困難診斷的腹膜偽黏液瘤：一位不明原因腹水表現之案例

Challenging with Pseudomyxoma Peritonei-A Case Report with Unexplained Ascites

腹水為臨床常見表徵，但其中不乏罕病引起。腹膜偽黏液瘤之膠凍狀腹水為其特殊，此病初期因不具特異性的腹部症狀導致診斷混淆。本案詳述一位47歲女性，因不明原因腹水且治療效果不佳，經腹水細胞及手術組織病理診斷，最終確診為闌尾低度惡性黏液瘤併升結腸、腹膜、子宮及左側卵巢轉移之歷程。希冀藉此困難診斷的案例分享，可提供當臨床遇到不明原因腹水且其呈膠凍狀質地時，腹膜偽黏液瘤就必須列入臨床思路，以達早期診治之目的。

Ascites is a common clinical manifestation; however, some rare diseases, such as pseudomyxoma peritonei (PMP), may contribute to ascites. The characteristic of ascites caused by PMP is jelly-like texture, and it is difficult to detect early because of non-specific abdominal symptoms. PMP may origin from appendix mucinous adenoma, followed by the ovary. The 47-year-old female with ascites had poor response to first-line treatment of ascites, then PMP diagnosis by ascites cytology. Therefore, the final diagnosis was low-grade appendiceal mucinous neoplasm (LAMN) with metastasis to the ascending colon, peritoneum, uterus and left ovary. The rare case provided valuable insights that ascites with jelly-like texture caused by unknown reason may consider pseudomyxoma of the peritoneum in clinical practice.