Myxoglobulosis of the appendix associated with a proximal carcinoid and a pseudodiverticulum

Appendiceal diverticulitis, a rare relevant pathology: Presentation of a case report and review of the literature

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Appendiceal diverticulitis is often overlooked with high risk of perforation.

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Appendiceal diverticula is often associated to appendiceal neoplasm.

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Accurate appendectomy should be performed in order to permit appropriate pathological examination.

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Prophylactic appendectomy should be performed in asymptomatic patients with appendiceal.

Introduction

Appendiceal diverticulitis is a rare pathology that mimics acute appendicitis. Appendiceal diverticula are classified into congenital and acquired with difference in incidence and pathogenesis. Appendiceal diverticulitis is often overlooked because of mildness of symptomatology with increasing risk of complications, such as perforation. Appendiceal diverticula are often associated to higher risk of neoplasm especially carcinoid tumors and mucinous adenomas.

Presentation of case

A 40-year-old caucasic male presented into Emergency Room with right lower quadrant pain associated with vomit, abdominal tenderness, fever and moderate leukocytosis (11.93 × 10; neutrophils 78.5%). Acute appendicitis was suspected and a surgical approach was chosen with a McBurney access. The removed specimen (Figs. 1 and 2) was 11 cm long with multiple hyperaemic and oedematous diverticular protrusions. The postoperative course was regular. Discharging was on 4th postoperative day in optimal clinical conditions. The histological examination (Fig. 3) showed acute inflammation of appendiceal pseudodiverticula with acute peridiverticulitis and abscess.

Discussion

Currently, appendiceal diverticulitis is often overlooked with high risk of complications, above all perforation. Attention should be kept during the surgical procedure and the patholological examination in order to identify any associated neoplasm.

Conclusion

Appendiceal diverticulitis should be considered in adult male patients with right lower quadrant pain or tenderness. Accurate appendectomy should be performed in order to permit an appropriate pathological examination and possible associate neoplasm should always be searched through. Prophylactic appendectomy should be performed in case of incidental finding of appendiceal diverticula in asymptomatic patients in order to avoid the high perforation risk.

Myxoglobulosis in the appendix

Myxoglobulosis is a specific type of mucocele consisting of mucoid material. It is characterized by opaque, transparent globules that resemble "fish eggs" or "frogspawns". It is generally diagnosed incidentally during an appendectomy or an autopsy. In this paper, we aim to present the case of a 58-year-old male patient who was referred to our hospital because of abdominal pain and loss of appetite. The patient underwent an appendectomy. Opaque intraluminal globules were found in the appendectomy material. The globules resembled pearls and they were 2-3 mm in diameter. After histopathological examinations, the patient was diagnosed with myxoglobulosis accompanied with acute appendicitis. According to our research, this is the first case of myxoglobulosis in our country.

Myxoglobulosis of appendix a rare entiy

We describe a case of the extremely rare entity of myxoglobulosis of the appendix in an 18-year-old man who underwent laparoscopic appendectomy with the clinical diagnosis of recurrent appendicitis. Transaction of the appendix after ligation resulted in extrusion of numerous whitish egg-like globules ranging in size from 0.2 to 0.7 cm in diameter. It was initially thought to be hydatid of appendix, resulting in emergent usage of povidine iodine as scolicidal after suction of all the cysts/eggs. On microscopic examination, the globules consisted of faintly eosinophilic laminations of mucin surrounding an amorphous granular core were found. The mucin was identified by positivity with histochemical mucin stains. After thorough microscopic examination of the appendix, our case was diagnosed as myxoglobulosis due to mucosal hyperplasia, associated with luminal obstruction with possibly a membrane.

Clinical characteristics of 12 cases of appendiceal diverticulitis: a comparison with 378 cases of acute appendicitis

PURPOSE

Previous authors have suggested that a diverticulum of the vermiform appendix has a higher risk of perforation than acute appendicitis. Therefore, this study compared appendiceal diverticulitis with acute appendicitis to explain the characteristics of appendiceal diverticulitis.

METHODS

Data for this study came from a retrospective analysis at the Department of Surgery at Fukuoka Tokushukai Hospital from January 2005 to June 2008. Twelve cases of appendiceal diverticulitis and 378 cases of acute appendicitis were analyzed.

RESULTS

The patients with appendiceal diverticulitis were older than those with acute appendicitis (42.7 ± 15.4 vs. 29.1 ± 17.7; p = 0.009). The white blood cell (WBC) level was lower (11332 ± 4658 vs. 14236 ± 3861; p = 0.011) and the CRP level was higher (8.65 ± 8.94 vs. 4.34 ± 6.34, p = 0.022) in those with appendiceal diverticulitis than in those with acute appendicitis. A preoperative diagnosis for appendiceal diverticulitis was made in 4 out of 12 (33.3%) by ultrasonography (US). The perforation rate was higher in appendiceal diverticulitis than that in acute appendicitis (33.3 vs. 9.8%; p = 0.009).

CONCLUSIONS

Appendiceal diverticulitis is more likely to perforate over the progression of the clinical course, which would mandate appendectomy when appendiceal diverticulitis is detected by US, even if the patient has no severe abdominal pain.

Myxoglobulosis of the appendix: a case associated with ruptured diverticulum

We describe a case of the extremely rare entity of myxoglobulosis of the appendix from a 45-year-old white man who was operated urgently with the clinical diagnosis of acute appendicitis. Sectioning of the appendix revealed the presence in the dilated appendiceal lumen of numerous whitish opaque globules ranging in size from 0.2 to 0.7 cm in diameter. A ruptured diverticulum and several smaller ones were also found. On microscopic examination, the globules consisted of faintly eosinophilic laminations of mucin surrounding an amorphous granular core. The mucin was identified by positivity with histochemical mucin stains. After thorough microscopic examination of the appendix, our case was diagnosed as myxoglobulosis due to mucosal hyperplasia, associated with ruptured diverticulum and acellular extra-appendiceal mucin deposits.