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

Abstract

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.

Appendiceal mucocele masquerading as an epithelial borderline ovarian tumor: a case report and literature review

“…A literature review of the PubMed/MEDLINE, Google Scholar, and Web of Science databases from 2000 to 2022 as searches of Science Citation Index (SCI) and Scopus journals revealed similar cases of appendiceal mucocele mimicking adnexal lesions, as summarized in Table 1 [2,4,[7][8][9][10][11][12][13][14]. A total of 18 cases of tumors originating from the appendix were preoperatively diagnosed as tumors originating from the adnexa.…”

“…It can be asymptomatic or present a variety of symptoms. Appendiceal mucocele may be discovered incidentally in radiologic or endoscopic tests or during surgery for other reasons [ 3 , 4 ]. Appendiceal masses usually show similar symptoms to appendicitis or adnexal masses, including pain in the right lower quadrant or pelvic area and palpable masses or enlarged intra-abdominal structures in imaging studies such as computed tomography (CT) or ultrasound.…”

Contrast-enhanced ultrasonography findings of LAMNs with peritoneal and splenic metastases: a case report and literature review

“…It usually presents with symptoms of acute-onset appendicitis caused by appendicular luminal obstruction by a neoplastic mass. Some patients may present with lower abdominal pain, while others may be asymptomatic; this discovery may be an incidental finding ( 5 ). Due to the inconsistency in the clinical manifestations of LAMNs, imaging examinations are extremely important to avoid misdiagnosis.…”