A 58-year-old woman presents with progressive abdominal distension over 3 months. CT abdomen shows scalloping of the liver and spleen surfaces with abundant mucinous ascites in the peritoneal cavity. A dilated appendix with a mucinous mass is identified. The diagnosis is pseudomyxoma peritonei. Which statement regarding the pathophysiology is most accurate?
- A Mucinous epithelial cells implant on peritoneal surfaces and secrete mucin that accumulates in dependent areas ✓
- B Mucin is carried via the portal circulation to the liver causing hepatic scalloping
- C It results from transmural inflammation of the appendix with secondary peritoneal involvement
- D The mucin arises from metastatic adenocarcinoma deposits throughout the peritoneum
Correct answer: A. Mucinous epithelial cells implant on peritoneal surfaces and secrete mucin that accumulates in dependent areas
Explanation
Pseudomyxoma peritonei results from rupture of an appendiceal mucinous neoplasm with dissemination of mucin-secreting cells throughout the peritoneal cavity. These cells implant on peritoneal surfaces and produce abundant mucin that accumulates in dependent areas (pouch of Douglas, paracolic gutters, subhepatic space) causing the characteristic visceral scalloping. Portal spread is not the mechanism.
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.