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Ionescu S, Marincas M, Madge OL, Dicu-Andreescu IG, Chitoran E, Rotaru V, Cirimbei C, Gherghe M, Ene A, Rosca R, Radu M, Simion L. Ovarian Causes of Pseudomyxoma Peritonei (PMP)-A Literature Review. Cancers (Basel) 2024; 16:1446. [PMID: 38672528 PMCID: PMC11047873 DOI: 10.3390/cancers16081446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/04/2024] [Accepted: 04/06/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Pseudomyxoma peritonei (PMP) is a rare, progressive, slowly growing, inadequately understood neoplasm with a 5-year progression-free survival rate of as low as 48%. It is characterized by varying degrees of malignancy and the production of mucinous and gelatinous structures. Typically, the development of pseudomyxoma peritonei is associated with the rupture of appendiceal mucinous tumors and other gastrointestinal or ovarian mucinous tumors. The goal of our literature review was to identify various aspects that characterize the ovarian causes of pseudomyxoma peritonei. MATERIALS AND METHODS The authors performed an extensive literature search between 1 February 2024 and 2 March 2024 on the following databases: Pubmed, Scopus, Oxford Journals, and Reaxys, and the findings were summarized into seven main clinical and paraclinical situations. RESULTS According to our research, the main instances in which pseudomyxoma peritonei can be triggered by an ovarian cause are the following: (1) mucinous cystadenoma; (2) mucinous ovarian cancer; (3) colon cancer with ovarian metastasis; (4) malignant transformation of an ovarian primary mature cystic teratoma; (5) appendiceal mucocele with peritoneal dissemination mimicking an ovarian tumor with peritoneal carcinomatosis; (6) mucinous borderline tumor developing inside an ovarian teratoma; and (7) the association between a mucinous bilateral ovarian cancer and a colonic tumor. CONCLUSIONS In our study, we aimed to provide a comprehensive overview of the ovarian causes of pseudomyxoma peritonei, including its epidemiology, imagery characteristics, symptoms, current treatment, and promising future therapies, in the hopes of finding feasible solutions, as a lack of understanding of this mucus-secreting malignant disease increases the risk of delayed diagnosis or uncontrolled deterioration.
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Affiliation(s)
- Sinziana Ionescu
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Marian Marincas
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Octavia Luciana Madge
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
- Faculty of Letters, University of Bucharest, 030018 Bucharest, Romania
| | - Irinel Gabriel Dicu-Andreescu
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Elena Chitoran
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Vlad Rotaru
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Ciprian Cirimbei
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
| | - Mirela Gherghe
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- The Clinical Nuclear Medicine Laboratory, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania
| | - Adina Ene
- Pathology Department, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania; (A.E.); (M.R.)
| | - Robert Rosca
- Pathology Department, Bucharest Emergency University Hospital, 050098 Bucharest, Romania;
| | - Madalina Radu
- Pathology Department, Oncological Institute “Prof. Dr. Alexandru Trestioreanu”, 022328 Bucharest, Romania; (A.E.); (M.R.)
| | - Laurentiu Simion
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (S.I.); (E.C.); (V.R.); (C.C.); (L.S.)
- General Surgery and Surgical Oncology Department I, Bucharest Institute of Oncology “Prof. Dr. Al. Trestioreanu”, 022328 Bucharest, Romania; (O.L.M.); (I.G.D.-A.)
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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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Bai D, Zhou N, Dou R, Wang J, Zhang P, Wang H, Wang Z, Liang L. The value of ultrasound combined with CT in identifying early low-grade appendiceal mucinous neoplasm and appendicitis. Front Oncol 2023; 13:1191785. [PMID: 37849798 PMCID: PMC10578960 DOI: 10.3389/fonc.2023.1191785] [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: 03/22/2023] [Accepted: 08/29/2023] [Indexed: 10/19/2023] Open
Abstract
Objective The aim of this study is to investigate the value of ultrasound combined with computed tomography (CT) in identifying early low-grade appendiceal mucinous neoplasm and appendicitis. Methods Patients with early low-grade appendiceal mucinous neoplasm and appendicitis from September 2017 to September 2021, including 40 patients with low-grade appendiceal mucinous neoplasm and 40 patients with appendicitis, were collected in this study. Clinical data as well as ultrasound and CT findings of all patients were retrospectively analyzed. Univariate and multivariate logistic regression analyses were applied to establish the ultrasound model, the CT model, and the combined model. Results The nomogram showed that specific characteristics of CT were dilated appendiceal diameter and clear surrounding fat space in the low-grade appendiceal mucinous neoplasm and that specific characteristics of ultrasound were thin or clear layer appendix wall and flocculent echo in the appendix cavity. These four features were used to construct a nomogram for predicting early low-grade appendiceal mucinous neoplasm, and the area under the curve value was 0.839. Conclusion Ultrasound combined with CT for diagnosis of early low-grade appendiceal mucinous neoplasm has a significant value; when found significantly dilated appendix in the lower right abdomen, with thin wall, wall calcification, clear surrounding fat space, and progressive enhancement, especially non-specific symptoms similar to appendicitis, the physician should timely consider the possibility of low-grade appendiceal mucinous neoplasm.
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Affiliation(s)
- Dong Bai
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Nan Zhou
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Ruixue Dou
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Jiajun Wang
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
| | - Pu Zhang
- Department of Myxoma, Aerospace Center Hospital, Beijing, China
| | - Haoyu Wang
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Zhiqun Wang
- Department of Radiology, Aerospace Center Hospital, Beijing, China
| | - Lei Liang
- Department of Ultrasound, Aerospace Center Hospital, Beijing, China
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Jelev G, Vassilev I, Usheva S, Yanev T, Sedloev T. А case of a mucocele of the appendix – A diagnostic and therapeutic dilemma. Int J Surg Case Rep 2023; 105:108082. [PMID: 37001374 PMCID: PMC10070622 DOI: 10.1016/j.ijscr.2023.108082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/04/2023] [Accepted: 03/16/2023] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Mucocele of the appendix is a rare pathology with an estimated incidence of less than 1 % of all appendectomies. Here is a report of a 67-year-old Bulgarian female, diagnosed with a low-grade appendiceal mucinous neoplasm (LAMN) after immunohistochemical analysis, which changed the therapeutic strategy. CASE PRESENTATION We present a case of a patient, initially admitted to the Gastroenterology Department due to complaints of dyspepsia and intermittent watery diarrhea. Abdominal ultrasound revealed an oval hypoechoic heterogeneous formation with mixed echo structure in the ileocecal region. Laparoscopic appendectomy with partial cecal resection was performed. The additional immunohistochemical assessments classified the finding as a LAMN with 12 % proliferative index (Ki-67), pancreatin-positive reaction in epithelial cells and CD68-positive reaction in macrophages. CLINICAL DISCUSSION Mucinous neoplasms of the appendix are classified on a spectrum from benign to malignant based upon certain features on histological examination. When there are signs of malignancy such as metastases in the loco-regional lymph nodes, perforation with intraperitoneal dissemination and affected base of the appendix (positive margins of resection), more aggressive approach is recommended - right hemicolectomy. Simple appendectomy is the choice for patients with benign mucocele as suggested by the presence of a normal caecum and appendicular base with no evidence of perforation. CONCLUSION Appendiceal mucocele could be an illustrative example of a diagnostic and therapeutic challenge due to the rarity of the disease. Pathohistological examination and mainly immunohistochemical tests are the key to correct diagnosis and treatment.
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Affiliation(s)
- Georgi Jelev
- Department of Surgery - University Hospital "Queen Joanna - ISUL", Medical University of Sofia, Bulgaria
| | - Ivan Vassilev
- Department of Surgery - University Hospital "Queen Joanna - ISUL", Medical University of Sofia, Bulgaria
| | - Slavyana Usheva
- Department of Surgery - University Hospital "Queen Joanna - ISUL", Medical University of Sofia, Bulgaria.
| | - Todor Yanev
- Department of Surgery - University Hospital "Queen Joanna - ISUL", Medical University of Sofia, Bulgaria
| | - Theophil Sedloev
- Department of Surgery - University Hospital "Queen Joanna - ISUL", Medical University of Sofia, Bulgaria
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Wang C, Yin XY, An LB, Zhai XC, Cai Y, Shi GJ, Fan XW, Zhang P, Wang KM, Ma RQ. Significance of laparoscopic cytoreductive surgery for appendiceal pseudomyxoma peritonei with limited disease and low tumor burden. Asian J Surg 2023; 46:1220-1225. [PMID: 36064480 DOI: 10.1016/j.asjsur.2022.08.052] [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] [Received: 05/03/2022] [Revised: 07/19/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the clinical value of laparoscopic cytoreductive surgery (CRS) in treating of appendiceal pseudomyxoma peritonei with limited disease and low tumor burden. METHODS The clinical data of patients with appendiceal pseudomyxoma peritonei treated by surgery with CRS at the Aerospace Center Hospital from January 2018 to December 2021 were retrospectively analyzed. The patients were divided into laparoscopic or open CRS groups according to the operation method. A propensity score-matched (PSM) analysis (1:1) was performed, the related clinical variables were compared between the two groups, and the effect on progression-free survival (PFS) was also analyzed. RESULTS One hundred and eight patients were included in this study. After PSM, 33 patients were selected from each group and the age and peritoneal cancer index were matched between the two groups. There were significant differences in operation time (P < 0.001), intraoperative bleeding (P < 0.001), intraoperative blood transfusion (P = 0.007), hospital stay (P < 0.001). The analysis of PFS showed that there was no significant difference between the two operation methods. After multivariate analysis, the pathologic subtype (P = 0.012) was identified as an independent prognostic factor for PFS. CONCLUSION The curative effect of laparoscopic CRS is like that of open operation, which can significantly shorten the operation time and hospital stay and reduce intraoperative bleeding and blood transfusion event. The laparoscopic CRS is safe and feasible in strictly selected patients. The pathologic subtype is an independent factor affecting the prognosis for PFS.
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Affiliation(s)
- Chong Wang
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Xiang-Yang Yin
- Peking University Aerospace School of Clinical Medicine, Aerospace Center Hospital, Beijing, 100049, China
| | - Lu-Biao An
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Xi-Chao Zhai
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Ying Cai
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Guan-Jun Shi
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Xi-Wen Fan
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Pu Zhang
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China
| | - Kai-Min Wang
- Department of Hepatobiliary Pancreatic Gastrointestinal, Changchun Tumor Hospital, Jilin, 130000, China.
| | - Rui-Qing Ma
- Department of Myxoma, Aerospace Center Hospital, Beijing, 100049, China.
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Muacevic A, Adler JR, Wagner SD, McAfee DR, Martin DE, Sukpraprut-Braaten S. Large Mucocele of the Appendix Discovered in a 48-Year-Old Male Presenting With Appendicitis: A Case Report. Cureus 2022; 14:e33011. [PMID: 36712713 PMCID: PMC9879591 DOI: 10.7759/cureus.33011] [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] [Accepted: 12/26/2022] [Indexed: 12/28/2022] Open
Abstract
The appendix is a vermiform-like organ that extends from the cecum and has been thought of as having a rudimentary immunologic function. However, the appendix can become distended and mucus-filled, classifying it as a mucocele appendix. Mucoceles can be found in various locations in the body, including the colon and the appendix, and have malignancy potential. We report a case of a 48-year-old male that presented to the ED with a history of two days of abdominal pain. Upon arriving at the ED, he had a CT scan showing a 9.5 x 4.2 x 6.4 cm fluid collection in the right lower quadrant (RLQ) juxtaposed to the cecum, suggesting appendicitis or an abscess. Initially, a laparoscopic approach was taken, which was then converted to an open laparotomy. The mass was excised and a right hemicolectomy was performed along with an ileocolonic anastomosis due to extensive involvement of the large intestine. Pathology reported a low-grade appendiceal mucinous neoplasm resected with negative margins and 16 negative lymph nodes.
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Charalambous C, Charalambous T, Nikitaras A, Christodoulou P. Superinfection of an Obstructive Appendiceal Mucocele: A Case Report. Cureus 2022; 14:e23974. [PMID: 35547418 PMCID: PMC9090127 DOI: 10.7759/cureus.23974] [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] [Accepted: 04/07/2022] [Indexed: 11/29/2022] Open
Abstract
Appendiceal mucocele is an uncommon entity that may arise due to benign or malignant processes. The radiologic exploration of this entity is necessary for diagnosis, and its imaging manifestations vary, with some findings being more common than others. More specifically, the radiological findings of a superinfected mucocele are rare, with few reports in the literature. Herein we present the case of a 68-year-old male patient with a superinfected appendiceal obstructive mucocele caused by a fecalith, which was diagnosed by abdominal CT evaluation.
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Hassan Y, Anees A, Peer J, Yadav M. Three cases of appendiceal mucocele: From diagnosis to management. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2022; 10:276-280. [PMID: 36247061 PMCID: PMC9555033 DOI: 10.4103/sjmms.sjmms_646_21] [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: 11/07/2021] [Revised: 05/25/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022] Open
Abstract
Appendiceal mucocele is an appendicular dilatation secondary to the intraluminal accumulation of mucous material. Adequate pre-operative diagnosis and surgical resection remains the standard management. Here, we present three cases of appendiceal mucocele. In the first case, a 60-year-old female presented with signs and symptoms of acute appendicitis and was admitted and operated. An inflamed distended globular cystic mass of appendix measuring 10 × 6 × 4 cm with a wide base was found and the patient underwent right hemicolectomy. In the second case, a 30-year-old male with symptoms and signs of acute appendicitis was admitted to the emergency department. An open surgery was performed and a distended, tense, and inflamed appendix without perforation of size 6 × 1 × 1 cm was discovered and removed. The diagnosis of mucocele appendix was suspected and confirmed by postoperative dissection of the specimen and histopathology. In the third case, a 25-year-old female patient was subjected to diagnostic laparoscopy in view of non-specific pain abdomen. A diagnosis of mucocele of appendix was made intraoperatively and removed using a specimen bag. Appendiceal mucocele with acute presentation is a rare pathology that clinically resembles acute appendicitis. Preoperative detailed investigations to reach a definitive diagnosis are critical for adequate surgical resection and overall outcome.
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