A 52-year-old woman presents with progressive abdominal distension over a year. Laparoscopy reveals abundant gelatinous material coating omental and peritoneal surfaces. Histology of an appendiceal specimen shows a mucinous neoplasm. What is the standard treatment approach?
- A Repeat laparoscopic drainage of mucin every six months
- B Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy ✓
- C Systemic FOLFOX chemotherapy alone
- D Total abdominal hysterectomy with bilateral salpingo-oophorectomy alone
Correct answer: B. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy
Explanation
Pseudomyxoma peritonei from a ruptured low-grade appendiceal mucinous neoplasm is treated with complete cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC), which offers durable disease control in selected patients. Repeated drainage only debulks mucin temporarily, and systemic chemotherapy has poor activity against these low-grade tumours. The key fact is that this is a peritoneal surface malignancy managed by locoregional treatment.
Reference: Sabiston Textbook of Surgery, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.