A rare case of infection and spontaneous rupture in ovarian mucinous cystadenoma

Ovarian cysts exhibit variable clinical presentations depending on their size, type and resulting sequelae. Rupture of ovarian cysts is infrequent, and cyst infections are even rarer. Here, we report an unusual case involving a young, non-pregnant woman who presented acutely with features of peritonitis and sepsis and was found to have a complex adnexal mass. Following a rigorous diagnostic evaluation, which included an urgent exploratory laparotomy and salpingo-oophorectomy, common diagnoses including tubo-ovarian abscess, endometriotic cyst and pelvic tuberculosis were ruled out. Instead, she was diagnosed with an ovarian mucinous cystadenoma that had become infected, possibly due to pelvic inflammatory disease, leading to spontaneous rupture. Such a presentation has rarely been reported, especially in a non-pregnant setting. Therefore, we emphasise the importance of considering this rare complication as a potential differential diagnosis in similar clinical presentations and discuss the management implications, including the importance of adequately treating pelvic inflammatory disease.

Müllerian Mucinous Cystadenomas of the Ovary: A Report of 25 Cases of an Unheralded Benign Ovarian Neoplasm Often Associated With Endometriosis and a Brief Consideration of Neoplasms Arising From the Latter

A subset of ovarian mucinous tumors demonstrates müllerian-type epithelium, with such lesions variably designated "endocervical-like" and seromucinous since their popularization based on a report of borderline examples in 1989. While müllerian mucinous borderline tumors and carcinomas have been highlighted in the literature, there has been minimal attention given to benign müllerian mucinous tumors, particularly müllerian mucinous cystadenomas. Given the paucity of literature describing the features of müllerian mucinous cystadenomas/cystadenofibromas, diagnostic difficulties may arise when papillary features are present and in cases that show a subtle transition from endometriosis. We thus reviewed 25 cases of müllerian mucinous cystadenoma/cystadenofibroma to highlight the notable characteristics of this entity, including gross, cytologic, and architectural features that aid in the distinction from müllerian mucinous borderline tumors as well as, rarely, metastatic tumors. The patients ranged in age from 26 to 85 yr old. Bilateral ovarian involvement was frequent (40%). The ovaries ranged from 2.3 to 26 cm in greatest dimension. Most were multicystic (18 cases) and contained tenacious mucoid material (14 cases). All cases demonstrated predominantly columnar mucinous epithelium with abundant pale-pink cytoplasm. A minor component of ciliated and endometrioid epithelium was seen in 15 and 2 cases, respectively. Broad papillary formations were frequently encountered (9 cases) as was epithelial papillary tufting comprising <10% of the tumor (6 cases). Endometriosis was present in 9 cases, with a transition from endometriosis to mucinous epithelium noted in 8 cases. This series highlights the morphologic features of a relatively uncommon, benign, endometriosis-associated ovarian tumor that may be confused with a müllerian mucinous borderline tumor or bland metastatic mucinous tumors. It also provides an argument for the terminology "müllerian mucinous cystadenoma" or "cystadenofibroma" rather than "seromucinous cystadenoma" due to the frequent association with endometriosis as well as the dominant mucinous epithelium.

Pulmonary mucinous cystadenoma complicated with infection: A rare case report

RATIONALE

Mucinous cystadenoma is a benign tumor that is commonly found in the pancreas, ovaries, or appendix, but is rarely encountered in the lungs. Worldwide, only a few reported cases of these tumors originate in the lungs. Herein, we analyzed the imaging features of a case of pulmonary mucinous cystadenoma (PMCA). To the best of our knowledge, this is the first reported case of PMCA complicated by significant infection.

PATIENT CONCERNS

A 57-year-old man was admitted to our hospital with blood in sputum for more than 2 months. Serum laboratory examination showed significantly elevated leukocyte and tumor marker, carcinoembryonic antigen. Enhanced thoracic computed tomography and whole-body positron emission tomography/computed tomography showed a cystic-solid ill-defined mass in the right upper lung.

DIAGNOSIS

The tumor was considered malignant, both clinically and radiologically.

INTERVENTIONS

The patient underwent right upper lobe tumor resection and mediastinal lymph node dissection.

OUTCOMES

Postoperative specimen pathology was diagnosed as PMCA with infection. The patient was not administered any further treatment. The patient was alive without any recurrence or metastasis of the tumor after 2 years of follow-up.

LESSONS

Preoperative diagnosis of PMCA with atypical imaging and clinical manifestations is extremely difficult. This is the first reported case of PMCA complicated by a significant infection that was misdiagnosed preoperatively as a malignancy.

Ovarian mucinous cystadenoma causing acute urinary retention

Acute urinary retention rarely occurs in women, and is only infrequently caused by a pelvic mass. We describe a case of acute urinary retention caused by a large ovarian mucinous cystadenoma. Point of care ultrasound characterized and localized the lesion, while computerized tomography demonstrated the anatomic distortions resulting in urinary retention. The patient's symptoms resolved immediately following a laparoscopic right salpingo-oophorectomy with complete tumor removal.

Pseudomixoma peritonei associated with appendiceal cistoadenoma rupture: case report

Appendiceal mucocele represents specimen finding in 0.2-0.3% out of appendectomies. The rupture or perforation in peritoneal cavity might cause pseudomixoma peritonei (PMP), with multiple mucinous deposits in the abdominal cavity. We report a case of PMP caused by a perforated appendiceal cistoadeonoma.

Pancreatic mucinous cystadenoma doubly complicated by acute pancreatitis and retroperitoneal rupture

Mucinous cystadenomas are the most frequent cystic benign tumors of the pancreas. They are characterized by a malignant potential. Acute pancreatitis is their most common complication. This manuscript reports a unique complication of mucinous cystadenomas of the pancreas: retroperitoneal rupture associated to acute pancreatitis. After resuscitation, the patient underwent surgery. A cystic mass of the pancreas tail with retroperitoneal rupture was found. Splenopancreatectomy was performed. Outcomes were straightforward. After 3 years of follow-up, no signs of recurrence are highlighted.

Improvement of hyperandrogenism, oligo-ovulation, and ovarian morphology in a patient with polycystic ovary syndrome: possible role of ovarian wedge resection

Polycystic ovary syndrome (PCOS) is an endocrinological abnormality which typically presents as hormones disorder and/or infertility. It has received more and more attention in recent years though its pathogenesis is still unclear. Ovarian mucinous adenoma is a rarely pathological type which generates from epithelial cell of ovary. Here we present a patient with PCOS and ovarian mucinous tumor (occasionally discovered by cesarean section) receiving a complete relief after benign ovarian tumor excision. In this case, tumor excision played as a partial resection of ovary which might result in the normalized concentration level of hormones and morphology of ovary. This report suggests that therapeutic strategies for PCOS should be considered more carefully and individually.

Appendiceal mucinous neoplasms: an uncertain nosological entity. Report of a case

INTRODUCTION

Appendiceal mucocele is a relatively rare condition characterized by progressive dilation of the appendix caused by intraluminal accumulation of mucoid substance. Its incidence is 0.07 - 0,63% of all appendectomies performed.

CASE REPORT

We report the case of a 70-year-old man who came to our observation with gravative pain in right lower abdominal region. A computed tomography abdominal scan revealed a cystic/tubular structure like an appendicular mass with wall enhancement but without calcifications suggestive of a mucocele. Into peritoneal cavity we found profuse mucinous material with a 1,5 cm size parietal nodule. We also identified a free perforation of the cecum with consensual spillage of gelatinous material mimicking a pseudomyxoma peritonei. We decided to perform a right hemicolectomy with excision of peritoneal lesion.

DISCUSSION

The controversy in the pathologic terminology can give rise to a clinical dilemma in terms of the management and follow-up plans. For mucosal hyperplasia and cystadenoma simple appendectomy is curative. Only in case of large base of implantation it may be necessary the resection of the ileum and caecum or right hemicolectomy. In case of mucinous cystoadenocarcinoma authors perform a right hemicolectomy.

CONCLUSION

Appendiceal mucinous neoplasms are different pathological entities. The correct surgical management depends on size and location of lesion. A preoperative diagnosis is obviously needed in order to perform the correct treatment. CT abdominal scan is the better diagnostic tool, but different authors show their inability to reach a preoperative diagnosis in the larger majority of cases.

Mechanical intestinal obstruction secondary to appendiceal mucinous cystadenoma: A case report and brief review

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.

Pre-operative Identification and Surgical Management of the Appendiceal Mucocele: A Case Report

An appendiceal mucocele (AM) is an uncommon differential in the patient being evaluated for acute appendicitis. Although often asymptomatic, AMs can clinically mimic acute appendicitis, and preoperative distinction between these processes facilitates optimal management. We report the case of a 60-year-old male with an AM presenting with nausea and periumbilical pain radiating to the right lower quadrant. Literature relevant to the diagnosis and treatment of AMs is reviewed, with emphasis on diagnosis through radiographic imaging and surgical management. Abdominal CT scan or ultrasound are useful in identifying AMs preoperatively. A decision to perform a right hemicolectomy should be influenced by the criteria reported by Gonzalez-Moreno. The safety of the laparoscopic resection relative to an open appendectomy is debated.

Primary retroperitoneal mucinous cystadenoma: A case report

Primary retroperitoneal mucinous cystic tumors are extremely rare. These tumors can be classified as a primary retroperitoneal mucinous cystadenoma with or without borderline malignancy or primary retroperitoneal mucinous cystadenocarcinoma. The most common of these is primary retroperitoneal mucinous cystadenoma, which almost always occurs in female patients; only ten cases have been reported in males. The most common clinical findings for this tumor type include nonspecific abdominal pain and a palpable abdominal mass. A definitive diagnosis is usually obtained from histopathology after surgical excision. Here, we report the case of a 60-year-old female patient who complained of abdominal pain that had been present for 3 mo and presented with a palpable abdominal mass. Multidetector computed tomography scanning revealed a large, unilocular cystic mass in the left retroperitoneal space. Surgical intervention was performed and the tumor was completely removed. Histopathologic examination confirmed that the tumor was a primary retroperitoneal mucinous cystadenoma. Two years after surgery, the patient remains disease free.

[A large abdomen can camouflage the symptoms of an ovarian tumour]

Mucinous cystadenomas of the ovaries are benign tumours which can grow to sometimes gigantic proportions. Symptoms may be vague and due to complications hence the tumour can go undiagnosed for several years. This is a case report of a 48-year-old woman with a 40-kg ovarian tumour developed through 19 years. In spite of discomfort and complaints of the very large abdomen she had not received thorough examination previously. A large abdomen and discomfort should always lead to transabdominal ultrasound when transvaginal ultrasound - as in this case - does not diagnose the condition.

Laparoscopic approach to mucocele of appendiceal mucinous cystadenoma: feasibility and short-term outcomes in 24 consecutive cases

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.

Adult intussusception of appendicular mucinous cystoadenoma

Intussusception is a rare cause of adult intestinal obstruction. Clinical manifestations are not specific, which makes a preoperative diagnosis difficult to establish and often causes delay. We report a case of acute intestinal obstruction due to ileocolic intussusception. An emergency laparoscopy was performed revealing an obstructive mass at the ileocecal region resulting from an appendicular tumor. A right hemicolectomy was conducted. The pathologic examination of the resected sample concluded the mass comprised an appendicular mucinous cystoadenoma. We discuss the clinical features, preoperative diagnosis, and surgical strategies of adult intussusception, as well as the uncommon finding of an appendicular mucinous tumor as its causative lesion, with a review of the available literature.

Intestinal obstruction secondary to appendiceal mucocele

Few cases of intestinal obstruction complicating an appendiceal mucocele have been recorded. We report the case of a young woman who presented to the emergency room with diffusely abdominal pain, nausea, vomiting and disruption of bowel movements. Her abdomen was mildly distended and tympanic. A flat film of the abdomen revealed dilated small bowel loops with air-fluid levels suggestive of small bowel obstruction. She also had leukocytosis. An emergency operation was performed under the diagnosis of intestinal obstruction. The intraoperatory findings showed a tumoral appendiceal mass permeated into the ileum in two distinct points, causing an enteral stenosis. We performed an appendectomy "en bloc" with two enteral loop resections of the permeated ileum followed by two T-T enteral anastomoses. The pathologic examination revealed appendiceal mucinous cystadenoma. Postoperative course was favorable, the patient being discharged on the seventh postoperative day. Postoperative checks performed at 3, 6, 12 and 24 months (including colonoscopy) have not showed pathological changes.

[Rectal pain and tenesmi caused by a large appendix mucocele]

A 60 year-old man presented with rectal pain and tenesmi. On digital rectal examination a pelvic mass was detected. Computed tomography and MR scans showed a 14 × 5.5 × 5 cm large cystic process located in the right side of the pelvis with no clear indication of its origin. Explorative laparotomy revealed a large appendix mucocele based on a cystadenoma. The mucocele was resected in healthy tissue and without perforation. Needle aspiration or drainage should be avoided in cystic intraabdominal processes of unknown origin, and careful operative handling is imperative, because spillage of mucin may result in later development of pseudomyxoma peritonei. Careful digital rectal examination may detect important pelvic pathology.

[Giant ovarian cyst and pregnancy. Case report and literature review]

Ovarian tumors represent approximately 30% of genital tumors, being the most frequent the germ and the epithelial tumors. During pregnancy the incidence of ovarian cysts is less than 5%, and they are almost always benign. Giant cysts have a frequency of less than 1%. A giant cyst in a primigravida 20 years, 15 weeks pregnant and the evolution of the same case is reported.

Primary appendicealtumors: clinical imaging and pathological findings. Report of four cases

Primary appendiceal tumors are rare clinical and radiological entities. We report 4cases including muscinous cystadenoma associated with pseudomyxoma peritonei, muscinous cystadenoma associated with mucocele, low-grade muscinous neoplasia associated with appendicitis in elderly patients, and carcinoid tumor associated with appendicitis in a young adult.

A rare case of the coexistence of ovarian clear cell carcinoma, mucinous cystadenoma, and endometriosis in the same ovary

Clear cell carcinomas and endometrioid carcinomas are associated with endometriosis. The association of clear cell carcinomas with mucinous lesions has only been reported infrequently, and with mucinous cystadenoma has been rarely reported. This is the second reported case of the coexistence of ovarian clear cell carcinoma, mucinous cystadenoma, and endometriosis in the same ovary. A 57-year-old woman presented with lower abdominal pain for three weeks. Ultrasonography revealed a 16 x 14 x 10 cm mass in the left ovary with solid and cystic components. Hysterectomy and bilateral salpingo-oophorectomy were performed. Histopathological examination of the left ovary revealed the presence of clear cell carcinoma, mucinous cystadenoma, and endometriosis. Continuity between the areas of mucinous epithelium and clear cell carcinoma were noted; this may suggest that clear cell carcinoma may arise from endometriosis or mucinous cystic tumors.

[Giant appendiceal mucocele during laparotomy for acute abdomen. Report of a case and brief review]

The authors describe a case of giant appendiceal mucocele, secondary to a mucinous neoplasm of the appendix, diagnosed during laparotomy for acute abdomen. By a review of the literature they stress the rarity of this lesion, the particular onset in their case as acute complication of appendiceal neoplasm with rupture of the intestinal wall, the difficulties of diagnosis and management in emergency.

Acute pancreatitis with a mucinous cystoadenoma of the pancreas in pregnancy

Pregnancy complicated by pancreatitis is a rare and difficultly managed clinical situation. Gallstones are the most frequent cause of pancreatitis in pregnancy. Non-gallstone pancreatitis in pregnancy has been shown to be significantly more prone to premature delivery and pseudocyst formation. Cystic lesions as a cause of pancreatitis in pregnancy have not, to our knowledge, been observed. Pancreatic cystic lesions in general are rare, but are difficult to treat given problems in clarifying their malignancy. Mucinous cystic neoplasms are considered premalignant lesions and resection is recommended. Receptors for estrogen and progesterone receptors in these cysts may cause cystic growth during pregnancy. Treatment recommendations for pancreatitis in pregnancy are not well defined; this applies as well to treatment protocols for cystic lesions. In this case report we describe a new potential cause of acute pancreatitis in pregnancy due to compression of the principal pancreatic duct by a mucinous cystoadenoma.

Mucinous cystadenoma of the ovary presenting as unilateral lower extremity edema

INTRODUCTION

Mucinous cystadenomas of the ovary are known for their potential to grow to massive proportions and are often incidentally diagnosed. They are typically benign tumors accounting for 15% of ovarian neoplasms and up to 80% of all mucinous tumors.

CASE REPORT

We report a 50-year-old, morbidly obese female admitted with left lower extremity edema who was incidentally found to have a massive, benign, mucinous cystadenoma of the ovary. The tumor was managed by laparotomy, cystectomy, and right salpingo-oophorectomy. Pathology revealed a benign cyst.

CONCLUSION

The clinically silent course of these large, benign tumors can have unique presentations.

Diagnosis and therapeutic management of cystic dystrophy of the duodenal wall in heterotopic pancreas. A case report and revision of the literature

CONTEXT

Cystic dystrophy in heterotopic pancreas is a rare and serious condition. Diagnosis is difficult because of non-specific clinical manifestations and radiologic and endoscopic imaging are pivotal. Therapeutic management is still under debate.

CASE REPORT

We describe a case of cystic dystrophy of the duodenal wall in heterotopic pancreas complicated with chronic pancreatitis and pancreatic cystadenoma.

DISCUSSION

Computed tomography and magnetic resonance are very useful in demonstrating the presence of cysts in a thickened duodenal wall but, for the most part, endoscopic ultrasonography is the most useful imaging examination. The choice of different therapeutic options is still under debate; although some authors have proposed a medical approach using octreotide or endoscopic treatment for selected patients, a pancreaticoduodenectomy is usually proposed for symptomatic patients.

CONCLUSION

When surgery is needed, a pancreaticoduodenectomy is preferred, reserving by-pass procedures for high risk patients. Because of the non-specific clinical manifestation and the very difficult diagnosis and therapeutic management, these patients should be studied and treated in specialized and dedicated centers.

Pancreaticoduodenectomy as the primary therapeutic choice in cystic dystrophy of the duodenal wall in heterotopic pancreas

On the basis of a review of the literature and description of a clinical case, the aim of this paper was to evaluate the role of pancreaticoduodenectomy as the primary therapeutic choice in a rare, serious condition such as cystic dystrophy of the duodenal wall in heterotopic pancreas. The diagnosis is difficult because of the non-specific clinical manifestations, and radiological and endoscopic imaging are decisive. Computed tomography and magnetic resonance are very useful for demonstrating the presence of cysts in a thickened duodenal wall but endoscopic ultrasonography is the most useful imaging examination. The choice of therapeutic option is still debated. Although some Authors have proposed a medical approach using octreotide or endoscopic treatment for selected patients, pancreaticoduodenectomy is usually proposed for symptomatic patients. When surgery is needed, pancreaticoduodenectomy should be preferred, reserving by-pass procedures for high-risk patients. Because of the non-specific clinical manifestations and the very difficult diagnostic and therapeutic management, these patients need to be studied and treated in specialised, dedicated centres.

Mucinous cystadenoma of the appendix: a rare cause of acute abdomen

BACKGROUND

We aimed to assess the acute abdominal conditions due to appendiceal mucinous cystadenomas.

METHODS

We retrospectively evaluated 11 patients with histopathologically confirmed appendiceal mucinous cystadenoma. Patient charts and data on patient demographics; clinical features; ultrasonography (US), colonoscopy and computed tomography (CT) findings; pathology reports; and operative and postoperative management were reviewed.

RESULTS

The incidence of appendiceal mucinous cystadenoma was 0.95% of all appendectomy specimens reviewed. In our review, there were 11 patients, five of whom were women. The median age was 70 years (50-85 years), and the most common presentation was abdominal pain (81.8%). On US in eight patients, findings were abdominal cystic mass and cyst wall calcification. The CT finding was well-encapsulated cystic mass in eight patients. In one case, a colonic mass was found in colonoscopic examinations. There was one patient with concomitant colon cancer. Appendectomy was performed in nine patients and right hemicolectomy was performed in two patients.

CONCLUSION

Colonoscopy, US, and CT are useful tools in diagnosing mucocele and synchronous cancer. However, diagnosis is usually made intraoperatively or postoperatively on histopathological examination. Appendectomy is the standard of care for mucinous cystadenoma. Furthermore, it is important to prevent spillage of the mucocele content.

Diverticular disease of the vermiform appendix: a diagnostic clue to underlying appendiceal neoplasm

Acquired diverticula of the vermiform appendix are rare and arise as a result of different pathogenetic mechanisms. One of the etiologies includes proximally located, often unsuspected small neoplasms. Although the association of appendiceal diverticulosis and neoplasia is known, it remains underemphasized in the teaching and practice of surgical pathology. To investigate the frequency of appendiceal neoplasms with acquired diverticulosis, we conducted a retrospective analysis of all appendectomy specimens received in our institution for a 55-month period (January 2002-July 2006). A total of 1361 appendectomy specimens were identified. Diverticulosis was diagnosed in 23 (1.7%) of all cases. Eleven (48%) appendectomy specimens with diverticulosis also harbored an appendiceal neoplasm. The association of appendiceal neoplasms with diverticulosis was statistically significant (P < .0001, 2-sided Fisher exact test). Neoplastic processes included 5 well-differentiated neuroendocrine tumors (carcinoids), 3 mucinous adenomas, 1 tubular adenoma, and 2 adenocarcinomas. In one case, routine representative sections sampled only a small focus of carcinoma, which originally went undiagnosed. We stress the need for meticulous gross assessment with histologic examination of the entire appendectomy specimen in cases of appendiceal diverticulosis. Thorough examination is required to rule out an underlying neoplasm as a cause of diverticulosis. As acquired diverticula represent a rare finding, examination of the entire appendix in this setting does not create a significant impact on the workload within the pathologic laboratory.

Mucinous cystadenoma of the appendix associated with muscular and neuromatous hyperplasia: report of a case

Mucinous cystadenoma of the appendix is a type of appendiceal mucocele and a rather rare condition usually found incidentally in the course of other abdominal surgery. A previous evaluation of 73 appendiceal mucoceles showed that this disease was often associated with adenocarcinoma and other epithelial atypia. This observation suggested that patients with mucinous cystadenoma of the appendix also have some underlying disorders. However, non-epithelial changes associated with appendiceal mucocele have not been reported so far. In this study, we presented for the first time a mucinous cystadenoma of the appendix associated with muscular and neuromatous hyperplasia.

Giant mucinous cystadenoma in a young patient. A case report

The Authors describe the clinical case of a seventeen-year-old girl who presented with abdominalgia, fever, nausea and vomiting. During surgery it proved necessary to remove not only the appendix but also a voluminous mucinous cystadenoma of the ovary. The authors take this observation as a starting point for a description of the pathophysiological and clinical findings of these neoplasms.

[Comparative study of appendical mucocela and pseudomyxoma peritonei. About 25 cases]

AIM

to study the clinicopathological features of the different types of appendical mucocele and to compare them with those of pseudomyxoma peritonei.

METHODS

25 cases of appendical mucocele were operated in the Cap-Bon region in Tunisia during a period of 13 years from 1994 to 2006.

RESULTS

9 retentionnal cysts, 13 mucinous cystadenomas, one serrated adenoma, one hyperplasia of the mucosa and one cystadenocarcinoma were diagnosed. Five cystadenomas as well as the only case of cystadenocarcinoma were associated with pseudomyxoma peritonei. Pseudomyxoma peritonei occurred 20 years later than in simple appendiceal mucocèle and complicated 5 cases of cystadenoma with low grade dysplasia and 1 case of cystadenocarcinoma.

CONCLUSION

Preoperative diagnosis of appendical mucocele and pseudomyxoma peritonei should be made on scannographic features in order to assess the adequate surgical management.

Virilization in pregnancy due to a borderline mucinous ovarian tumor

Virilization in pregnancy due to borderline mucinous ovarian tumors is very rare. A case of a 28-year-old patient who was noted at 28 weeks' gestation to have marked virilization with raised serum androgens, ascites and a large complex right adnexal mass is presented. Delivery was carried out by cesarean section and at surgery a large tumor was noted in the right ovary. Histology revealed a borderline mucinous ovarian tumor with stromal luteinization, but there was no evidence of stromal invasion. Serum androgens returned to normal levels following surgery and the maternal virilization had resolved at the 6-week postnatal visit. Stromal changes in borderline mucinous ovarian tumors may result in virilization due to androgen production; surgical removal is associated with an excellent clinical outcome.

[Mucinous cystadenoma of pancreatic head with focal malignant alteration in a 52-year-old man]

Mucinous cystadenomas of the pancreas are rare tumors appearing usually within the body and the tail of the pancreas in a young and middle-aged women. They rarely communicate with the pancreatic duct and occasionally may become malignant. The authors present a patient with a number of rare features. In a 52-year-old male, we did a radical pylorus-preserving cephalic duodenopancreatectomy for a mucinous cystadenoma within the head of the pancreas, which perforated into the main pancreatic duct causing chronic obstructive pancreatitis having few foci of malignant alteration. The postoperative recovery was uneventful, but three months later the patient died due to exacerbation of the underlying serious heart disease.

Clear cell carcinoma of ovary with associated mucinous cystadenoma and endometriosis

A 45 year old woman presented with right sided ovarian mass with multiple omental deposits and liver metastases. The right ovary was enlarged and showed a partly cystic partly solid cut surface. Histological picture showed clear cell carcinoma with areas of mucinous cystadenoma and endometriosis. Clear cell carcinoma is known to be associated with endometriosis. To the best of author's knowledge, it's association with mucinous cystadenoma has been described only once in the literature, where clear cell carcinoma was shown to be associated with mucinous cystadenoma without any evidence of endometriosis.

Gastric variceal bleed in a patient without liver cirrhosis: an unusual cause of haematemesis

Tumours of the pancreas presenting as haematemesis are rare entities, with scarce documentation in literature. We report a 50-year-old woman who presented with haematemesis secondary to gastric fundal variceal bleeding due to splenic vein occlusion by a large mucinous cystadenoma of the pancreas. We also review the literature pertaining to unusual pathologies presenting as haematemesis.

Appendiceal mucocoeles and pseudomyxoma peritonei

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.

Mucinous cystadenoma of the appendix associated with adenocarcinoma of the sigmoid colon and hepatocellular carcinoma of the liver: report of a case

Mucinous cystadenoma of the appendix is a rare condition and represents one of the three entities with the common name mucocele of the appendix. It is characterized by a cystic dilatation of the lumen with stasis of mucus inside it. Histopathologically mucocele is divided into three groups: focal or diffuse mucosal hyperplasia, mucinous cystadenoma and mucinous cystadenocarcinoma. This condition is often associated with other neoplasia, especially adenocarcinoma of the colon and ovaries. We here describe a 57 year old male patient who presented with abdominal discomfort, constipation, fresh blood in stool and frequent urination. He had a big cystadenoma of the appendix associated with adenocarcinoma of the colon and hepatocellular carcinoma of the liver. The patient underwent right haemicolectomy, sigmoid colon resection and segmental resection of the liver. Now 3 years later he has no evidence of disease relapse. According to this, we stress the need of accurate preoperative diagnosis and intraoperative exploration of the whole abdomen in these patients.

Mucinous cystadenoma of the appendix associated with adenocarcinoma of the sigmoid colon and hepatocellular carcinoma of the liver: Report of a case

Mucinous cystadenoma of the appendix is a rare condition and represents one of the three entities with the common name mucocele of the appendix. It is characterized by a cystic dilatation of the lumen with stasis of mucus inside it. Histopathologically mucocele is divided into three groups: focal or diffuse mucosal hyperplasia, mucinous cystadenoma and mucinous cystadenocarcinoma. This condition is often associated with other neoplasia, especially adenocarcinoma of the colon and ovaries. We here describe a 57 year old male patient who presented with abdominal discomfort, constipation, fresh blood in stool and frequent urination. He had a big cystadenoma of the appendix associated with adenocarcinoma of the colon and hepatocellular carcinoma of the liver. The patient underwent right haemicolectomy, sigmoid colon resection and segmental resection of the liver. Now 3 years later he has no evidence of disease relapse. According to this, we stress the need of accurate preoperative diagnosis and intraoperative exploration of the whole abdomen in these patients.

[Appendiceal mucocele due to mucinous cystadenoma: case report and review of the literature]

Mucinous cystadenomas of the appendix are rare tumours. In this article we describe the case of a young woman who presented with abdominal pain and a clinical pattern likely to a chronic appendicitis. At laparotomy we found a dilatation of the appendix which contained an abundant quantity of mucus. Histological examination showed a mucinous cystadenoma of the appendix. This neoplasm requires a surgical treatment, usually only appendectomy and right hemicolectomy in case of involvement of the caecum. During operation, the surgeon must take care in handling the appendix because of the risk of rupture with consequent dissemination of epithelial cells in the peritoneal cavity (pseudomyxoma peritonei).

Tumeur intracanalaire papillaire mucineuse du pancréas dégénérée et fistulisée dans l'estomac, le duodénum, et le côlon

We report a case of intraductal papillary mucinous tumor of the pancreas (IPMT) degenerated and fistulized into the stomach, the duodenum and the colon. Diagnoses of malignancy and fistulization were proven preoperatively. Pancreaticoduodenectomy extended to the body was performed. Pathological examination revealed a malignant IPMT with an invasive component. Of the 3 fistulizations tracts, both gastric and duodenal ones were malignant. To our knowledge, this is the first reported case of IPMT with colonic fistulization. Twelve months later, the patient is alive without signs of recurrence.

A case of torsion of a mucinous cystadenoma in triple-X syndrome with pure gonadal dysgenesis

Triple-X female characterized by primary amenorrhea and pure gonadal dysgenesis is extremely rare. We present a patient of triple-X syndrome who has not had menarche or the development of the secondary sexual characteristics. She had a hypoplastic uterus and streaked gonads on both sides with a twisted mucinous cystadenoma in the right adnexa.