SHM Converge Scientific Abstract ePoster Gallery-The Bedside Paracentesis That Wouldn't Drain: Mucinous Ascites From Stage IV Appendiceal Adenocarcinoma

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This case describes a 70-year-old woman with 5 months of progressive, massive abdominal distension. Imaging showed large-volume ascites with a relatively high density, and bedside paracentesis unexpectedly yielded only a small amount of thick, gelatinous fluid. A repeat attempt by Interventional Radiology, even with a larger catheter and vacuum suction, removed only 1 liter of mucin. Cytology demonstrated abundant mucinous material but no malignant cells, highlighting that cytology can be falsely negative in mucinous appendiceal disease.<br /><br />Because of persistent concern for an underlying pathology, the patient underwent exploratory laparotomy. Surgeons evacuated 10 liters of mucin and found a firm nodularity on the appendix, mucinous deposits on the appendix surface, a large mucinous lesion of the left ovary, and diffuse peritoneal involvement. Additional procedures included appendectomy, left oophorectomy, omentectomy, and peritoneal stripping. Pathology confirmed stage IV mucinous adenocarcinoma of appendiceal origin.<br /><br />The case emphasizes that mucinous appendiceal neoplasms are rare and may present as distended, mucus-filled appendices or with peritoneal spread after rupture or transmural extension. They are often not obvious on imaging alone, and cytology may not reveal tumor cells despite extensive disease. The authors note that a combined treatment strategy using cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) can improve long-term outcomes in metastatic appendiceal adenocarcinoma. The patient was started on adjuvant FOLFOX, with future consideration of complete cytoreduction and HIPEC.

Asset Subtitle

Joseph Han

Meta Tag

Author List Cindy Fang, Joseph Han

Category Clinical Vignettes

Concept Mucinous Appendiceal Neoplasm

Concept Gelatinous Ascites

Concept Cytoreductive Surgery

Concept HIPEC

Concept Surgical Exploration

Distinguished Non-Finalist

Presenter Organization NYU Langone

Presenting Author Joseph Han

Track Adult

Keywords

appendiceal adenocarcinoma

mucinous neoplasm

massive ascites

gelatinous fluid

negative cytology

peritoneal spread

cytoreductive surgery

HIPEC

appendectomy

FOLFOX

Mucinous Appendiceal Neoplasm

Gelatinous Ascites

Cytoreductive Surgery

HIPEC

Surgical Exploration