Appendicular mucocele: two case reports and literature review

Abstract

L.R., a 45-years-old woman, Caucasian race. Past medical history: tonsillectomy in childhood; Laparoscopic cholecystectomy in 1993; in 2004 ATC-HCV positivity (transaminases always remained normal and HCV-RNA quantitative research always negative). Menarche at 12 years; regular menstrual cycles; abortion 18 years; abortion 36 years for fetal genetic disease; then subsequent pregnancy terminated in the first quarter; 3 attempts at artificial insemination with ovarian stimulation, without success.She comes to our attention in October 2012 for relapsing pelvic effusion in the absence of other symptoms of note. The general physical examination does not reveal any pathologies of organs or systems. The periodic ultrasound scans performed in the fall of 2011 to March 2012 showed hypoechoic fluid in the pelvis (50x25 mm) posterior to the uterus, and attached to the uterus towards the space with the bladder; hypoechoic area in the content of superimposed layers of different densities compatible with psudomyxoma peritonei or pseudocyst adhesions; hypoechoic collection in Douglas 6 cm in content more dense with small marginal hyperechoic area. Blood tests and tumor markers (CA 19.9, CA 125) were still in the normal range.In October 2014 the patient underwent diagnostic laparoscopy. Explorating the abdominal cavity we found an important effusion of gelatinous material, which also involved other abdominal organs, and an appendicular neoplasm, which was removed. We also appreciated peritoneal soft-consistency nodes; some of them were removed and sent for histology.Cytology on gelatinous intraperitoneal substance showed fibrous tissue containing mucoid material and inflammatory cells; histology of peritoneal nodes showed hyperplastic mesothelium, with chronic inflammatory infiltrate and focal deposits of mucoid material. Definitive histology showed appendicular mucinous neoplasm of low grade, extensive tissue and serous.Due to the results of the histological results, the patient was sent to a specialized center for the treatment of the peritoneal cavity diseases.During the follow up, the patient underwent CT abdomen (December 2014), that revealed the presence of small flap of abdominal effusion disposed around the li-SUMMARY: Appendicular mucocele: two case reports and literature review.

Surveillance Colonoscopy Revealing Asymptomatic Low-Grade Appendiceal Mucinous Neoplasm

“…While appendiceal tumors comprise only a small percentage of gastrointestinal neoplasms, the subclassification of low-grade appendiceal mucinous neoplasm (LAMN) is even rarer by comparison. LAMNs are three times more likely to affect females than males and are typically found in patients between the ages of 50-60 years [3,4]. The clinical presentation of an appendiceal neoplasm varies greatly for both men and women, making it difficult to diagnose on initial presentation.…”

“…Some patients remain asymptomatic, while others present with weight loss, hematochezia, bowel obstruction, or bowel perforation, which may be signs of advanced disease. Because of this spectrum of possible presentations, LAMNs result in broad differentials and can be mistaken for various pathologies such as appendiceal diverticulitis or endometriosis [4,5]. It is also important to note that nearly a quarter of patients present without symptoms, and therefore are diagnosed with a LAMN based on an incidental finding [5].…”

“…A mucocele is a cyst-like space that harbors mucinproducing cells, which progress by filling the appendix with mucus [3]. In response to this mucus accumulation, the appendix begins to dilate, which can cause ulceration and loss of epithelium with an increased risk of rupture [4,5]. Mucoceles are classified into histological groups of both non-neoplastic and neoplastic origins.…”

Colonic mucinous adenocarcinoma causing intussusception and distant metastasis

“…The preoperative diagnosis of mucinous tumors is rare because of the low incidence of these tumors, the nonspecific symptoms and the relatively few significant biochemical parameters and imaging findings. [20] Ultrasound and abdominal and pelvic CT can be useful to identify swelling in the right iliac fossa or thickening of the wall of the cecum, but these findings may be common with other diseases, such as adenocarcinoma of the cecum, Crohn's disease, or ileocolonic intussusception. Thus, these findings are not conducive to the early detection and treatment of MAC.…”

“…Thus, these findings are not conducive to the early detection and treatment of MAC. [20,21] It has been reported that endoscopic ultrasound (EUS) has a unique advantage for the diagnosis of MAC associated with ascites; EUS frequently identifies ascites missed by other imaging studies, including abdominal CT. This study also demonstrated that EUS-guided paracentesis could identify malignancy in ascetic patients.…”