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Fujita M, Manabe N, Ayaki M, Bukeo-Uji E, Konishi T, Nakamura J, Katsumata R, Murao T, Suehiro M, Fujiwara H, Monobe Y, Takaoka M, Kato K, Kawamoto H, Kamada T, Urakami A, Yamatsuji T, Naomoto Y, Haruma K, Hata J. Appendiceal mucocele pathologically classified as appendiceal epithelial hyperplasia and preoperatively diagnosed by contrast-enhanced ultrasonography: A case report. Radiol Case Rep 2024; 19:1166-1170. [PMID: 38259698 PMCID: PMC10801138 DOI: 10.1016/j.radcr.2023.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/05/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
We report a patient with a mucocele with diffuse wall thickening diagnosed by transabdominal ultrasonography and contrast-enhanced ultrasonography. Transabdominal ultrasonography showed diffuse thickening of the entire appendix wall and an anechoic area that appeared to be fluid collected throughout the appendix lumen. However, the "onion skin sign" was not detected. Contrast-enhanced ultrasonography combined with superb microvascular imaging revealed abundant mucosal blood flow and no abnormal vascular network within the mucosa of the appendix wall. We preoperatively diagnosed a mucocele complicated by acute and chronic appendicitis, and ileocecal resection was performed. Macroscopic and microscopic findings of the resected specimens demonstrated that the appendiceal wall was diffusely thickened, with fibrosis and inflammatory cell infiltration, and that the appendiceal root rumen was narrowed with epithelial hyperplasia. No neoplastic changes were observed. The cause of the appendiceal mucocele was likely fibrosis and stenosis at the root of the appendix due to initial acute appendicitis.
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Affiliation(s)
- Minoru Fujita
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Noriaki Manabe
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Maki Ayaki
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
- Department of Gastroenterology and Hepatology, HITO Medical Center, Shikokuchuou, Japan
| | - Emiko Bukeo-Uji
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Takako Konishi
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
- Department of General Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Jun Nakamura
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Ryo Katsumata
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
- Department of Health Care Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Takahisa Murao
- Department of Health Care Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Mitsuhiko Suehiro
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Hideyo Fujiwara
- Department of Pathology, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Yasumasa Monobe
- Department of Pathology, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Munenori Takaoka
- Department of General Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Katsuya Kato
- Department of Radiology, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Hirofumi Kawamoto
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Tomoari Kamada
- Department of Health Care Medicine, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Atsushi Urakami
- Department of General Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Tomoki Yamatsuji
- Department of General Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Yoshio Naomoto
- Department of General Surgery, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Ken Haruma
- Department of General Internal Medicine 2, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Jiro Hata
- Division of Endoscopy and Ultrasonography, Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School Hospital, Kurashiki, Japan
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Abuaagla K, Faridoon S, Hassan A, Bafadni M, Rabih MA, Alsaadi A. Myxoglobulosis of the appendix presenting as acute appendicitis. J Surg Case Rep 2023; 2023:rjad624. [PMID: 38026753 PMCID: PMC10663062 DOI: 10.1093/jscr/rjad624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Myxoglobulosis is a rare form of appendiceal mucocele characterized by mucoid material inside the appendix that resembles fish eggs. It is usually asymptomatic and diagnosed incidentally, but it can also present as a surgical abdomen, which can create a diagnostic dilemma. This case report presents a 37-year-old male patient with features suggestive of acute appendicitis. A computed tomography scan of the abdomen showed features of appendiceal mucocele. The patient underwent appendicectomy through a lower midline incision. The macroscopic finding was myxoglobulosis, and the patient had an uneventful postoperative course. The histopathology report of the appendix confirmed the diagnosis.
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Affiliation(s)
- Khalid Abuaagla
- General Surgery Department, Prince Abdelmohsin Hospital, Alula 70, Al Ula 43543, Saudi Arabia
| | - Shehla Faridoon
- General Surgery Department, Prince Abdelmohsin Hospital, Alula 70, Al Ula 43543, Saudi Arabia
| | - Atef Hassan
- General Surgery Department, Prince Abdelmohsin Hospital, Alula 70, Al Ula 43543, Saudi Arabia
| | - Mudather Bafadni
- General Surgery Department, Prince Abdelmohsin Hospital, Alula 70, Al Ula 43543, Saudi Arabia
| | - Mohammed A Rabih
- General Surgery Department, Prince Abdelmohsin Hospital, Alula 70, Al Ula 43543, Saudi Arabia
| | - Abdelhakim Alsaadi
- General Surgery Department, Prince Abdelmohsin Hospital, Alula 70, Al Ula 43543, Saudi Arabia
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Al Laham O, Albrijawy R, Adi A, Al Kurdi MF, Atia F, Hamed H. A rare case of a Low Grade Appendiceal Mucinous Neoplasm in a 46-year-old Middle Eastern female - A case report. Int J Surg Case Rep 2022; 93:106997. [PMID: 35366611 PMCID: PMC8976147 DOI: 10.1016/j.ijscr.2022.106997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction and importance Mucinous cell neoplasia are rare and conceivably fatal causes of surgical abdomen. Adult manifestations can be obscure and ill-defined, yielding misdiagnoses and wasting precious time and effort to reach the correct one. Clinical awareness ought to be present once presented with a surgical abdomen in such a patient because this neoplasm may present with misleading presentations which mask the actual diagnosis and masquerade as a different one, and in turn, may result in performing a dissimilar treatment intervention. Rapid learnt surgical judgments must be taken and put into action to diminish the morbidity and mortality consequential to this pathology. Case presentation Our case is of a 46-year-old female, who was admitted into our hospital with a 2-month-history of general fatigue. Colicky abdominal pain and discomfort developed shortly prior to admission. Multi-Slice Computed Tomography (MSCT) scan exposed cystic formation in the terminal ileum. Exploratory laparotomy was warranted, in addition to performing a right hemicolectomy. Clinical discussion We treated our patient via open surgery and performing an appendectomy with right hemicolectomy in addition to the excision of several surrounding lymph nodes. Diagnosis is traditionally reached intraoperatively relying on gross morphology and postoperatively through histopathological analysis of the excised specimens. Conclusion Low Grade Appendiceal Mucinous Neoplasm is a scarce entity and varies critically in its manifestations, hence, it is existential to thoroughly study this kind of neoplasia, document it, and consider it, so that we can construct precise decisions to reach ideal results for patients who suffer from this neoplasm. Appendiceal primary tumors have an incidence rate of less than 2% of all excised samples of the appendix. Mucinous cell tumors of the appendix are ubiquitous in merely 0.2%–0.3% of all the excised samples of the appendix. Symptoms are ill-defined. This warrants high clinical suspicion when presented with a case of surgical abdomen. Surgery is the chief treatment method. Open surgery is favored over laparoscopic in appendiceal mucinous cell neoplasm.
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Affiliation(s)
- Omar Al Laham
- Department of Surgery, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Department of Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
| | - Reham Albrijawy
- Department of Surgery, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Department of Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
| | - Amir Adi
- Department of Radiology, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Department of Radiology, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
| | - M Fadi Al Kurdi
- Department of Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
| | - Fareed Atia
- Department of Surgery, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Department of Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
| | - Hamoud Hamed
- Department of Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria; Department of Surgery, Faculty of Medicine, Damascus University, Damascus, Syria.
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Kaneko M, Kawai K, Nozawa H, Hata K, Tanaka T, Nishikawa T, Shuno Y, Sasaki K, Emoto S, Murono K, Ishii H, Sonoda H, Watadani T, Takao H, Abe O, Ishihara S. Utility of computed tomography and 18 F-fluorodeoxyglucose with positron emission tomography/computed tomography for distinguishing appendiceal mucocele caused by mucinous adenocarcinoma from other pathologies. Colorectal Dis 2020; 22:1984-1990. [PMID: 32780478 DOI: 10.1111/codi.15308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/04/2020] [Indexed: 02/08/2023]
Abstract
AIM Differentiating appendiceal mucocele with mucinous adenocarcinoma from other pathologies before surgery is difficult. The objective of this study was to evaluate the utility of CT and 18 F-fluorodeoxyglucose (FDG) with positron emission tomography (PET)/CT for differentiating mucinous adenocarcinoma of appendiceal mucocele from other pathologies. METHOD The study included 25 patients who underwent surgery for clinically diagnosed appendiceal mucoceles detected on CT at the University of Tokyo Hospital. Among these patients, 19 underwent FDG-PET/CT preoperatively. We compared features of the CT imaging findings and maximum standard uptake values (SUVmax ) detected by FDG-PET/CT between mucocele with mucinous adenocarcinoma and other pathologies. RESULTS A total of 13 men (52%) and 12 women (48%) were included in this study, with a median age of 65 years (range 34-83). There were six patients (24%) with pathologically confirmed mucinous adenocarcinoma, 15 patients (60%) with appendiceal mucinous neoplasm and four patients (16%) with simple mucocele caused by chronic inflammation. On the CT findings, wall irregularity was the only significant feature for the two groups in this study (83.3% vs 0.0%, P < 0.01). There was a significant difference in the SUVmax levels on PET/CT between the two groups (100.0% vs 20.0%, P < 0.01). CONCLUSION Distinguishing between mucocele with mucinous adenocarcinoma and other pathologies using imaging modalities is challenging. Our results suggest that wall irregularity on CT and elevated SUVmax on PET/CT are useful factors that can be employed for such discrimination.
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Affiliation(s)
- M Kaneko
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - K Kawai
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - H Nozawa
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - K Hata
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - T Tanaka
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - T Nishikawa
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - Y Shuno
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - K Sasaki
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - S Emoto
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - K Murono
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - H Ishii
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - H Sonoda
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - T Watadani
- Department of Radiology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - H Takao
- Department of Radiology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - O Abe
- Department of Radiology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - S Ishihara
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
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Soon JQJ, Aftab S, Ling LLA, Uppaluri SAS, Kok SXS. Appendicitis mimicking the CT appearance of an appendiceal mucinous neoplasm. J Radiol Case Rep 2020; 14:26-38. [PMID: 33708342 DOI: 10.3941/jrcr.v14i11.4081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Occasionally, radiologically diagnosed acute appendicitis is found to harbour underlying appendiceal neoplasm on post-surgical histopathology. Conversely, a situation in which radiologically, the appendix demonstrates features consistent with an underlying tumour but post-operative pathology finds no evidence of neoplastic change is rare. We describe a case of a 50-year-old man who presented with a markedly dilated "mass-like" appendix with minimal inflammatory changes on a computed tomography scan. Radiological findings were suspicious for an appendiceal neoplasm/mucocele (i.e. low-grade mucinous neoplasm). However, the post-surgical histopathological diagnosis did not concur with the radiological diagnosis and instead demonstrated findings compatible with acute appendicitis without neoplastic change. In this case report we provide a histopathological correlation and an explanation as to how this may have happened with the hope of helping radiologists avoid this pitfall in the future.
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Affiliation(s)
- Jia Qi Jeremy Soon
- Department of Diagnostic Radiology, Sengkang General Hospital Singapore, Singapore
| | - Syed Aftab
- Department of Diagnostic Radiology, Sengkang General Hospital Singapore, Singapore
| | | | | | - Shi Xian Shawn Kok
- Department of Diagnostic Radiology, Sengkang General Hospital Singapore, Singapore
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Revzin MV, Moshiri M, Bokhari J, Pellerito JS, Menias C. Sonographic assessment of infectious diseases of the gastrointestinal tract: from scanning to diagnosis. Abdom Radiol (NY) 2020; 45:261-292. [PMID: 31960117 DOI: 10.1007/s00261-019-02358-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sonography of the gastrointestinal (GI) tract is a practical, safe, inexpensive, and reproducible diagnostic tool for the evaluation, diagnosis, and follow-up of infectious bowel disease. The modality is rapidly gaining prominence among clinicians on a global scale. In the United States, however, ultrasound of the bowel remains underutilized primarily due to insufficient experience among radiologists and sonographers in performing sonographic bowel assessment. This lack of experience and knowledge results in misinterpretations, missed diagnoses, and underutilization of this modality in patients with acute abdomen, with the majority of GI pathology on sonography discovered incidentally. OBJECTIVES This article aims to demonstrate the characteristic sonographic findings associated with GI infectious processes as well as provide dedicated ultrasound protocols for evaluation of the GI tract. CONCLUSION This article serves a twofold purpose, raising awareness of the utility of this imaging modality within the radiology community and also providing practical teaching points for sonographic evaluation of infectious disorders of the GI tract.
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Affiliation(s)
- Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT, 06520, USA.
| | - Mariam Moshiri
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Jamal Bokhari
- Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT, 06520, USA
| | - John S Pellerito
- Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Christine Menias
- Radiology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
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Guerra F, Coco D, Patriti A. A man with peri-cecal, calcified mass-disseminated peritoneal adenomucinosis. Indian J Gastroenterol 2019; 38:367-369. [PMID: 31478147 DOI: 10.1007/s12664-019-00982-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
Recent advances, specifically cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC), offer advantages compared to the traditional therapeutic approach of systemic chemotherapy in the treatment of peritoneal carcinomatosis from mucinous appendiceal neoplasms (MAN). This review provides an up-to-date, comprehensive summary of the histologic classification of MAN, reviews common imaging findings of mucoceles and pseudomyxoma peritonei, and describes the radiologist's role in the multidisciplinary care team in quantifying disease and in helping select patients for definitive surgery.
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B B SK, Jasuja P. Appendiceal mucocele-A rare case report. Int J Surg Case Rep 2019; 58:21-25. [PMID: 30999148 PMCID: PMC6468153 DOI: 10.1016/j.ijscr.2019.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/28/2019] [Accepted: 04/04/2019] [Indexed: 11/24/2022] Open
Abstract
A Mucocele appendix with wide base communicating with caecum is a rare presentation. Presentation is same as acute appendicitis. Pre-operative diagnosis even with the help of USG & CT is really a challenging issue. Diagnosis of wide base mucocele appendix (preoperatively/intraoperatively) changes whole course of surgical management.
Introduction Appendiceal mucocele is a rare disease and has a clinical picture that resembles acute appendicitis. A correct diagnosis before surgery is very important for the selection of surgical technique(appendicectomy/colectomy)to avoid severe intraoperative and postoperative complications. The work has been reported in line with the SCARE criteria (Agha et al. [23]). Presentation of case We present a case of 70 year old female admitted with chief complaints of right iliac fossa pain intermittent in nature with nausea and generalized weakness since 1 month. With the help of USG and CECT preoperative diagnosis of Appendiceal Mucocele was made. Midline incision Laparotomy was performed. Preoperative diagnosis of Appendix Mucocele changing the course of management has been reported rarely in literature. Discussion Intraoperatively a cystic mass of appendix with dimensions 8 cm × 5 cm with broad base and inflamed walls communicating with caecum but without perforation was discovered in right iliac fossa. Extended right hemicolectomy with ileotransverse anastomosis was done. Histopathological diagnosis of Mucinous Cystadenoma with Mucocele was reported. After 6 months of surgery patient is doing well with no postoperative complications. Conclusion In our opinion every patient more than 50 years old presenting in emergency department with clinical symptoms of acute appendicitis must undergo CT and open surgery should be favoured against laparoscopic surgery.
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Affiliation(s)
- Sunil Kumar B B
- Department of Surgical Gastroenterology, JSS Medical College and Hospital, Mysore, India
| | - Pranav Jasuja
- Deprtment of General Surgery, JSS Medical College and Hospital, Mysore, India.
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Kwag KS, Kim HJ, Jang SK, Yeon JW, Paik S, Jeon BG, Kim KH, Park JH, Shin E. Sonographic Findings of Malignant Appendix Tumors in Seven Cases. J Med Ultrasound 2018; 26:52-55. [PMID: 30065515 PMCID: PMC6029189 DOI: 10.4103/jmu.jmu_16_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 10/26/2017] [Indexed: 12/03/2022] Open
Abstract
We report the sonographic features of confirmed malignant appendiceal tumors in seven cases. The histologic diagnoses of these tumors were mucinous cystadenocarcinoma (n = 2), colonic type adenocarcinoma (n = 4), and signet-ring cell carcinoma (n = 1). The 2 mucinous cystadenocarcinomas showed mucocele type, which had markedly enlarged inner luminal diameters (mean, 23 mm; range, 15–31 mm) and thick, irregular walls (mean wall thickness, 5.5 mm; range, 5–6 mm). In contrast, the 5 nonmucinous carcinomas (4 adenocarcinomas and 1 signet-ring cell carcinoma) showed nonmucocele type, which had relatively small inner luminal diameters (mean ± standard deviation [SD], 6.6 ± 4.5 mm; range, 2–15 mm) and prominent wall thickening (mean wall thickness ± SD, 6.2 ± 2.3 mm; range, 3–10 mm). Of the 5 nonmucinous tumors, only one had a discernible mass, three had thick irregular walls, two had loss of the wall layer pattern, and four had submucosal hypoechogenicity. Regardless of the histologic type, five of the seven malignant appendiceal tumors showed a severe periappendiceal fat infiltration or periappendiceal abscess, suggestive of perforation. Although the sonographic findings of the malignant appendiceal tumors were nonspecific, some of the sonographic features seen in these seven cases may help radiologists consider the possibility of underlying malignant appendiceal tumors.
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Affiliation(s)
- Kyung Su Kwag
- Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam-Dong, Gyeonggi-Do, South Korea
| | - Hyuk Jung Kim
- Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam-Dong, Gyeonggi-Do, South Korea
| | - Suk Ki Jang
- Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam-Dong, Gyeonggi-Do, South Korea
| | - Jae Woo Yeon
- Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam-Dong, Gyeonggi-Do, South Korea
| | - Soya Paik
- Department of Pathology, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam-Dong, Gyeonggi-Do, South Korea
| | - Byeong Geon Jeon
- Department of Surgery, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam-Dong, Gyeonggi-Do, South Korea
| | - Ki Ho Kim
- Department of Surgery, Daejin Medical Center Bundang Jesaeng General Hospital, Seongnam-Dong, Gyeonggi-Do, South Korea
| | - Ji Hoon Park
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-Dong, Gyeonggi-Do, South Korea
| | - Eun Shin
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam-Dong, Gyeonggi-Do, South Korea
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Kim TK, Park JH, Kim JY, Kim BC, Kang BM, Min SK, Kim JW. Safety and feasibility of laparoscopic surgery for appendiceal mucocele: a multicenter study. Surg Endosc 2018; 32:4408-4414. [DOI: 10.1007/s00464-018-6182-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 04/06/2018] [Indexed: 01/05/2023]
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Affiliation(s)
- Jason Behary
- Department of Gastroenterology and Hepatology, The Sutherland Hospital, Caringbah, New South Wales, Australia
| | - Jason Minco Hui
- Department of Gastroenterology and Hepatology, The University of New South Wales, The Sutherland Hospital, Caringbah, New South Wales, Australia
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Yakan S, Caliskan C, Uguz A, Korkut MA, Çoker A. A Retrospective Study on Mucocele of the Appendix Presented with Acute Abdomen or Acute Appendicitis. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective We reported the demographic, clinical, radiologic, preoperative and postoperative characteristics and outcomes on patients of appendix mucocele that presented with or operated for acute appendicitis or acute abdomen. Methods A retrospective study. Patients who were presented or operated for acute appendicitis or acute abdomen and had an operative histopathological diagnosis as appendix mucocele (simple mucocele, mucinous cystadenoma, mucinous cystadenocarcinoma) were included. Demographic, clinical, radiologic, preoperative and postoperative data of eligible cases were evaluated. Results From January 2003 to February 2010, a total of 2120 patients with the pre-operative diagnosis of acute appendicitis were treated in our center, and nine (0.42%) patients were diagnosed to have mucocele of the appendix. Seven patients (78%) were female. Average age of the patients was 59.5 (range=25-74). Major complaint was right lower quadrant pain in eight (89%) patients. In preoperative ultrasonographic examination of the patients, appendiceal cystic masses (mucocele) were diagnosed in four (44.5%) patients. In histopathologic examination, the number of patients diagnosed to have simple mucocele was two (22%), mucinous cystadenoma was four (45%), and mucinous cystadenocarcinoma was three (33%). No postoperative morbidity or mortality was noted. Conclusion Appendix mucocele is a rare disease and it is usually diagnosed histopathologicaly in appendectomy specimens. When a cystic mass in appendix is seen during operation, appendiceal mucocele should be kept in mind to avoid iatrogenic perforation causing pseudomyxoma peritonei and possible concomitant malignancies should be searched.
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Abstract
We present the case of an 81-year-old man with a known appendicular mucocele who presented to the emergency department with acute abdominal pain. A CT scan showed a change in orientation of the previously seen ovoid mass with surrounding fat stranding suggesting torsion. An emergency laparotomy with appendicectomy and resection of the caecal pole was performed. We discuss the findings and histopathology.
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15
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Xu ZS, Xu W, Ying JQ, Cheng H. Mechanical intestinal obstruction secondary to appendiceal mucinous cystadenoma: A case report and brief review. Medicine (Baltimore) 2017; 96:e6016. [PMID: 28151903 PMCID: PMC5293466 DOI: 10.1097/md.0000000000006016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Appendiceal mucinous cystadenoma can present in various ways, and it is most commonly encountered incidentally during appendectomy, but mechanical intestinal obstruction secondary to an appendiceal mucocele has been rarely reported. METHODS We report a case of mechanical intestinal obstruction secondary to appendiceal mucinous cystadenoma. After nasogastric decompression and initial aggressive intravenous fluid resuscitation, an emergency operation was performed under the diagnosis of acute mechanical intestinal obstruction. RESULTS We performed an appendectomy and intraoperative enteral decompression without anastomoses. The pathologic examination (PE) revealed appendiceal mucinous cystadenoma. After the operation, the patient's recovery went smoothly, and the patient was discharged on the fifth postoperative day. No tumor recurrence was recorded over an 8 month follow-up period. CONCLUSION Early operative intervention should be recommended to the patient with acute mechanical complete intestinal obstruction, especially the patient who had no previous abdominal surgery. And it is vital to discriminate benign and malignantappendiceal mucocel in determining the extent of surgery.
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Ahmed N, Vimplis S, Deo N. A mucocele of the appendix seen as an adnexal mass on ultrasound scan. J OBSTET GYNAECOL 2016; 37:116-117. [PMID: 27868468 DOI: 10.1080/01443615.2016.1209172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Nida Ahmed
- a Russells Hall Hospital, The Dudley Group NHS Foundation Trust , Dudley , UK
| | - Sotoris Vimplis
- b Whipps Cross University Hospital, Barts NHS Trust , London , UK
| | - Nandita Deo
- b Whipps Cross University Hospital, Barts NHS Trust , London , UK
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Nakatani K, Tokuhara K, Sakaguchi T, Ryota H, Yoshioka K, Kon M. Low-grade mucinous neoplasia in a cecal diverticulum: A case report. Int J Surg Case Rep 2015; 15:66-9. [PMID: 26318130 PMCID: PMC4601971 DOI: 10.1016/j.ijscr.2015.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/04/2015] [Accepted: 08/15/2015] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION Low-grade mucinous neoplasia is an uncommon benign tumor that develops in the appendix. The development of mucocele disease has never been reported in a colonic diverticulum. We present a case developing low-grade mucinous neoplasia in a cecal diverticulum. PRESENTATION OF CASE A tumor in the ileocecal region was found during a medical examination of a 66-year-old woman. Three months later, the tumor was still present and the patient developed abdominal pain. Laparoscopic ileocecal resection with D2 lymph node dissection was performed. Histopathological examination revealed a low-grade mucinous neoplasm in a cecal diverticulum. DISCUSSION Colonic mucoceles reportedly originate from the appendix. There are no previous reports of mucocele disease in a colonic diverticulum worldwide. This report reviews and discusses the management of the appendiceal mucoceles. CONCLUSION The incidence of colonic diverticula has recently begun to increase in Japan. The possibility of a mucocele within a colonic diverticulum should be considered in patients with submucosal colonic tumors.
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Affiliation(s)
- Kazuyoshi Nakatani
- Department of Surgery, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka 570-8507, Japan.
| | - Katsuji Tokuhara
- Department of Surgery, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka 570-8507, Japan.
| | - Tatsuma Sakaguchi
- Department of Surgery, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka 570-8507, Japan.
| | - Hironori Ryota
- Department of Surgery, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka 570-8507, Japan.
| | - Kazuhiko Yoshioka
- Department of Surgery, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka 570-8507, Japan.
| | - Masanori Kon
- Department of Surgery, Kansai Medical University, 10-15 Fumizonocho, Moriguchi, Osaka 570-8507, Japan.
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Petit É. Quinzième leçon de sémiologie échographique de la pathologie pelvienne. IMAGERIE DE LA FEMME 2015. [DOI: 10.1016/j.femme.2014.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Idris LO, Olaofe OO, Adejumobi OM, Kolawole AO, Jimoh AK. Giant mucocele of the appendix in pregnancy: A case report and review of literature. Int J Surg Case Rep 2015; 9:95-7. [PMID: 25744561 PMCID: PMC4392372 DOI: 10.1016/j.ijscr.2015.02.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Mucocoele of the appendix is an obstructive dilatation of the appendix by intraluminal accumulation of mucoid material. Mucocoeles may develop by one of four processes: Retention cysts, Mucosal hyperplasia, Cystadenomas, and Cystadenocarcinomas. The clinical presentation of a mucocele is nonspecific and often an incidental finding at operation for acute appendicitis. If mucocoele is allowed to rupture either spontaneously or during surgery, the escape of mucin and epithelial cells into the peritoneal cavity - Pseudomyxoma Peritonei - may occur. PRESENTATION OF CASE We present the case of a 35 years old pregnant woman, who was admitted to the accident and emergency department with history and ultrasound findings suggestive of acute appendicitis. The ultrasound scan also confirmed a viable fetus at about 23week's gestational age. She had an open appendectomy. The intra-operative findings were an enlarged, tense, cystic retro-caecal appendix which was about 14cm×5cm×3cm in dimensions. Histopathological examination confirmed mucocoele of the appendix. She had normal vaginal delivery at term and postoperative follow up for 1 year was uneventful. DISCUSSION Mucocele of the appendix is an uncommon disorder with nonspecific presentation ranging from asymptomatic disease diagnosed incidentally to clinical features of appendicitis. The treatment is surgery. CONCLUSION Appendiceal mucocoele is difficult to diagnose preoperatively, and a giant size of the simple mucocoele may be connected to hormonal influence of pregnancy. In the index case, as in majority of cases, the definitive diagnosis is made at surgery.
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Affiliation(s)
- Lateef O Idris
- Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.
| | - Olaniyi O Olaofe
- Department of Pathology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.
| | - Olaniyi M Adejumobi
- Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.
| | - Adedayo O Kolawole
- Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.
| | - Ademola K Jimoh
- Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.
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Park KJ, Choi HJ, Kim SH. Laparoscopic approach to mucocele of appendiceal mucinous cystadenoma: feasibility and short-term outcomes in 24 consecutive cases. Surg Endosc 2015; 29:3179-83. [PMID: 25582961 DOI: 10.1007/s00464-014-4050-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 12/16/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mucocele of the appendix is an uncommon condition where luminal distention by mucin is usually attributable to a mucinous cystadenoma. From a surgical standpoint, it is critical that the mucin-filled tumor remains intact during resection. Spillage of mucin into peritoneal cavity may otherwise lead to pseudomyxoma peritonei. Although acute appendicitis is managed successfully by laparoscopic appendectomy, the potential for rupture has fueled concerns over laparoscopic resection of appendiceal mucoceles. Our aim was to evaluate feasibility, safety, and short-term outcomes of laparoscopic resection in patients with a mucocele of appendix secondary to mucinous cystadenoma. METHODS Data collected prospectively at the Department of Surgery from October 2005 to December 2013 were reviewed, selecting all instances of preoperatively identified appendiceal mucoceles, which was confirmed as mucinous cystadenomas by histology after elective laparoscopic surgery. Patient demographics, surgical data (operative procedures and times, intraoperative complications), and short-term postoperative outcomes were analyzed retrospectively. RESULTS Twenty-four consecutive patients (female 14) were studied. Mean age was 60.0 years (range 42-81 years). Surgical procedures included simple appendectomy (1/24, 4.2 %), partial cecectomy (15/24, 62.5 %), and ileocecal resection (8/24, 33.3 %). Mean operative time was 108.5 min (range 40-205 min). No intraoperative spillage of mucin occurred due to inadvertent rupture of tumor. Resection margins uniformly were negative for tumor. Mean maximal length and diameter of tumors were 7.9 cm (range 3.0-20.0 cm) and 3.2 cm (range 1.0-7.5 cm), respectively. One patient (4.2 %) suffered postoperative morbidity (wound infection). CONCLUSIONS A laparoscopic approach proved feasible and safe for surgical management of appendiceal mucocele due to mucinous cystadenoma. However, long-term follow-up is warranted for more conclusive support.
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Affiliation(s)
- Ki-Jae Park
- Department of Surgery, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 602-715, Korea.
| | - Hong-Jo Choi
- Department of Surgery, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 602-715, Korea.
| | - Sung-Heun Kim
- Department of Surgery, Dong-A University College of Medicine, 26, Daesingongwon-ro, Seo-gu, Busan, 602-715, Korea
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Abstract
Mucocele of the appendix is an aseptic dilatation secondary to obstruction. The preoperative clinical diagnosis of appendiceal mucoceles can therefore be difficult because of this lack of clinical symptomotology. Surgical excision is the treatment of choice in benign mucocele. We report a case presenting to the surgeons where initial clinical findings and investigations suggested a cyst in the right adnexa. Diagnostic laparoscopy revealed mucocele of the appendix and laparoscopic appendicectomy was done.
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Affiliation(s)
- Manish Kumar Singh
- Department of Surgery, Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, India
| | - Mani Kant Kumar
- Department of Pediatrics, Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, India
| | - Ramanuj Singh
- Department of Anatomy, Narayan Medical College and Hospital, Jamuhar, Sasaram, Bihar, India
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Kameda T, Kawai F, Taniguchi N, Omoto K, Kobori Y, Arakawa K. Evaluation of whether the ultrasonographic onion skin sign is specific for the diagnosis of an appendiceal mucocele. J Med Ultrason (2001) 2014; 41:439-43. [DOI: 10.1007/s10396-014-0527-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/30/2014] [Indexed: 12/27/2022]
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QUIZ. J Taibah Univ Med Sci 2013. [DOI: 10.1016/j.jtumed.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Appendiceal mucocele: A diagnostic dilemma in differentiating malignant from benign lesions with CT. AJR Am J Roentgenol 2013; 201:W590-5. [PMID: 24059397 DOI: 10.2214/ajr.12.9260] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the feasibility of using CT to differentiate malignant from benign lesions in patients with pathologically confirmed appendiceal mucoceles. MATERIALS AND METHODS CT scans of 18 consecutively registered patients (11 men, seven women; age range, 21-78 years) with pathologically confirmed appendiceal mucocele were reviewed retrospectively. Patients were classified into three groups according to pathologic results: nonneoplastic mucocele (n = 3), mucinous cystadenoma (n = 10), and mucinous cystadenocarcinoma (n = 5). The nonneoplastic and mucinous cystadenoma groups were formed into a benign group, and the mucinous cystadenocarcinoma constituted the malignant group. Two experienced radiologists working in consensus assessed the shape, short diameter, density, contour, and wall thickness of the masses. The presence of calcifications, internal septations, soft-tissue thickening, periappendiceal fat stranding, intraperitoneal free fluid and pseudomyxoma peritonei were also evaluated. The CT results were compared for malignant and benign appendiceal mucoceles. RESULTS CT showed statistically significant differences in wall irregularity and soft-tissue thickening between malignant and benign cases (p < 0.05). Short diameter of mucoceles, attenuation of intraluminal contents, maximal wall thickness, calcifications, internal septations, periappendiceal fat stranding, intraperitoneal free fluid, and pseudomyxoma peritonei in the lesions did not differ significantly between the benign and malignant groups (p > 0.05). CONCLUSION Differentiating malignant from benign mucoceles can be difficult with CT. Irregular walls and soft-tissue thickening are features most likely to be associated with malignancy.
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Abstract
Mucocele of the appendix is an uncommon disorder that is often asymptomatic, but can present similarly to acute appendicitis. Timely diagnosis and treatment is imperative due to the many complications that can result from the mucocele, such as perforation. Appendiceal mucoceles (AM) were previously thought to be either benign or malignant; however, a different pathological classification of AM is currently favored. Also, only a few cases of volvulus of a benign AM have been reported. Here, we present the first reported case of a low-grade appendiceal mucinous neoplasm resulting in a volvulus of the cecum.
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Affiliation(s)
- Vincent Costa
- School of Medicine, Stony Brook University, Stony Brook, NY, USA and Department of Surgery, Winthrop University Hospital, Mineola, NY, USA
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26
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Distinguishing between acute appendicitis and appendiceal mucocele: is this possible preoperatively? Eur J Trauma Emerg Surg 2013; 39:523-9. [DOI: 10.1007/s00068-013-0321-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 08/12/2013] [Indexed: 01/07/2023]
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Pulighe F, Paliogiannis P, Cossu A, Palmieri G, Colombino M, Scognamillo F, Trignano M. Molecular analysis of appendiceal mucinous cystadenoma and rectal adenocarcinoma in a patient with urothelial carcinoma: a case report. J Med Case Rep 2013; 7:170. [PMID: 23809582 PMCID: PMC3702410 DOI: 10.1186/1752-1947-7-170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 05/31/2013] [Indexed: 12/31/2022] Open
Abstract
Introduction In this report, we present the case of a patient affected by appendiceal cystadenoma, a colorectal adenocarcinoma, and a concomitant bladder carcinoma, as well as the results of the molecular study of the most relevant mutational pathways involved in these tumors. Case presentation A 68-year-old Italian man was admitted to our unit complaining of macrohematuria, rectorrhagia, and rectal tenesmus for about 2 months. A colonoscopy showed the presence of a rectal lesion at 11cm from the anal margin; multiple biopsies were performed and a diagnosis of moderately differentiated adenocarcinoma was made. Abdominal ultrasonography and total body computed tomography performed subsequently to stage the rectal cancer showed the presence of two round nodules, interpreted as swollen lymph nodes of neoplastic origin, at the anterior aspect of the iliopsoas muscle and a budding lesion affecting the bladder. The patient underwent transurethral biopsy of the lesion in the right retrotrigonal region; the diagnosis was grade II urothelial carcinoma. The patient underwent an open anterior rectal resection with loco-regional lymphadenectomy. An enlarged appendix and a voluminous whitish soft-tissue lesion requiring an appendicectomy were detected perioperatively. Transurethral resection of the bladder lesion was also performed. The histological examination revealed that the nodular lesions in the appendix were due to a cystadenoma. For mutation analysis, genomic deoxyribonucleic acid was isolated from tumor tissue samples; for PIK3CA mutations, screening revealed that all three samples analyzed carried mutations in exon 9. Conclusions Appendiceal mucoceles are rare but require adequate surgical treatment, given their malignant potential and the possibility of causing peritoneal pseudomyxoma. It is essential to make a correct preoperative evaluation based on a colonoscopy rather than ultrasound and computed tomography to exclude synchronous neoplasias often associated with mucoceles and to plan the optimum surgical strategy. The association between appendiceal mucoceles and other neoplasias is relatively frequent, especially with colorectal cancer. Oncogenic activation in the PIK3CA-depending pathway may contribute substantially to the pathogenesis of the different solid tumors in the same patient.
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Affiliation(s)
- Fabio Pulighe
- Department of Surgical, Microsurgical and Medical Sciences, University of Sassari, Viale San Pietro 43B, 07100 Sassari, Italy.
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Wakui N, Fujita M, Yamauchi Y, Takeda Y, Ueki N, Otsuka T, Oba N, Nishinakagawa S, Takezoe T, Hiroyoshi J, Kono Y, Katahira S, Minagawa M, Takeda Y, Shiono S, Kojima T. Mucinous cystadenocarcinoma of the appendix in which contrast-enhanced ultrasonography was useful for assessing blood flow in a focal nodular lesion in the tumor cavity: A case report. Exp Ther Med 2013; 6:3-8. [PMID: 23935709 PMCID: PMC3735569 DOI: 10.3892/etm.2013.1094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/25/2013] [Indexed: 12/19/2022] Open
Abstract
A 63-year-old woman was admitted to hospital with pain in the right lower quadrant. Abdominal computed tomography (CT) revealed a 60-mm cystic mass at a site corresponding to the appendix. The mass wall on the appendicular ostium was thickened and enhanced by contrast, while calcification was observed in the mass wall on the appendicular tip. No projection was observed in the mass cavity. On abdominal ultrasonography (US), the mass wall on the appendicular ostium was thickened and projections were observed at two sites in the mass cavity. On contrast-enhanced US (CEUS), only one of these projections was enhanced. Based on the thickened and contrast-enhanced wall of the mass on the appendicular ostium on CT and US, as well as the contrast enhancement of a projection on US, the mass was diagnosed as mucinous cystadenocarcinoma of the appendix. Ileocecal resection was subsequently performed on day 10. A detailed examination of the surgical specimen revealed carcinoma cells in the mass wall on the appendicular ostium. The contrast-enhanced projection was identified as granulation tissue that had grown to come into contact with the tumor, while the non-contrast-enhanced projection was identified as solidified mucus. US enabled successful visualization of projections in the mass cavity that were not visible on abdominal CT. CEUS also proved useful for assessing blood flow in these projections.
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Affiliation(s)
- Noritaka Wakui
- Departments of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
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Opreanu RC, Sobinsky J, Basson MD. Appendicitis and benign appendiceal mucocele presenting as large bowel obstruction. J Gastrointest Surg 2013; 17:609-10. [PMID: 23099734 PMCID: PMC3837578 DOI: 10.1007/s11605-012-2054-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 10/11/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Appendiceal mucocele is most commonly encountered incidentally during appendectomy. METHODS We report a case of large bowel obstruction presenting as a closed loop with an appendiceal mucocele as the lead point, superimposed on a chronic ileal stricture that had been misdiagnosed as irritable bowel syndrome. RESULTS The patient underwent ileocecal resection and primary anastomosis. She did well postoperatively, and her irritable bowel syndrome disappeared. CONCLUSIONS Appendiceal mucocele can present in a variety of ways, and surgeons should be alert for atypical presentations. Moreover, some patients with intermittent abdominal pain deserve anatomic investigation before being dismissed as having irritable bowel.
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Affiliation(s)
- Razvan C Opreanu
- Department of Surgery, College of Human Medicine, Michigan State University, Lansing, MI 48912, USA
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30
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Cross WW, Kowdley GC, Levien DH. Appendiceal Cystadenoma: Presentation, Intraoperative and Pathological Findings. Am Surg 2012. [DOI: 10.1177/000313481207800221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Wirt W. Cross
- Department of Surgery Saint Agnes Hospital Baltimore, Maryland
| | | | - David H. Levien
- Department of Surgery Saint Agnes Hospital Baltimore, Maryland
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Imari AA, Vajpeyi R. Neuroendocrine Tumor (Carcinoid) of the Appendix With Mucocele. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2011. [DOI: 10.1177/8756479311413816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute right lower quadrant pain is a common emergency department presentation. Medical imaging has a main role to rule out appendicitis. Distinguishing between appendicitis and the other two major appendix pathologies, mucocele and carcinoid tumors, is not easy, but it is important for medical and surgical management planning. Appendix mobility is not usually assessed during sonography, but is it helpful? When comparing sonography and computerized tomography with histopathology findings to distinguish appendiceal pathologies, appendix mobility was found to be a key component. Appendix diameter, wall thickness, hyperemia, and surrounding echogenic fat are signs of an inflammatory process that will fix the appendix. Appendiceal carcinoids and mucoceles, on the other hand, will not initially have an inflammatory component for years, and thus patients present with only mild recurrent vague abdominal pain, normal blood work, and mild or borderline imaging findings. Sonography should be the first-choice medical imaging modality to rule out appendiceal pathologies because appendix mobility should be assessed and reported.
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Affiliation(s)
- Ahmed Al Imari
- Joint Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, Canada
| | - Rajkumar Vajpeyi
- Department of Pathology, Toronto General Hospital, Toronto, Ontario, Canada
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Ju YT, Park ST, Ha WS, Hong SC, Lee YJ, Jung EJ, Jung CY, Jeong SH, Choi SK. Laparoscopic resection of a appendiceal mucocele. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 80 Suppl 1:S21-5. [PMID: 22066077 PMCID: PMC3205373 DOI: 10.4174/jkss.2011.80.suppl1.s21] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 07/02/2010] [Indexed: 11/30/2022]
Abstract
Laparoscopic resection of appendiceal mucoceles has recently been described, but the safety and efficacy are controversial. We present two cases of laparoscopic mucocelectomies involving 14 and 15 cm cystic masses originating from the appendix. The laparoscopic mucocelectomies were performed using four ports. From the beginning of the procedure, a laparoscopic bag was used to safely contain the mucocele, prevent rupture of the mucocele, and retract the mucocele. An endoscopic stapling device was used to transect the base of the cecum. Minimal handling was achieved by gravity and with the use of laparoscopic instruments. Laparoscopic appendectomies are widely performed for acute appendicitis, but laparoscopic resection is not routinely performed for an appendiceal mucocele because of the risk of perforation and subsequent pseudomyxoma peritonei. We report two cases of laparoscopic appendiceal mucocelectomies, which were performed safely with laparoscopic instruments and minimal manipulation.
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Affiliation(s)
- Young-Tae Ju
- Department of Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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Attarde V, Patil P, Apte A, Barhate K, Gandhe A, Sorte S, Hattangadi N. Sonographic appearance of a giant appendicular mucocele. JOURNAL OF CLINICAL ULTRASOUND : JCU 2011; 39:290-292. [PMID: 21425276 DOI: 10.1002/jcu.20809] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 01/18/2011] [Indexed: 05/30/2023]
Abstract
Mucocele of the appendix is a rare but well-known entity. Accurate preoperative diagnosis of this surgically curable entity is very important to prevent intraoperative rupture. With multimodality approach using ultrasound and CT, it has been possible to preoperatively diagnose mucocele of the appendix. We describe the ultrasound and CT findings of a giant appendicular mucocele that led us to the correct preoperative diagnosis.
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Affiliation(s)
- Vinod Attarde
- Department of Radiodiagnosis, Grant Medical College, Sir JJ Hospital, Mumbai, India 400008
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Incidental diagnosis of appendiceal mucocele with vaginal ultrasonography and computed tomography. Obstet Gynecol 2011; 117:479-481. [PMID: 21252796 DOI: 10.1097/aog.0b013e318203ea37] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Appendiceal mucocele is an uncommon entity that may be encountered at the time of abdominal surgery performed for an unrelated indication. The diagnosis may be suggested by imaging with ultrasonography or computed tomography of the abdomen and pelvis. Whereas early resection is curative, failure to recognize the disorder may lead to rupture and the devastating consequences of pseudomyxoma peritonei. CASE Following an annual gynecologic checkup in a healthy 63-year-old woman, vaginal ultrasonography along with a subsequent computed tomographic study raised the possibility that an incidental appendiceal mucocele was present. At laparoscopy, this diagnosis was confirmed and the lesion was resected using minimally invasive techniques. CONCLUSION Early diagnosis and treatment of appendiceal mucocele facilitates the successful management of this rare disorder.
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Amyand's hernia with mucinous cysadenoma of the appendix. Indian J Surg 2010; 72:341-3. [PMID: 23133292 DOI: 10.1007/s12262-010-0077-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 02/14/2010] [Indexed: 10/18/2022] Open
Abstract
Amyand's hernia is a rare condition in which the appendix is positioned in the inguinal hernia sac. Mucinous cysadenoma of the appendix is rather extremely rare. We report a case of a mucinous cystadenoma of the appendix which presented as an incarcerated right indirect inguinal hernia (Amyand's hernia).
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Moyle PL, Kataoka MY, Nakai A, Takahata A, Reinhold C, Sala E. Nonovarian Cystic Lesions of the Pelvis. Radiographics 2010; 30:921-38. [DOI: 10.1148/rg.304095706] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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37
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Goyal A, Goyal S, Bagree R, Sharma S, Jindel DK. Giant mucocele of appendix as pelvic mass: A rare presentation. Indian J Surg 2010; 72:347-8. [PMID: 23133294 DOI: 10.1007/s12262-010-0101-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 11/17/2009] [Indexed: 10/18/2022] Open
Affiliation(s)
- Amit Goyal
- Department of General Surgery, SMS Medical College, Jaipur, India
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Jongsma TEF, Puylaert JBCM. Infection of a malignant appendiceal mucocele masquerading as an appendiceal abscess: role of preoperative sonography and CT. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:236-238. [PMID: 19253351 DOI: 10.1002/jcu.20550] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We report the case of a 71-year-old lady with a suspected appendiceal abscess in whom preoperative sonography and CT demonstrated an infected appendiceal mucocele. The lesion was surgically removed and final pathologic examination revealed malignancy. Correct recognition of the mucocele prevented a potentially disastrous percutaneous drainage.
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Affiliation(s)
- Thomas E F Jongsma
- Department of Radiology, Medical Center Alkmaar, Alkmaar, The Netherlands
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CT diagnosis of mucocele of the appendix in patients with acute appendicitis. AJR Am J Roentgenol 2009; 192:W103-10. [PMID: 19234237 DOI: 10.2214/ajr.08.1572] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The purpose of this study was to identify the CT features of mucocele of the appendix coexisting with acute appendicitis and to determine whether this entity can be differentiated from acute appendicitis without mucocele. MATERIALS AND METHODS CT scans of 70 patients (12 with acute appendicitis with mucocele, 29 with acute appendicitis without mucocele, 29 with a normal appendix) were retrospectively interpreted by two readers. The appendix was evaluated for maximal luminal diameter, cystic dilatation, luminal attenuation, appendicolith, mural calcification and enhancement, periappendiceal fat stranding, fluid, and lymphadenopathy. CT findings were compared by use of Mann-Whitney U and Fisher's exact tests. Receiver operating characteristics analysis was performed to assess the diagnostic utility of appendiceal luminal diameter in differentiating acute appendicitis with from that without coexisting mucocele. RESULTS Cystic dilatation of the appendix and maximal luminal diameter achieved statistical significance (p < 0.05) for the diagnosis of acute appendicitis with mucocele. Mural calcification achieved statistical significance for one reader (p = 0.0049) and a statistical trend for the other (p < 0.1). A maximal luminal diameter greater than 1.3 cm had a sensitivity of 71.4%, specificity of 94.6%, and overall diagnostic accuracy of 88.2% for the diagnosis of acute appendicitis with mucocele. CONCLUSION Although there is overlap with acute appendicitis without mucocele, CT features suggestive of coexisting mucocele in patients with acute appendicitis include cystic dilatation of the appendix, mural calcification, and a luminal diameter greater than 1.3 cm.
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Fairise A, Barbary C, Derelle AL, Tissier S, Granger P, Marchal F, Laurent V, Régent D. [Mucocele of the appendix and pseudomyxoma peritonei]. ACTA ACUST UNITED AC 2008; 89:751-62. [PMID: 18641562 DOI: 10.1016/s0221-0363(08)73781-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- A Fairise
- Service de Radiologie Adultes, CHU Nancy-Brabois, Allée du Morvan, Vandoeuvre-lès-Nancy Cedex, France.
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Khanna M, Buddhavarapu SR. Primary Burkitt's Lymphoma Of The Appendix Presenting As Acute Abdomen: A Case Report. J Radiol Case Rep 2008; 2:9-14. [PMID: 22470604 DOI: 10.3941/jrcr.v2i5.80] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Leukemic and lymphomatous involvement of the appendix is rare and even rarer is its presentation as appendicitis. Burkitt's lymphoma is a high grade B-cell neoplasm. Its non-endemic form typically presents as abdominal mass in children. This rapidly growing tumour may cause symptoms due to mass effect or direct involvement of the bowel. Clinical presentations like acute abdomen can be secondary to intestinal obstruction, intussusception or sometimes perforation.We describe here a case of an adult male with an unusual presentation of appendiceal Burkitt's lymphoma mimicking acute cholecystitis or appendicitis.
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Affiliation(s)
- Maneesh Khanna
- Department of Radiology, NAH, Hamad Medical Corporation, Doha; State of Qatar
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Papaziogas B, Koutelidakis I, Tsiaousis P, Goula OC, Lakis S, Atmatzidis S, Makris J, Paraskevas G, Atmatzidis K. Appendiceal Mucocele. A retrospective Analysis of 19 Cases. J Gastrointest Cancer 2008; 38:141-7. [DOI: 10.1007/s12029-008-9030-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Krieg A, Esch JSA, Poll LW, Braunstein S, Knoefel WT. Mucinous cystadenoma of the appendix misdiagnosed as cystic hydatid disease of the liver: a case report. J Med Case Rep 2008; 2:218. [PMID: 18578871 PMCID: PMC2478665 DOI: 10.1186/1752-1947-2-218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 06/25/2008] [Indexed: 11/15/2022] Open
Abstract
Introduction Primary neoplastic lesions presenting with a mucocele of the appendix are very rare and can be divided into benign variants of mucinous adenomas or cystadenomas, mucinous tumours of uncertain malignant potential or mucinous cystadenocarcinomas. Most of these tumourous mucoceles are asymptomatic and are found incidentally. The major complication of neoplastic mucinous appendiceal tumours is the development of a pseudomyxoma peritonei due to spreading of mucin-producing cells within the abdominal cavity. Case presentation A 44-year-old man presented with a history of non-specific symptoms of right upper abdominal pain. Abdominal ultrasound and computed tomography scan identified a cystic mass consistent with the morphological characteristics of an echinococcal hydatid cyst. After completing systemic albendazole therapy, an explorative laparotomy revealed a cystic tumour of the appendix. Ileocaecal resection was performed and pathology reports confirmed the diagnosis of a mucinous cystadenoma of the appendix. The postoperative course was uneventful. Conclusion Here we present the case of a man with a mucinous cystadenoma of the appendix mimicking cystic hydatid disease. We discuss the importance of re-evaluation and differential diagnostic reflections in cases of appendiceal mucocele.
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Affiliation(s)
- Andreas Krieg
- Department of General and Visceral Surgery, Heinrich Heine-University, Duesseldorf, Germany.
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Massive mucinous cystadenoma of the appendix with intussusception in an adult: usefulness of reconstructed computed tomography images. ACTA ACUST UNITED AC 2008; 26:88-91. [PMID: 18301985 DOI: 10.1007/s11604-007-0201-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 10/17/2007] [Indexed: 10/22/2022]
Abstract
We present an adult patient with a massive mucinous cystadenoma of the appendix that induced intussusception. Multiplanar reconstruction images and maximum intensity projection images enabled us to assess the tumor accurately and characterize the intussusception. Thus, reconstructed computed tomographic images proved highly useful for diagnosis.
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Bartlett C, Manoharan M, Jackson A. Mucocele of the appendix - a diagnostic dilemma: a case report. J Med Case Rep 2007; 1:183. [PMID: 18093329 PMCID: PMC2245959 DOI: 10.1186/1752-1947-1-183] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2007] [Accepted: 12/19/2007] [Indexed: 11/17/2022] Open
Abstract
Introduction Mucocele of the appendix secondary to mucinous cystadenoma is a rare clinical finding. Clinical presentation is varied with more than half being asymptomatic. Case presentation We report such a case presenting to the surgeons where initial clinical findings and investigations suggested an ovarian cyst. The patient was subsequently referred to the Gynaecologists for further management. In spite of extensive preoperative investigations, the diagnosis was only made at the time of surgery. Conclusion In women presenting with a right iliac fossa mass and clinical features not indicative of gynaecological pathology, an appendiceal origin should be considered in the differential diagnosis.
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Affiliation(s)
- Ciprian Bartlett
- Department of Obstetrics and Gynaecology, Homerton University NHS Foundation Trust, London, UK.
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Lee J, Lim HK, Lee SJ. Ureteral obstruction caused by mucocele of the appendix: MDCT findings. ACTA ACUST UNITED AC 2007; 51 Spec No.:B59-61. [PMID: 17875160 DOI: 10.1111/j.1440-1673.2007.01800.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Mucocele of the appendix is characterized by distension of the appendiceal lumen due to abnormal accumulation of mucoid substance. Among the known complications of appendiceal mucocele, it is known to be unusual for the appendiceal mucocele to be a cause of ureteral obstruction. Only a few reports have been published in the English literature. We describe a case of right hydronephroureterosis secondary to appendiceal mucocele diagnosed with multidetector-row CT.
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Affiliation(s)
- J Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Rudloff U, Malhotra S. Volvulus of an appendiceal mucocele: report of a case. Surg Today 2007; 37:514-7. [PMID: 17522774 DOI: 10.1007/s00595-006-3435-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Accepted: 07/27/2006] [Indexed: 11/30/2022]
Abstract
Few cases of volvulus of an appendiceal mucocele have been reported. The mechanism of torsion seems to be similar to that suggested for ovarian or appendegeal torsion, where a solid organ or mass fixed onto a narrow stalk is a precondition. We report the case of a young woman who presented with signs and symptoms of acute appendicitis. Computed tomography showed a cystic mass of fluid consistency in the right lower quadrant. An emergency laparoscopy revealed a 720 degrees torsion of a gangrenous mucocele around the proximal part of the appendix. We performed a laparoscopic appendectomy and she recovered uneventfully. The presentation of volvulus of an appendiceal mucocele can mimic other common conditions. Prompt surgical intervention is essential to prevent gangrene and perforation. The combination of a cystic, right lower quadrant mass, and clinical findings suggestive of acute appendicitis should alert the clinician to include volvulus of an appendiceal mucocele in the differential diagnosis.
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Affiliation(s)
- Udo Rudloff
- Department of Surgery, New York University Medical Center, New York, NY 11040, USA
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Abstract
Mucocoele of the appendix occurs when obstruction of the appendiceal lumen results in mucus accumulation and consequent abnormal dilatation. The most impor-tant aetiology, from a surgical perspective, is either mucinous cystadenoma or cystadenocarcinoma. In the latter, a spontaneous or iatrogenic rupture of the mucocoele can lead to mucinous intraperitoneal ascites, a syndrome known as pseudomyxoma peritonei. Optimal management of mucoceles is achieved through accurate preoperative identification and subsequent careful resection. We report two cases and subsequently discuss the clinical presentation of mucocoeles, their association with pseudomyxoma peritonei and an optimal management of both conditions.
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Affiliation(s)
- Anupam Dixit
- Colorectal Department, The London Clinic, 20 Devonshire Place, London W1G 6BW, United Kingdom.
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Derelle AL, Tissier S, Granger P, Barbary C, Rousseau A, Laurent V, Tortuyaux JM, Marchal F, Régent D. Diagnostic précoce de pseudomyxome péritonéal localisé à la zone de rupture d’une mucocèle appendiculaire : imagerie et aspects anatomopathologiques. ACTA ACUST UNITED AC 2007; 88:289-95. [DOI: 10.1016/s0221-0363(07)89819-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Behranwala KA, Agarwal T, El-Sharkawi D, Shorvon D, Chang A. Laparoscopic resection of mucinous cystadenoma of appendix: a careful decision. Surg Laparosc Endosc Percutan Tech 2007; 16:347-8. [PMID: 17057579 DOI: 10.1097/01.sle.0000213704.94687.9e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Appendiceal mucoceles are mainly due to cystadenoma or cystadenocarcinoma. Definite diagnosis is difficult preoperatively and is usually peroperatively. Surgical excision, either by laparoscopy or by laparotomy, is the mainstay of treatment. Rupture of the lesion causes pseudomyxoma peritonei. We present a case to highlight this point and especially deplore the use of laparoscopy if the tumor clearly extends beyond the appendix.
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