An 81-year-old female with a previous history of high blood pressure and glaucoma was brought to the outpatient clinic due to a progressive abdominal distension. Her family claimed that she had hyporexia, asthenia, and progressive weight loss.
In the physical examination she was found to be cachectic with a distended and dull abdomen. No mass was palpable. Blood tests were performed, and the most remarkable finding was normocytic normochromic anemia. Due to the high degree of suspicion of gastrointestinal neoplasia, an endoscopic study was ordered.
The results of the gastroscopy and the colonoscopy were normal. A CT Scan was performed, which revealed abundant ascites that mobilized the small bowel up to the superior hemiabdomen. This ascites produced liver scalloping, which suggested pseudomyxoma peritonei (FIG 1).
A 40mm tubular image arising from the cecum was found. This was a pathological appendix with had calcified walls and contained liquid, with similar characteristics to the other one, distributed throughout the entire abdomen (FIG 2). There was also a big cystic mass in the pelvis with suggested metastatic implants in the ovary (FIG 1).
A sample of this liquid was obtained by means of a puncture. Pathological evaluation described atypical cells and abundant mucinous material compatible with metastasis of mucinous adenocarcinoma.
Unfortunately, as this was an elderly and fragile patient, radical treatment was not possible and she was referred for palliative care.