A 52-year-old woman presents with progressive abdominal distension over 18 months. Aspiration yields thick gelatinous mucoid fluid. Laparoscopy shows abundant jelly-like material coating omentum and peritoneal surfaces with scattered implants; ovaries appear normal. Records show an appendiceal mucinous neoplasm removed 6 years ago. What is the most appropriate definitive treatment strategy?

• A Systemic FOLFOX chemotherapy alone
• B Bilateral salpingo-oophorectomy with hysterectomy alone
• C Cytoreductive surgery with complete peritonectomy combined with heated intraperitoneal chemotherapy (HIPEC) ✓
• D Repeated debulking laparotomies with drainage of mucin at each admission

Explanation

Pseudomyxoma peritonei usually arises from a low-grade appendiceal mucinous neoplasm and spreads by transcoelomic implantation, sparing visceral invasion early. Because these tumours are chemoresistant, the standard curative approach is aggressive cytoreduction to visible disease status plus HIPEC, offered at specialised centres. Systemic chemotherapy gives poor response rates, and serial drainage only palliates while disease progresses.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.