Pseudomyxoma peritonei associated with low-grade mucinous tumor of the appendix (Diffuse Peritoneal Adenomucinosis). The image shows mucinous epithelium lacking significant cytologic atypia in the omental fat. Pseudomyxoma peritonei pursues an indolent but relentless clinical course with multiple bouts of mucinous ascites. The treatment options include watchful waiting, tumor debulking, hyperthermic intraperitoneal chemotherapy, and cytoreductive surgery. Cytoreductive surgery involves removing peritoneal lining and any organs which appeared to be seeded by the tumor. This commonly includes removal of ovaries, fallopian tubes, uterus, parts of small and large bowel, partial or even total gastrectomy, gall bladder, and spleen. Most patients end up requiring multiple surgical procedures over a long period of time.