Incidental appendiceal mucinous neoplasm mimicking a left adnexal mass: A case report

Aleter, Ammar; Ansari, Walid El

doi:10.1016/j.ijscr.2020.07.081

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…Moreover, 4 of our 50 patients (8%) were found to have appendicular mucocele incidentally without any presenting symptoms related to AMN, and another 2 patients presented with symptoms and imaging findings suggestive of ovarian cystic neoplasm, one of the pathologies known to mimic appendicular mass, and were subsequently found to have AMN on post-operative histology examination. These findings agree with evidence suggesting the incidental and atypical presentation of AMN [ [20] , [21] , [22] ].…”

Section: Discussionsupporting

confidence: 91%

Epidemiology, histopathology, clinical outcomes and survival of 50 cases of appendiceal mucinous neoplasms: Retrospective cross-sectional single academic tertiary care hospital experience

Aleter

Ansari

Toffaha

et al. 2021

Annals of Medicine &Amp; Surgery

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Background Appendicular neoplasms are rare, most commonly as carcinoids followed by appendicular mucinous neoplasms (AMN). To date, there remains controversy regarding the best treatment of AMN and factors affecting its prognosis. Method Retrospective chart review of patients operated for appendicular pathology (January 2011–December 2018, follow up to December 2020) at our institution. For all AMN patients, data included pre-operative clinical presentation, and operative/post-operative findings. Results 12454 patients underwent appendectomy, of whom 50 (0.4%) had AMN histopathologically (mean age = 47.2). Most patients had laparoscopic appendectomy as primary surgery. Low grade AMN was the most common subtype (n = 41, 82%), and pseudomyxoma peritonei (PMP) was found in 8 (16%) patients. Based on histopathology and margin involvement, the 50 patients were categorized into 3 prognostic categories of recurrence risk (no risk, 24 patients; low risk, 8; high recurrence risk, 18 patients). Disease-free survival (DFS) was lowest for high recurrence risk group (P < 0.001). Eleven (22%) patients had AMN involving resection margin, of whom 3 had no completion surgery and had no recurrence. Higher tumor markers were associated with lower DFS, however it was not statistically significant. Conclusion AMNs are rare but serious due to the risk of PMP. Laparoscopic approach for AMN may be feasible. Prognostic categories were significantly inversely correlated with recurrence risk; hence useful in predicting prognosis. Contrary to previous proposals, AMNs with acellular mucin at margin or local acellular mucin spillage may not require secondary surgery, especially if the patient is in low recurrence risk group. Tumor markers may predict risk of recurrence.

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Section: Discussionsupporting

confidence: 91%

Epidemiology, histopathology, clinical outcomes and survival of 50 cases of appendiceal mucinous neoplasms: Retrospective cross-sectional single academic tertiary care hospital experience

Aleter

Ansari

Toffaha

et al. 2021

Annals of Medicine &Amp; Surgery

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“…A correct diagnosis may be difficult, but on physical examination large tumors can be found as a complete oval mass with no surrounding adhesions. An appendiceal mucinous cyst that forms from an appendiceal lesion can easily be misdiagnosed as a common appendiceal abscess, right adnexal cyst, and so on[ 7 , 8 ]. A recent case report described a patient with LAMN that was initially diagnosed as an ovarian tumor[ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Treatment of a giant low-grade appendiceal mucinous neoplasm: A case report

Xu¹,

Yang²

2021

WJCC

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BACKGROUND Low-grade appendiceal mucinous neoplasm (LAMN) is extremely rare and easily misdiagnosed before surgery. CASE SUMMARY We report the treatment of an asymptomatic case of LAMN diagnosed by magnetic resonance imaging (MRI) and surgical findings. A 70-year-old woman presented with an adnexal mass found by physical examination in July 2020. Gynecologic ultrasonography revealed a cystic mass in the right adnexa, and computed tomography showed a cystic mass in the pelvic cavity. All tumor markers were normal. A further MRI examination suggested mucinous neoplasm in the right pelvic cavity, excluding the possibility of adnexal cyst. Laparoscopic exploration found a huge cystic mass of about 10 cm × 7 cm that originated from the apex of the appendix, with spontaneous rupture. LAMN was confirmed by pathological examination. As of May 2021, no disease recurrence occurred after an open appendectomy. CONCLUSION This case indicates that we should pay more attention to female patients who are clinically diagnosed with an adnexal mass at admission,. The physical examination should be done carefully, and the laboratory and imaging examination results should be comprehensively analyzed to avoid misdiagnosis and to ensure prompt diagnosis and treatment, and to improve prognosis. MRI may be a better option for the diagnosis of appendiceal mucinous neoplasm.

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“…The literature consistently reinforces the idea that the presence of a right-sided adnexal mass should allow for the possibility of an appendiceal neoplasm[ 15 , 16 ]. Interestingly, cases of left-sided appendiceal neoplasms mimicking an adnexal mass have recently been reported[ 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

Low-grade mucinous appendiceal neoplasm mimicking an ovarian lesion: A case report and review of literature

Borges¹,

Reis‐de‐Carvalho²,

Chorão³

et al. 2021

WJCC

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BACKGROUND Appendiceal tumors are rare lesions that may not be easily differentiated from primary ovarian lesions preoperatively, despite the use of advanced diagnostic methods by experienced clinicians. CASE SUMMARY A 59-year-old G2P2 woman, with chronic pelvic pain, underwent a pelvic ultrasound that revealed an adnexal mass measuring 58 mm × 34 mm × 36 mm, with irregular borders, heterogeneous echogenicity, no color Doppler vascularization and without acoustic shadowing. Normal ovarian tissue was visualized in contact with the lesion, and it was impossible to separate the lesion from the ovary by applying pressure with the ultrasound probe. Ascites, peritoneal metastases or other alterations were not observed. With the international ovarian tumor analysis ADNEX model, the lesion was classified as a malignant tumor (the risk of malignancy was 27.1%, corresponding to Ovarian-Adnexal Reporting Data System category 4). Magnetic resonance imaging confirmed the presence of a right adnexal mass, apparently an ovarian tumor measuring 65 mm × 35 mm, without signs of invasive or metastatic disease. During explorative laparotomy, normal morphology of the internal reproductive organs was noted. A solid mobile lesion involved the entire appendix. Appendectomy was performed. Inspection of the abdominal cavity revealed no signs of malignant dissemination. Histopathologically, the appendiceal lesion corresponded to a completely resected low-grade mucinous appendiceal neoplasm (LAMN). CONCLUSION The appropriate treatment and team of specialists who should provide health care to patients with seemingly adnexal lesions depend on the nature (benign vs malignant) and origin (gynecological vs nongynecological) of the lesion. Radiologists, gynecologists and other pelvic surgeons should be familiar with the imaging signs of LAMN whose clinical presentation is silent or nonspecific. The assistance of a consultant specializing in intestinal tumors is important support that gynecological surgeons can receive during the operation to offer the patient with intestinal pathology an optimal intervention.

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Incidental appendiceal mucinous neoplasm mimicking a left adnexal mass: A case report

Cited by 6 publications

References 25 publications

Epidemiology, histopathology, clinical outcomes and survival of 50 cases of appendiceal mucinous neoplasms: Retrospective cross-sectional single academic tertiary care hospital experience

Epidemiology, histopathology, clinical outcomes and survival of 50 cases of appendiceal mucinous neoplasms: Retrospective cross-sectional single academic tertiary care hospital experience

Treatment of a giant low-grade appendiceal mucinous neoplasm: A case report

Low-grade mucinous appendiceal neoplasm mimicking an ovarian lesion: A case report and review of literature

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