Management of Low-Grade Appendiceal Mucinous Neoplasm withExtensive Peritoneal Spread Diagnosed during Pregnancy: TwoCase Reports and Literature Review

Clinical decisions in patients with peritoneal dissemination of low-grade appendiceal mucinous neoplasms (LAMN)diagnosed during pregnancy are challenging. However, their slow progression and favorable prognosis allow deferring definitivetreatment until after spontaneous delivery, a reasonable period of breastfeeding, and fertility preservation.Case Presentation.Two pregnant patients were incidentally diagnosed with LAMN and extensive peritoneal spread at 20 weeks gestation and atcesarean section. Treatment with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in both cases wasdelayed until spontaneous delivery at term and breastfeeding in thefirst patient and breastfeeding and fertility preservation inthe second patient. Both patients remain disease-free for over 5 years, and their children are healthy. The literature reviewhighlights the challenges that physicians face in treating pregnant patients with stage IV appendiceal tumors.Conclusion.Pregnancy management decisions in patients with peritoneal spread from mucinous appendiceal tumor should be based onunderstanding the tumor biology and prognosis. Definitive treatment in pregnant patients with favorable tumors, such asLAMN, may be delayed until spontaneous delivery without compromising maternal surviva