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IMAGES AND VIDEOS
Year : 2017  |  Volume : 6  |  Issue : 1  |  Page : 69-70

Endoscopic ultrasound-guided fine-needle aspiration of peritoneal deposits in patients with ascites of unknown cause (with videos)


1 Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
2 Department of Pathology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India

Date of Submission31-Mar-2016
Date of Acceptance11-May-2016
Date of Web Publication15-Feb-2017

Correspondence Address:
Piyush Somani
Department of Gastroenterology, Jaswant Rai Speciality Hospital, Saket, Meerut - 250 001, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2303-9027.200208

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How to cite this article:
Somani P, Sharma M, Patil A, Shastri C. Endoscopic ultrasound-guided fine-needle aspiration of peritoneal deposits in patients with ascites of unknown cause (with videos). Endosc Ultrasound 2017;6:69-70

How to cite this URL:
Somani P, Sharma M, Patil A, Shastri C. Endoscopic ultrasound-guided fine-needle aspiration of peritoneal deposits in patients with ascites of unknown cause (with videos). Endosc Ultrasound [serial online] 2017 [cited 2020 Oct 24];6:69-70. Available from: http://www.eusjournal.com/text.asp?2017/6/1/69/200208

A 50-year-old male with no significant medical history presented with loss of weight, anorexia, and abdominal distension for last 1 month. Physical examination showed ascites. Laboratory examination revealed low serum ascites albumin gradient ascites. Diagnostic workup including upper gastrointestinal endoscopy, colonoscopy, echocardiography, ascitic fluid malignant cytology and adenosine deaminase levels were non-contributory. Contrast-enhanced computed tomography (CECT) of the abdomen revealed ascites and thickened omentum. Endoscopic ultrasonography (EUS) was performed from the stomach with the aim of doing fine-needle aspiration (FNA) of peritoneal/omental deposits. It revealed anechoic ascites and multiple hyperechoic loose floating structures suggestive of peritoneal/omental deposits [Figure 1]a, [Figure 1]b and [Video 1]. EUS-guided FNA with 22-gauge needle (Expect; Boston Scientific, Natick, Massachusetts, USA) from omental deposits was performed [Figure 2]a and [Video 1]. Cytopathology showed epithelial cells with moderate atypia with abundant mucin confirming the diagnosis of pseudomyxoma peritonei [Figure 2]b. The patient underwent cytoreductive surgery with heated intraperitoneal chemotherapy but unfortunately he died.
Figure 1: (a and b) Endoscopic ultrasonography image showing hyperechoic omental deposits with anechoic ascites

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Figure 2: (a) Hyperechoic omental deposits punctured with endoscopic ultrasonography-fine needle aspiration(b) Histopathological image showing epithelial cells with moderate atypia with abundant mucin

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Pseudomyxoma peritonei is an uncommon clinical entity with an estimated incidence of 1–2/million/year. It is characterized by diffuse intra-abdominal gelatinous collections (jelly belly) with mucinous implants on peritoneal surfaces and the omentum. The origin of tumor is appendix or ovary. Symptoms are nonspecific; abdominal pain and distension are the most common presenting manifestations.[1] The imaging and staging modality of choice is CECT of the abdomen, with scalloping and characteristic patterns of disease on visceral surfaces being almost pathognomic of pseudomyxoma peritonei.[2] In the majority of cases, pseudomyxoma peritonei is an incidental finding at exploratory laparotomy or laparoscopy, which remains the main diagnostic tool for accurately diagnosing pseudomyxoma peritonei. In a series of four patients, it has been shown that EUS-FNA of peritoneal lesions is a safe, minimally invasive alternative for tissue diagnosis in ascites of unknown etiology.[3] We describe an interesting case where EUS-guided FNA of the omental deposits helped in the diagnosis of pseudomyxoma peritonei.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Bevan KE, Mohamed F, Moran BJ. Pseudomyxoma peritonei. World J Gastrointest Oncol 2010;2:44-50.  Back to cited text no. 1
    
2.
Chauhan A, Patodi N, Ahmed M. A rare cause of ascites: Pseudomyxoma peritonei and a review of the literature. Clin Case Rep 2015;3:156-9.  Back to cited text no. 2
    
3.
Peter S, Eltoum I, Eloubeidi MA. EUS-guided FNA of peritoneal carcinomatosis in patients with unknown primary malignancy. Gastrointest Endosc 2009;70:1266-70.  Back to cited text no. 3
    


    Figures

  [Figure 1], [Figure 2]



 

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