{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T06:07:22Z","timestamp":1788934042834,"version":"build-2803163510"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>Pseudomyxoma peritonei (PMP) is a rare peritoneal malignancy. Its typical clinical manifestations include abdominal distension, increased abdominal girth, or abdominopelvic masses. It is extremely rare for an umbilical hernia to be the initial manifestation, so this can easily lead to clinical misdiagnosis. A 60-year-old woman presented with a reducible umbilical mass for 10 months. Physical examination revealed marked abdominal distension and a 6-cm firm, irreducible umbilical mass. Serum tumor markers were normal. Computed tomography (CT) showed diffuse low-density abdominopelvic masses consistent with PMP, an appendiceal cystic lesion suggestive of mucinous neoplasm, omental thickening, and periumbilical tumor extension. Ultrasound revealed 9.4-cm ascites with mucin particles and septations. She underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy. Intraoperatively, extensive gelatinous mucin, a ruptured cystic appendix, and periumbilical tumor involvement were noted. Postoperative pathology confirmed a high-grade appendiceal mucinous tumor with PMP. The immunohistochemistry results were as follows: cytokeratin 20 positive, caudal type homeobox 2 positive, and Ki-67 labeling index of 30%. Telephone follow-up 3 months after surgery indicated that the patient was doing well. PMP presenting with umbilical hernia as the initial symptom is relatively rare and is often misdiagnosed as a simple umbilical hernia. For middle-aged and elderly female patients with umbilical hernia who have concurrent ascites, thickened peritoneum, or a hard and fixed hernia mass, abdominopelvic CT and ultrasound should be performed to rule out PMP to avoid blindly performing hernia repair and delaying diagnosis and treatment.<\/jats:p>","DOI":"10.3389\/fsurg.2026.1962278","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:52:25Z","timestamp":1788933145000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Umbilical hernia as the initial manifestation of pseudomyxoma peritonei: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Guanjun","family":"Shi","sequence":"first","affiliation":[{"name":"Department of Myxoma, Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lubiao","family":"An","sequence":"additional","affiliation":[{"name":"Department of Myxoma, Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiyan","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Myxoma, Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haipeng","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Myxoma, Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shi","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Myxoma, Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruiqing","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Myxoma, Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Myxoma, Aerospace Center Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1097\/PAS.0000000000000535","article-title":"A consensus for classification and pathologic reporting of pseudomyxoma peritonei and associated appendiceal neoplasia","volume":"40","author":"Carr","year":"2016","journal-title":"Am J Surg Pathol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1097\/00000658-199402000-00001","article-title":"Pseudomyxoma peritonei a cancer whose biology is characterized by a redistribution phenomenon","volume":"219","author":"Sugarbaker","year":"1994","journal-title":"Ann Surg"},{"key":"B3","first-page":"1527","article-title":"Expert consensus on cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy for the treatment of pseudomyxoma peritonei","volume":"99","author":"Li","year":"2019","journal-title":"Chin Med J"},{"key":"B4","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1097\/COC.0000000000000911","article-title":"Comprehensive understanding and evolutional therapeutic schemes for pseudomyxoma peritonei","volume":"45","author":"Ye","year":"2022","journal-title":"Am J Clin Oncol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1016\/j.ejso.2007.04.002","article-title":"Appendiceal neoplasms and pseudomyxoma peritonei: a population based study","volume":"34","author":"Smeenk","year":"2008","journal-title":"Eur J Surg Oncol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1245\/s10434-020-08655-8","article-title":"Estimating the prevalence of pseudomyxoma peritonei in Europe using a novel statistical method","volume":"28","author":"Patrick-Brown","year":"2021","journal-title":"Ann Surg Oncol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e104402","DOI":"10.7759\/cureus.104402","article-title":"Pseudomyxoma peritonei presenting with progressive abdominal distension and abdominal hernia: a case report","volume":"18","author":"Marouf","year":"2026","journal-title":"Cureus"},{"key":"B8","doi-asserted-by":"publisher","first-page":"505","DOI":"10.3760\/cma.j.cn441530-20251229-00484","article-title":"Clinical analysis of pseudomyxoma peritonei presenting with external abdominal hernia as the initial symptom","volume":"29","author":"Yang","year":"2026","journal-title":"Zhonghua Wei Chang Wai Ke Za Zhi"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e88200","DOI":"10.7759\/cureus.88200","article-title":"Appendiceal mucocele in Amyand\u2019s hernia: a case report","volume":"17","author":"Moreno Hernandez","year":"2025","journal-title":"Cureus"},{"key":"B10","doi-asserted-by":"publisher","first-page":"101166","DOI":"10.1016\/j.jaim.2025.101166","article-title":"An ayurvedic intervention for pseudomyxoma peritonei\u2014a case report","volume":"16","author":"Sukumar","year":"2025","journal-title":"J Ayurveda Integr Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1111\/1754-9485.47_12784","article-title":"Scalloping of the liver: pseudomyxoma peritonei","author":"Xiang","year":"2018","journal-title":"J Med Imaging Radiat Oncol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1111\/j.1365-2559.2006.02512.x","article-title":"Cdx-2 expression in pseudomyxoma peritonei: a clinicopathological study of 42 cases","volume":"49","author":"Nonaka","year":"2006","journal-title":"Histopathology"},{"key":"B13","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1016\/j.ejso.2020.02.012","article-title":"Appendiceal tumours and pseudomyxoma peritonei: literature review with PSOGI\/EURACAN clinical practice guidelines for diagnosis and treatment","volume":"47","author":"Govaerts","year":"2021","journal-title":"Eur J Surg Oncol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1186\/s13023-021-01723-6","article-title":"Consensuses and controversies on pseudomyxoma peritonei: a review of the published consensus statements and guidelines","volume":"16","author":"Lin","year":"2021","journal-title":"Orphanet J Rare Dis"},{"key":"B15","doi-asserted-by":"publisher","first-page":"bcr2014204748","DOI":"10.1136\/bcr-2014-204748","article-title":"A weeping umbilical hernia: bilateral ovarian mucinous cystadenoma with disseminated peritoneal adenomucinosis","volume":"2014","author":"Singh","year":"2014","journal-title":"BMJ Case Rep"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1962278\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:52:27Z","timestamp":1788933147000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1962278\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,9]]},"references-count":15,"alternative-id":["10.3389\/fsurg.2026.1962278"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1962278","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,9]]},"article-number":"1962278"}}