An Invasive Treatment of Pseudomyxoma Peritonei with Intrathoracic Involvement.

Pseudomyxoma peritonei (PP) is a rare disease characterized by the presence of mucinous ascites and low and progressive accumulation of peritoneal implants. We report the case of a 44-year-old man presented with ascites, imaging evaluations suggesting the diagnosis of gelatinous peritoneal carcinomatosis. The patient underwent laparoscopy with extensive cytoreductive surgery combined with hyperthermic intraoperative peritoneal chemotherapy (HIPEC). Microscopic features confirmed the diagnosis of low-grade PP. Nine months later the patients developed left pleural effusion and cytological examination releaved the intrathoracic extension of PP. The treatment consisted in extensive intrathoracic cytoreductive surgery in combination with hyperthermic intrathoracic chemotherapy perfusion (HITOC). Further surgery was requiered due to intra-abdominal recurrence and finally, the patient developed hepatic and pulmonary metastases treated by systemic chemotherapy, with good tolerability and complete response.