Incidental diagnosis of a low-grade mucinous appendicular neoplasm: A case report

Abstract

Introduction and importance Low-Grade Appendiceal Mucinous Neoplasms (LAMN) are noninvasive epithelial tumors of the appendix. Symptomatology is unspecific and can simulate appendicitis. The multidisciplinary approach for the correct diagnosis and management of this kind of tumor is important, as the prognosis depends on it. Presentation of the case A 70-years-old man with an appendiceal picture is presented. McBurney and Blumberg's signs were found and the Echography has reported an acute appendicitis. He underwent laparoscopic surgery, founding a Tumor in the Cecum of 10 × 5 cm. We decided to perform an appendectomy with a total cecectomy. The pathological diagnosis was a LAMN. Ten months later, a Computed Tomography (CT) Scan control was performed reporting no evidence of Tumoral activity or Distance Metastasis, neither pseudomyxoma peritonei (PMP) evidence. Discussion LAMN has been a very controversial tumor. The definitive management is appendectomy. There are controversies about the laparoscopic and open approach, and when there are positive margins. The stage was a pTis (LAMN) pNx according to the 8th edition of the American Joint Committee on Cancer (AJCC). The prognosis depends on the tumoral stage and the presence of PMP. In our case, we have performed a CT scan follow up and there was no Tumoral activity or Distance Metastasis, neither PMP evidence. Conclusion LAMN is a very interesting and rare tumor. The diagnosis of this case was a real challenge. Our management was simple due to the tumoral stage. Pathology played a very important role in treatment and prognosis.

Delivery of an Incidental Appendiceal Mucinous Neoplasm

“…At present, no clear treatment guidelines exist for the management of LAMNs, with the strategies for the surgical approach, adjuvant therapy, and follow-up duration all remaining somewhat controversial [2][3][4][5]. Surgically, a lack of consensus remains regarding the required extent of surgical resection and whether laparoscopic versus an open procedure is recommended, with some concerns regarding the increased risk of rupture with a laparoscopic approach and subsequent peritoneal dissemination of neoplastic cells [5]. The most widely utilized approach is an appendicectomy alone, with a right hemicolectomy reserved for cases with infiltration of malignancy into the submucosa, positive appendicectomy margin, or the presence of lymph node metastasis [2][3][4].…”

“…At present, no clear treatment guidelines exist for the management of LAMNs, with the strategies for the surgical approach, adjuvant therapy, and follow-up duration all remaining somewhat controversial [ 2 - 5 ]. Surgically, a lack of consensus remains regarding the required extent of surgical resection and whether laparoscopic versus an open procedure is recommended, with some concerns regarding the increased risk of rupture with a laparoscopic approach and subsequent peritoneal dissemination of neoplastic cells [ 5 ].…”

“…Prognosis is determined by the tumor stage, peritoneal mucin spillage, and the presence or absence of PMP [ 5 ]. Literature suggests a significant prognostic difference between acellular and cellular mucin, and, therefore, CRS is advocated for relatively early lesions with localized cellular mucin spillage due to the high likelihood of progression to extensive intra-abdominal disease if such cases are treated with only appendicectomy or right hemicolectomy [ 7 ].…”