Mucus-filled lesion of a distal viable remnant tip of an appendix that developed 23 years after appendectomy

Tomida, Hidenori; Hashimoto, Shinichi; Hayashi, Masahiro; Koyama, Masamichi

doi:10.1016/j.ijscr.2020.05.070

Cited by 1 publication

(6 citation statements)

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“…The frequency of residual appendicitis after appendectomy is reported to be 0.06%–0.25% of all appendectomies [ 12 ], and only ten or more cases of appendiceal mucinous lesions derived from the residual appendix have previously been reported [ 11 ]. Histologically, appendiceal mucinous lesions are classified as either non-neoplastic or neoplastic appendiceal mucinous lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Appendiceal mucinous lesions have poor prognosis if they become cancerous or rupture and progress to PMP [ 4 , 15 – 20 ]. In a prior report, Tomida et al reviewed 10 cases of mucinous lesions derived from the residual appendix that developed 10–40 years after appendectomy [ 11 ]; however, changes in tumors over time were not described in these reports. In our first case, we observed CT images taken for other diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Residual appendicitis or appendiceal tumors reported in previous studies are largely derived from the appendiceal stump [ 11 , 12 , 21 ]; those derived from appendiceal tip remnants are very rare. To the best of our knowledge, there have been nine reported cases, including the two reported here (Table 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…With regard to tumor development from the residual appendiceal tip, none developed cancer, and the time to occurrence ranged from 9 to 24 years after the initial surgery. Regarding the reasons for determining that the appendiceal tip remnant was primary, one report described it as having a separate mesentery [ 6 ]; however, few reports have described it in detail [ 7 – 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported as lesions that are not continuous with the appendiceal root or cecum. And it was described that they were derived from tip remnants due to their locations or morphologies, pathological diagnoses, or initial surgical reports [ 6 – 11 ]. However, the rationales for the diagnoses as being derived from the tip remnants are often unclear.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Appendiceal neoplasms derived from appendiceal tip remnants following appendectomy: a report of two cases

Fujii,

Hida,

Sugimoto

et al. 2024

surg case rep

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Background Neoplasms derived from remnant appendix are rarely described, with most cases arising from the appendiceal “stump”. Here, we present two surgical cases of appendiceal neoplasms derived from appendiceal “tip” remnants. Case presentation The first patient was a 71-year-old man who had undergone laparoscopic appendectomy for acute appendicitis 12 years prior. During appendectomy, the appendiceal root was ligated, but the appendix was not completely removed due to severe inflammation. At the most recent presentation, computed tomography (CT) was performed to examine choledocholithiasis, which incidentally revealed a cystic lesion of approximately 90 mm adjacent to the cecum. A retrospective review revealed that the cystic lesion had increased in size over time, and laparoscopic ileocecal resection was performed. Pathology revealed no continuity from the appendiceal orifice to the cyst, and a diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) was made from the appendiceal tip remnant. The patient was discharged without complications. The second patient was a 65-year-old man who had undergone surgery for peritonitis due to severe appendicitis 21 years prior. During this operation, the appendix could not be clearly identified due to severe inflammation; consequently, cecal resection was performed. He was referred to our department with a chief complaint of general fatigue and loss of appetite and a cystic lesion of approximately 85 mm close to the cecum that had increased over time. CT showed irregular wall thickening, and malignancy could not be ruled out; therefore, laparoscopic ileocecal resection with D3 lymph node dissection was performed. The pathological diagnosis revealed mucinous adenocarcinoma (TXN0M0) arising from the remnant appendiceal tip. The patient is undergoing follow-up without postoperative adjuvant chemotherapy, with no evidence of pseudomyxoma peritonei or cancer recurrence for 32 months postoperatively. Conclusions If appendicitis-associated inflammation is sufficiently severe that accurate identification of the appendix is difficult, it may remain on the apical side of the appendix, even if the root of the appendix is ligated and removed. If the appendectomy is terminated incompletely, it is necessary to check for the presence of a residual appendix postoperatively and provide appropriate follow-up.

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Section: Discussionmentioning

confidence: 99%