Extraperitoneal Presentation of Pseudomyxoma Peritonei as a Scrotal Mass: Case Report and Review of the Literature

Abstract

IA Al-Bozom, Extraperitoneal Presentation of Pseudomyxoma Peritonei as a Scrotal Mass: Case Report and Review of the Literature. 2000; 20(3-4): [297][298][299] Pseudomyxoma is a poorly understood condition which results from implantation of malignant tumors or irritation from ruptured benign cysts.1 Pseudomyxoma peritonei is a form of regional spread of gastrointestinal, gynecological and other malignancies of mucinous nature.2 It is characterized by the accumulation of abundant mucinous material within the peritoneal cavity. The case presented here is unique in that extraperitoneal presentations of pseudomyxoma peritonei are exceedingly rare, and presentation with scrotal mass is even rarer. To the best of my knowledge, there is only one case in the English literature with similar scrotal mass presentation, and 10 other cases with other types of extraperitoneal presentations. Literature review of extraperitoneal presentation of pseudomyxoma peritonei is also discussed. Case ReportA 75-year-old male patient presented to King Khalid University Hospital with nine months' history of left testicular and groin swellings. The patient had a history of right inguinal hernia repair 24 years prior to the recent presentation. Initial examination revealed a normal testis with paratesticular swelling that measured 4.5 cm in diameter, and extended to the spermatic cord, where there was another smaller swelling at the level of the left groin. The swellings were firm, non-tender, irreducible and without cough impulse. Ultrasonography demonstrated the presence of hypoechoic nodules in relation to the epididymis, which focally had a beaded appearance, particularly at the spermatic cord level. There was no focal lesion seen in the testis. His initial workup showed microcytic hypochromic anemia (HB=6.3, MCV=59.7, MCH=17.5, MCHC=29.2), with mild thrombocytosis and ESR value of 66. Total serum iron level was 9 (normal value, 14-32 mmol/L), and TIBC (total iron-binding capacity) value was 40 (normal value, 40-70 mmol/L). The initial clinical impression was tuberculosis of the spermatic cord and testicular adnexa. Surgery was performed after limited anesthesia (spinal anesthesia) due to the poor general condition of the patient. The findings were of inguinal hernia sac communicating with the peritoneal cavity which drained yellowish fluid from the scrotum. Further dissection showed multiple yellow-gelatinous nodules along the spermatic cord and on the outer surface of the testis. Left orchiectomy and repair of the hernia were done.After the histopathology results, a thorough examination of the patient revealed multiple ill-defined paraumbilical swellings that were soft in consistency. Ultrasonography of the abdomen revealed multiple echogenic masses in the peritoneal cavity and multiple echogenic lesions in the liver. Barium enema, and upper and lower gastrointestinal endoscopies were unremarkable. Laparoscopy was performed under spinal anesthesia, and a large appendiceal mass with yellow surface and gelatinous consistency was seen. In...