Figure 7

Histopathology of pseudomyxoma peritonei. In the least aggressive group of appendiceal mucinous tumors, the malignancy found within the abdomen is termed diffuse peritoneal adenomucinousis. This is in contrast to peritoneal carcinomatosis. Histologic study shows a single layer of epithelial cells positioned on a bland and relatively avascular stroma. Large mucin lakes occupy the majority of the field of view. (H&E x 250).

Figure 8

Intermediate grade mucinous tumor of the appendix. This photomicrograph shows the histopathology of a mucinous appendiceal tumor that has characteristics of pseudomyxoma and also mucinous adenocarcinoma. The cells are more bizarre, are multi-layered, and show occasional mitosis. No necrosis or sheets of malignant epithelial cells as would be seen with mucinous adenocarcinoma were present. (H&E x 500).

Figure 9

Peritoneal lesion in disseminated peritoneal adenomucinosis. Strips of mucinous epithelium with minimal cytologic atypia are found associated with pools of mucin and fibrous tissue. (H&E). Ronnett BM, Shmookler BM, Sugarbaker PH, Kurman RJ: Pseudomyxoma peritonei: New concepts in diagnosis, origin, nomenclature, and relationship to mucinous borderline (low malignant potential) tumors of the ovary. In: Fechner RE, Rosen PP (Eds): Anatomic Pathology 1997 ASCP Press, Chicago, IL, 1997.

Figure 10

Photomicrograph of adenomucinosis after four cycles of intraperitoneal chemotherapy. The tissue shown in this photomicrograph was taken from the surface of this tumor. The tumor shows complete disruption of its architecture, with no viable epithelial cell remaining. (H&E).

Figure 11

Photomicrograph of intermediate grade mucinous tumor of appendiceal origin prior to the initiation of intraperitoneal chemotherapy. (H&E).

Figure 12

Intermediated grade mucinous adenocarcinoma after four cycles of intraperitoneal chemotherapy with mitomycin C and 5-fluorouracil. Some mucin remains behind, but the mucinous adenocarcinoma cells are absent. (H&E).

Figure 10

Peritoneal surface after intraperitoneal chemotherapy. The photomicrograph shows considerable fibrosis at the peritoneal surface. This is typical of the abdominopelvic cavity surfaces after numerous cycles of intraperitoneal chemotherapy. Residual mucus accumulations are evident throughout the tissue that is contiguous with the abdominal space. The atypical cells associated with the mucin globules are no longer visible. (H&E).

Figure 14

Predicative value of computed tomographic findings by a tree-structured diagram. CR = complete resection; IR = incomplete resection; and RLQ = right lower quadrant. From Jacquet P, Jelinek JS, Chang D, Koslowe P: Abdominal computed tomographic scan in the selection of patients with mucinous peritoneal carcinomatosis for cytoreductive surgery. Journal of the American College of Surgeons 181:530-538, 1995.