Clinicopathological Features and Management of Appendiceal Mucoceles: A Systematic Review

Abstract

Appendiceal mucoceles (AMs) are rare mucin-containing neoplasms with malignant potential. Lack of evidence-based data exists defining clinicopathological features for management. MEDLINE search between 1995 and 2015 was performed using search criteria “Appendix mucocele.” Systematic review of patient-, pathologic-, and treatment-related characteristics was performed and data analyzed. Among 276 cases of non-perforated AMs, 163 (59%) patients were female, with variable and nonspecific presentation. Patients were treated with appendectomy (52.1%), right hemicolectomy (17.6%), partial cecectomy (17.2%), and ileocecetomy (13.1%). Pathologic evaluation revealed the following: cystadenoma/low-grade appendiceal mucinous neoplasm (54%), unspecified/benign (25%), retention cyst (14.1%), cystadenocarcinoma (4.2%), and mucosal hyperplasia (2.9%). All 11 (4.2%) patients with cystadenocarcinoma were female ( P = 0.004), odds ratio for malignancy 1.07 times higher for women. Synchronous colonic malignancy was reported in three patients (27%) with cystadenocarcinoma ( P = 0.007), odds ratio of 12.1. AMs have low risk for malignancy. Treatment should begin with appendectomy-only and subsequently guided by pathologic diagnosis.

Histopathologic study of Mucinous lesions of the appendix

“…Mucinous lesions of appendix are rare and accounted for 0.8% (10/1200) of all the appendicectomy specimens in our study. This is in comparision to other studies where they represented 0.2 -0.7% of all appendicetomy surgeries [1][2][3][4][5] Benign mucinous lesions are more common than malignant lesions similar to studies by Morano et al and Higa et al 1,20 In our study, Male to female ratio is 2:3. This is in contrast to other studies by Carr NJ et al 16 which showed a male predominance (5 : 2).…”

“…But in comparision to a retrospective study of 135 patients by Omari et al 10 where 55% were females Benign and mucinous lesions as a whole are more common in females as comparable to study by Morano WF. 20 Higa et al 1 Mucoceles and mucinous cystadenomas are seen in females and all the mucinous adeno carcinomas are seen in males. However, AM are considered to occur more frequently in women.…”

Mucocele de apêndice: relato de caso

“…Febre, anorexia, náuseas, vômitos e perda ponderal podem estar associados, assim como sintomas urinários, de apendicite aguda e quadros ginecológicos. Além disso, a sintomatologia está mais associada a patologias malignas [2][3][4] .…”

“…Se a parede cecal ou o íleo forem invadidos por tumor ou as margens cirúrgicas adequadas não puderem ser seguras, a ressecção ileocecal ou a hemicolectomia direita podem ser necessárias. No entanto, por causa da raridade, existe falta de diretrizes baseadas em evidências para o manejo dessas lesões 4,5 .…”

Pseudomyxoma peritonei do apêndice cecal: caracterização anatomopatológica e associação com dados clínicos

“…A ressonância magnética é reconhecida como uma alternativa à tomografia 781.7.2 Tratamento das neoplasias mucinosas do apêndice na doença localizada no sítio primárioPacientes com LAMN, margens negativas e sem evidência de perfuração ou envolvimento peritoneal podem ser tratados apenas com apendicectomia, sem a necessidade de colectomia parcial direita 11,49. Estudos observacionais mostraram taxas de recorrência muito baixas para LAMN sem perfuração ou envolvimento peritoneal, o que é consistente com o comportamento indolente dessas neoplasias 79,80. A presença de linfonodos acometidos na doença de baixo grau é rara, embora descrita na literatura 33.…”