyxoma from other causes of peritnoitis. Typically does not invade visceral organs or spread by lymphatic or hematogenous routes unlike mucinous carcinomatosis	The echoes within pseudomyxoma peritonei are not mobile Echogenic septations within the gelatinous ascites are frequently observed. Scalloping of the hepatic and splenic margins	Gelatinous ascites in peritoneum and visceral organs,usually right hemidiaphragm, liver.	Diagnostic laparascopy/laparatomy	Immunohistochemisty CK 20 CDX2 MUC2 MUC5AC
Peritoneal carcinomatosis without mucinous ascites^[5]	Abdominal pain Abdominal distention	Negative	Abdominal distention Abdominal pain	Non specific	Pleural effusion and/or masses in chest Mesenteric or retroperitoneal lymphadenopathy Omental caking, and invasion into parenchymal organs	Echoes are mobile No scalloping of visceral organs.			Immunohistochemisty CEA
Peritoneal sarcomatosis	Abdominal pain Abdominal distention Bloating Nausea	Negative	Abdominal mass	Non specific	Heterogeneous bulky masses Hypervascularity with or without Hemoperitoneum Variable presence of ascites.			CT-guided percutaneous tissue biopsy
Lymphomatosis	Abdominal pain Bloating Swollen lymph node	Fever Night sweat Weight loss	Splenomegaly Lymphadenopathy Abdominal mass Abdominal tenderness	Anemia Pancytopenia Thrombocytopenia Thrombocytosis	Mostly non-specific Aneurysmal dilatation of the bowel loop with wall thickening may differentiate lymphomatosis from other peritoneal diseases.		Atypical lymphoid cells	Biopsy and histology	Rare manifestation of lymphoma, seen most frequently with non-Hodgkin lymphoma Associated with Herpes virus 8 (HHV-8), which is also associated with Kaposi sarcoma, and Epstein-Barr virus Immunohistochemistry: CD20 CD79a CD10
Tuberclousis Peritonitis^[6]^[6]	Abdominal pain	Fever Night sweat Weight loss	Abdominal tenderness Abdominal mass or bulging of flanks	Elevated serum CA-125 level Normal serum CA 19-9, and CEA associated with lymphocyte predominant benign ascites A positive tuberculin skin test Ascitic fluid will have an elevated white blood cell count with a lymphocytic predominance	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	Tuberclousis
Endometriosis^[7]^[8]^[9]	Menstrual cramps Painful bowel movements Painful urination during menstrual periods Heavy menstrual periods Pain during or after sex	Negative	Immobile uterine Cervical motion tenderness Fixed and retroverted uterus Tender adnexal mass Tender uterosacral nodularity	Thomsen-Friedenreich (T) antigen (Gal beta1-3GalNAc)		Hypoechogenic linear thickening or nodules/masses	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
Sclerosing encapsulating peritonitis^[10]^[11]^[12]	Fever, Weight loss, Loss of appetite Altered bowel movement Abdominal pain	Negative	Abdominal mass Abdominal tenderness		Diffusely thickened peritoneum and ascites Small bowel may be matted within loculated fluid collections Encapsulated small bowel	Thin echogenic strands can be seen within ascitic fluid; Tethered small bowel	Dense,opaque peritoneum Progressive collagen formation with an associated chronic inflammatory infiltrate		Most commonly in patients who undergo continuous ambulatory peritoneal dialysis. It may also be idiopathic, associated with ventriculoperitoneal shunts, liver transplantation
Gliomatosis Peritonei^[13]^[14]	Abdominal pain Bloating	Negative		SOX2+/OCT4-/NANOG- immunophenotype			Mature glial tissue in the peritoneal cavity Micronodular growth pattern		Association with solid or immature ovarian teratomas, but it has also been reported to occur in association with ventriculoperitoneal shunts
Osseous metaplasia	Abdominal pain Nausea Vomiting Bloating	Negative			Multiple, high-attenuation, linear-branching structures within the mesentery that extend to the peritoneal surfaces
Splenosis	Increase in abdominal girth	Negative	Abdominal mass Abdominal tenderness Splenomegaly Abdominal rigidity and guarding due to spleen rupture in some cases and retroperitoneal bleeding.				Lesions are typically multiple, small, reddish-brown nodules that range in size from a few millimeters to 7 cm
Melanosis^[15]^[16]^[17]^[18]	Majority of cases are asymptomatic Increase in abdominal girth	Negative					Pigmentation within the dermoid, omentum, and peritoneal cavity Pigment-laden macrophages within the mucosa on PAS staining	Biopsy and histology	Enteric duplication cyst Associated with ovarian cystic teratomas Reported case of gastric triplication and its association with melanosis peritonei.
Inflammatory Pseudotumor^[19]	Fever Weight loss Growth retardation Symptoms of Anemia Symptoms related to mass effect,	Negative		Anemia Thrombocytosis Polyclonal hypergammaglobulinemia Stain positive for ALK with immunohistochemistry	CT findings are non specific ascites, masses may be seen in peritoneum,mimic neoplasm.		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: ALK gene Immunochemistry: IgG4 positive plasma cell

References

↑ 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.
↑ 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.
↑ Carranza-Martínez I, Cornejo-López G, Monroy-Argumedo M, Villanueva-Sáenz E (2014). "[Pseudomyxoma peritonei. Two-case-report]". Cir Cir (in Spanish; Castilian). 82 (2): 206–11. PMID 25312322.
↑ Ronnett BM, Zahn CM, Kurman RJ, Kass ME, Sugarbaker PH, Shmookler BM (December 1995). "Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to "pseudomyxoma peritonei"". Am. J. Surg. Pathol. 19 (12): 1390–408. PMID 7503361.
↑ Winder T, Lenz HJ (2010). "Mucinous adenocarcinomas with intra-abdominal dissemination: a review of current therapy". Oncologist. 15 (8): 836–44. doi:10.1634/theoncologist.2010-0052. PMC 3228029. PMID 20656916.
↑ ^6.0 ^6.1 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.
↑ 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.
↑ 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.
↑ 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.
↑ Suh WN, Lee SK, Chang H, Hwang HJ, Hyung WJ, Park YN, Kim TI (June 2007). "Sclerosing encapsulating peritonitis (abdominal cocoon) after abdominal hysterectomy". Korean J. Intern. Med. 22 (2): 125–9. PMC 2687622. PMID 17616031.
↑ Al Ani AH, Al Zayani N, Najmeddine M, Jacob S, Nair S (2014). "Idiopathic sclerosing encapsulating peritonitis (abdominal cocoon) in adult male. A case report". Int J Surg Case Rep. 5 (10): 735–8. doi:10.1016/j.ijscr.2014.07.017. PMC 4189066. PMID 25217877.
↑ Sharma D, Nair RP, Dani T, Shetty P (2013). "Abdominal cocoon-A rare cause of intestinal obstruction". Int J Surg Case Rep. 4 (11): 955–7. doi:10.1016/j.ijscr.2013.08.004. PMC 3825929. PMID 24055916.
↑ Liang L, Zhang Y, Malpica A, Ramalingam P, Euscher ED, Fuller GN, Liu J (December 2015). "Gliomatosis peritonei: a clinicopathologic and immunohistochemical study of 21 cases". Mod. Pathol. 28 (12): 1613–20. doi:10.1038/modpathol.2015.116. PMC 4682736. PMID 26564007.
↑ Lovell MA, Ross GW, Cooper PH (April 1989). "Gliomatosis peritonei associated with a ventriculoperitoneal shunt". Am. J. Clin. Pathol. 91 (4): 485–7. PMID 2648802.
↑ Chang ES, Bachul P, Szura M, Szpor J, Okoń K, Walocha JA (September 2015). "Peritoneal "melanosis"". Pol J Pathol. 66 (3): 330–3. PMID 26619112.
↑ Gao R, Liu NF, Sheng XG (April 2010). "Malignant ovarian melanoma with extensive pelvic and peritoneal metastasis: a case report and literature review". Chin J Cancer. 29 (4): 460–2. PMID 20346227.
↑ Kim SS, Nam JH, Kim SM, Choi YD, Lee JH (March 2010). "Peritoneal melanosis associated with mucinous cystadenoma of the ovary and adenocarcinoma of the colon". Int. J. Gynecol. Pathol. 29 (2): 113–6. doi:10.1097/PGP.0b013e3181bb4182. PMID 20173496.
↑ De la Torre Mondragón L, Daza DC, Bustamante AP, Fascinetto GV (December 1997). "Gastric triplication and peritoneal melanosis". J. Pediatr. Surg. 32 (12): 1773–5. PMID 9434025.
↑ Maves, C K; Johnson, J F; Bove, K; Malott, R L (1989). "Gastric inflammatory pseudotumor in children". Radiology. 173 (2): 381–383. doi:10.1148/radiology.173.2.2678252. ISSN 0033-8419.

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References

Template:WikiDoc Sources

[pmid15701175-1] 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.

[pmid28746986-2] 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.

[pmid25312322-3] Carranza-Martínez I, Cornejo-López G, Monroy-Argumedo M, Villanueva-Sáenz E (2014). "[Pseudomyxoma peritonei. Two-case-report]". Cir Cir (in Spanish; Castilian). 82 (2): 206–11. PMID 25312322.

[pmid7503361-4] Ronnett BM, Zahn CM, Kurman RJ, Kass ME, Sugarbaker PH, Shmookler BM (December 1995). "Disseminated peritoneal adenomucinosis and peritoneal mucinous carcinomatosis. A clinicopathologic analysis of 109 cases with emphasis on distinguishing pathologic features, site of origin, prognosis, and relationship to "pseudomyxoma peritonei"". Am. J. Surg. Pathol. 19 (12): 1390–408. PMID 7503361.

[pmid20656916-5] Winder T, Lenz HJ (2010). "Mucinous adenocarcinomas with intra-abdominal dissemination: a review of current therapy". Oncologist. 15 (8): 836–44. doi:10.1634/theoncologist.2010-0052. PMC 3228029. PMID 20656916.

[pmid21912057-6] 6.0 ^6.1 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.

[pmid29247637-7] 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.

[pmid11949946-8] 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.

[pmid15980014-9] 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.

[pmid17616031-10] Suh WN, Lee SK, Chang H, Hwang HJ, Hyung WJ, Park YN, Kim TI (June 2007). "Sclerosing encapsulating peritonitis (abdominal cocoon) after abdominal hysterectomy". Korean J. Intern. Med. 22 (2): 125–9. PMC 2687622. PMID 17616031.

[pmid25217877-11] Al Ani AH, Al Zayani N, Najmeddine M, Jacob S, Nair S (2014). "Idiopathic sclerosing encapsulating peritonitis (abdominal cocoon) in adult male. A case report". Int J Surg Case Rep. 5 (10): 735–8. doi:10.1016/j.ijscr.2014.07.017. PMC 4189066. PMID 25217877.

[pmid24055916-12] Sharma D, Nair RP, Dani T, Shetty P (2013). "Abdominal cocoon-A rare cause of intestinal obstruction". Int J Surg Case Rep. 4 (11): 955–7. doi:10.1016/j.ijscr.2013.08.004. PMC 3825929. PMID 24055916.

[pmid26564007-13] Liang L, Zhang Y, Malpica A, Ramalingam P, Euscher ED, Fuller GN, Liu J (December 2015). "Gliomatosis peritonei: a clinicopathologic and immunohistochemical study of 21 cases". Mod. Pathol. 28 (12): 1613–20. doi:10.1038/modpathol.2015.116. PMC 4682736. PMID 26564007.

[pmid2648802-14] Lovell MA, Ross GW, Cooper PH (April 1989). "Gliomatosis peritonei associated with a ventriculoperitoneal shunt". Am. J. Clin. Pathol. 91 (4): 485–7. PMID 2648802.

[pmid26619112-15] Chang ES, Bachul P, Szura M, Szpor J, Okoń K, Walocha JA (September 2015). "Peritoneal "melanosis"". Pol J Pathol. 66 (3): 330–3. PMID 26619112.

[pmid20346227-16] Gao R, Liu NF, Sheng XG (April 2010). "Malignant ovarian melanoma with extensive pelvic and peritoneal metastasis: a case report and literature review". Chin J Cancer. 29 (4): 460–2. PMID 20346227.

[pmid20173496-17] Kim SS, Nam JH, Kim SM, Choi YD, Lee JH (March 2010). "Peritoneal melanosis associated with mucinous cystadenoma of the ovary and adenocarcinoma of the colon". Int. J. Gynecol. Pathol. 29 (2): 113–6. doi:10.1097/PGP.0b013e3181bb4182. PMID 20173496.

[pmid9434025-18] De la Torre Mondragón L, Daza DC, Bustamante AP, Fascinetto GV (December 1997). "Gastric triplication and peritoneal melanosis". J. Pediatr. Surg. 32 (12): 1773–5. PMID 9434025.

[MavesJohnson1989-19] Maves, C K; Johnson, J F; Bove, K; Malott, R L (1989). "Gastric inflammatory pseudotumor in children". Radiology. 173 (2): 381–383. doi:10.1148/radiology.173.2.2678252. ISSN 0033-8419.

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@@ Line 25: / Line 25: @@
 ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
 | colspan="3" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
-! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
+! colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
 | colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
 ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
@@ Line 32: / Line 32: @@
 ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Signs
 |-
-! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
 ! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
 ! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
@@ Line 40: / Line 40: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical exam
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Other lab values
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immunohistochemistry
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT Scan
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Ultrasound
@@ Line 54: / Line 53: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * Non specific
-|
-* CK 20, CDX2 and MUC2,MUC5AC
 | style="background: #F5F5F5; padding: 5px;" |
 *Low-attenuation
@@ Line 70: / Line 67: @@
 * Diagnostic laparascopy/laparatomy
 | style="background: #F5F5F5; padding: 5px;" |
+* Immunohistochemisty
+** CK 20
+** CDX2
+** MUC2
+** MUC5AC
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |Peritoneal carcinomatosis without mucinous ascites<ref name="pmid20656916">{{cite journal |vauthors=Winder T, Lenz HJ |title=Mucinous adenocarcinomas with intra-abdominal dissemination: a review of current therapy |journal=Oncologist |volume=15 |issue=8 |pages=836–44 |date=2010 |pmid=20656916 |pmc=3228029 |doi=10.1634/theoncologist.2010-0052 |url=}}</ref>
@@ Line 84: / Line 87: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * Non specific
-|
 | style="background: #F5F5F5; padding: 5px;" |
 *Pleural effusion and/or masses in chest
@@ Line 98: / Line 100: @@
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
+* Immunohistochemisty
+** CEA
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |Peritoneal sarcomatosis
@@ Line 115: / Line 120: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * Non specific
-|
 | style="background: #F5F5F5; padding: 5px;" |
 * Heterogeneous bulky masses
@@ Line 155: / Line 159: @@
 *
-|
-* CD20,
-* CD79a,
-* CD10
 | style="background: #F5F5F5; padding: 5px;" |
 * Mostly non-specific
@@ Line 172: / Line 172: @@
 * Associated with Herpes virus 8 (HHV-8), which is also associated with Kaposi sarcoma, and Epstein-Barr virus
+* Immunohistochemistry:
+** CD20
+** CD79a
+** CD10
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 |-
@@ Line 196: / Line 200: @@
 * Ascitic fluid will have an elevated [[white blood cell]] count with a lymphocytic predominance
-|
 | style="background: #F5F5F5; padding: 5px;" |
 * Miliary microabscesses in the liver or spleen
@@ Line 237: / Line 240: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * Thomsen-Friedenreich (T) antigen (Gal beta1-3GalNAc)
-|
 | style="background: #F5F5F5; padding: 5px;" |
 *
@@ Line 266: / Line 268: @@
 * Abdominal tenderness
 | style="background: #F5F5F5; padding: 5px;" |
-|
 | style="background: #F5F5F5; padding: 5px;" |
 * Diffusely thickened peritoneum and ascites
@@ Line 293: / Line 294: @@
 | style="background: #F5F5F5; padding: 5px;" |
 * SOX2+/OCT4-/NANOG- immunophenotype
-|
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 316: / Line 316: @@
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
-|
 | style="background: #F5F5F5; padding: 5px;" |
 * Multiple, high-attenuation, linear-branching structures within the mesentery that extend to the peritoneal surfaces
@@ Line 338: / Line 337: @@
 * Abdominal rigidity and guarding due to spleen rupture in some cases and retroperitoneal bleeding.
 | style="background: #F5F5F5; padding: 5px;" |
-|
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 355: / Line 353: @@
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
-|
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
@@ Line 389: / Line 386: @@
 * Polyclonal hypergammaglobulinemia
 * Stain positive for ALK with immunohistochemistry
-|
-* IgG4 positive plasma cell
 | style="background: #F5F5F5; padding: 5px;" |
 * CT findings are non specific ascites, masses may be seen in peritoneum,mimic neoplasm.
@@ Line 401: / Line 396: @@
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px;" |
-* Chromosomal translocations involving the ALK gene
+* Chromosomal translocations:
+** ALK gene
+* Immunochemistry:
+** IgG4 positive plasma cell
 |}

Pseudomyxoma peritonei differential diagnosis: Difference between revisions

Revision as of 20:32, 21 January 2019

Overview

Differential Diagnosis

Differentiating pseudomyxoma peritonei from other diseases

References

References

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