Torsion of an appendiceal mucinous cystadenoma. Report of a case and review of literature

Vermiform appendix torsion is rare, and even more uncommon is the volvulus of appendiceal mucinous tumors. To our knowledge, only nine cases of torsion of the vermiform appendix associated with appendiceal mucinous neoplasms have been reported up to date. We report a case of secondary torsion of the vermiform appendix with mucinous cystadenoma in a 30-year-old man. The symptoms were consistent with acute appendicitis. Diagnostic laparoscopy revealed a mucinous tumor of the appendix with a 360 degrees twisted appendix. In order to avoid peritoneal dissemination open appendectomy was performed. The final pathologic diagnosis was a mucinous cystadenoma of the appendix. The postoperative recovery was uneventful. Secondary torsion of vermiform appendix with mucinous cystadenoma is a rare entity. Correct preoperative diagnosis is unlikely. Open appendectomy is the standard of care for benign mucinous appendiceal tumors. Furthermore, it is important to prevent spillage of the appendiceal mucocele content.

Primary retroperitoneal mucinous cystadenoma adjacent to the kidney: report of two cases and review

We report two cases of primary retroperitoneal mucinous cystadenomas mistaken as renal cysts and discuss the differential diagnosis and management of this tumor.

Pseudomyxoma peritonei presenting with inguinal hernia

Pseudomyxoma peritonei (PMP) is rare being characterized by intraperitoneal accumulation of mucinous ascites produced by neoplastic cells, mostly originating from a perforated appendiceal adenoma. The clinical signs of the disease are variable, and preoperative diagnosis is often difficult. We describe the clinical case of a 67-year-old patient referred to our unit one month after a left inguinal hernia repair, presenting clinical signs compliant with PMP. Surgical cytoreduction, peritonectomy, appendectomy, and greater omentectomy with perioperative intraperitoneal chemotherapy were performed. The patient was disease free for a 15 month period when he died apparently due to a cardiac event. We advocate that in all cases of gelatinous fluid in a hernia sac PMP must be suspected, thus histological investigation is mandatory as well as abdominal computed tomography (CT) in order to confirm the diagnosis.

Pancreatic true cysts--diagnosis and treatment difficulties

Pancreatic true cysts represent a rare, heterogeneous group of pancreatic tumors; therapeutic strategy is based on patient's general status, cyst topography, and especially the estimated risk of malignancy. This paper aim is to present 7 cases of pancreatic true cysts, operated on a six years period (January 2004-January 2010) in our surgical clinic: 2 men and 5 women, aged between 24-61 years old; cyst diameter varies between 3.5-15 cm, tumor location being pancreatic head in two cases and the distal pancreas in 5 cases. Surgical treatment consisted in cyst enucleation (two cases), splenopancreatectomy (three cases), duodenopancreatectomy (one case), and subtotal splenopancreatectomy (one case). Histology was represented by serous cystadenoma (one case), mucinous cystadenoma (2 cases), intraductal papillary mucinous cystadenoma (one case), and papillary cystadenocarcinoma (3 cases).Postoperative results were good in all cases, with 3 postoperative pancreatic external fistulas, resolved conservatory; no case of post-pancreatectomy diabetes mellitus was registered. In conclusion, surgical removal of the pancreatic cystic tumors is necessary, especially due to the risk of malignancy, at least in the absence of rigorous histological proofs of benignancy. Postoperative results are favorable in terms of postoperative morbidity and mortality.

[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.

Mucinous cystadenoma of the appendix. A diagnostic dilemma?

Mucocele of the appendix due to mucinous cystadenoma is a rare clinical finding. Approximately half of the patients are asymptomatic. It's defined as the dilatation of the appendiceal lumen due to abnormal accumulation of mucus in to it. The pseudomyxoma peritonei, as a result of rupture of the appendix, is the most dangerous complication. We present two case reports of patients that were presented in our Department with different clinical findings. The first patient was presented with symptoms of acute appendicitis, while the second patient showed with atypical symptoms such as abdominal pain, a palpable mass in the right iliac fossa and a diagnosed mucocele of the appendix with the use of computerized tomography. In both patients was performed an appendicectomy and the final histopathology diagnosis confirmed the presence of the mucinous cystadenoma of the appendix which caused the creation of the mucocele. In conclusion mucocele is a rare tumor which must be considered in the differential diagnosis of a mass in the right lower quadrant of the abdomen.

[Giant ovarian tumor--case report and proposal for clinical management]

A case report of a woman with 90 kg ovarian tumor is presented. Paracentesis and intravenous alimentation was performed before operation. During the surgery the ovarian tumor was excised and abdominal cavity packing, followed by slow pressure decreasing, was done. Intravenous together with oral alimentation was continued after the operation. The patient was discharged on the 10th postoperative day without any complications, in a good overall condition.

[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.

[The diagnosis and therapy of pancreatic cystic tumors]

OBJECTIVE

To discuss the surgical option and the treatment of complications of pancreatic cystic tumors.

METHODS

From January 1997 to December 2009, 32 patients with pancreatic cystic tumors in our center were reviewed retrospectively. There were 6 male and 26 female, aging from 24 to 76 years. Of the 32 patients, 16 patients had serous cystadenoma, 9 patients had mucinous cystadenoma; 1 patients had mucinous cystadenocarcinoma; 4 patients had intraductal papillary mucinous neoplasms and 3 patients had pancreatic solid pseudopapillary neoplasms. Tumor located in pancreatic head in 12 patients and in pancreatic body and tail in 20 patients.

RESULTS

All patients received surgical treatment and there was no perioperative death. Pancreato-duodenectomy was performed in 10 patients, duodenum-preserving pancreatic head resection in 1 patient, distal pancreactomy in 13 patients, including laparoscopic distal pancreactomy in 2 patients, pancreatic tumor resection in 3 patients, middle segmental resection in 4 patients; 1 patients with mucinous cystadenocarcinoma received palliative surgery. Complication included gastroparesis in 3 patients and pancreatic fistula in 5 patients, and all recovered by conservative treatment. These 29 patients were followed up 4 - 120 months, 3 patients died from tumor metastasis or other disease within 4 to 34 months after surgery. Others were alive and there was no tumor recurrence or metastasis.

CONCLUSIONS

CT scan should be the first choice of non-invasive examination for cystic pancreatic diagnosis. Positive and timely operation should be performed in the patient with cystic pancreatic tumor, and it acts as a cancer preventive treatment. The selection of surgical approach should be individualized, the principal of damage control surgery should be followed. Complications such as gastroparesis and pancreatic fistula should be paid more attention.

Mucinous cystic neoplasms of the pancreas: how much preoperative evaluation is needed?

Cystic lesions of the pancreas are identified with increasing frequency by modern imaging. The mucinous cystic neoplasm (MCN) is treated with resection for its malignant potential. How much preoperative evaluation is needed before undertaking operation is frequently a diagnostic dilemma. A retrospective review of 32 patients who underwent resection of a MCN between 1994 and 2007 was performed to define the preoperative evaluation and operative treatment of MCN patients. Thirty-two patients (30 women; mean age 49) had histology-proven MCN. Twenty-seven patients had symptomatic cysts (84%). Five had a history of gallstones and/or acute pancreatitis. All patients were worked up with CT and/or MRI. Endoscopic ultrasound was performed in 14 (44%) and endoscopic retrograde cholangiopancreatography in six (18%). Cytology was obtained in 13 (40%). Pathology revealed 22 benign MCNs (68%), five malignant MCNs (16%), and five MCNs with borderline pathology. Preoperative workup including CT or MRI imaging and cytology suggested MCN as the lesion in 15 patients (46%). CT features by itself predicted MCN in three patients (9%). Cytology revealed another six patients (19%) with possible MCN. In this series, preoperative workup did not identify three of five patients with MCN malignancy. A preoperative diagnosis cannot be made in most patients with MCN. Operative treatment can be based on clinical presentation and CT imaging because endoscopic ultrasound and fine needle aspiration for evaluation may be misleading. Middle-aged women with cystic lesions in the tail of the pancreas without prior gallstone or pancreatitis history most typically fit the profile of the MCN patient.

Mucinous cystadenoma of the appendix. Case report

BACKGROUND

Pathology of the appendix represents >50% of surgical activity. It is necessary to consider rare pathologies such as mucoceles. These have a high frequency in females with a F/M ratio of 4:1, as well as in patients >50 years of age. The objective of this study is to report on a case of mucinous cystadenoma of the appendix.

CLINICAL CASE

We present the case of a 34-year-old male with a history of juvenile rheumatoid arthritis diagnosed at 9 years of age. At 22 years of age, the patient underwent bilateral hip arthroplasty. Since 1998, the patient has presented with renal amyloidosis and has been under steroid treatment to date. The current problem evolved 1 year ago during control studies for his disease. Computed tomography (CT) of the abdomen was done, demonstrating a tumor in the right iliac fossa. Colonoscopy confirmed a tumor with smooth edges located in the cecum. Surgery was recommended with a diagnosis of lipoma of the cecum. During surgery, a large tumor was found, indicating a poor prognosis. Right hemicolectomy was done. Surgical specimen was sent to pathology with a report of mucinous cystadenoma.

CONCLUSIONS

The group of symptoms of cystadenoma is nonspecific. Diagnostic methods include X-rays, ultrasound, CT and colonoscopy. Mucinous cystadenoma is the most common form of mucocele of the appendix. Diagnostic protocols are the same for benign appendix pathology. Treatment is surgical and type of surgery depends on the size of the mucocele. Mucoceles of the appendix are pathologies with a favorable prognosis when appropriate treatment is done.

Hepatobiliary mucinous cystadenoma and cystadenocarcinoma: report of six cases and review of the literature

BACKGROUND/AIMS

The aim of this investigation was to describe the clinical features, diagnosis, pathologic characteristics, and optimal surgical management for patients with mucious hepatobiliary cystadenomas (HBCAs).

METHODOLOGY

From 2005 to 2008, our institutional experience for treating six patients with HBCAs was reviewed and reported. The clinical features, radiological characteristics and management were analyzed retrospectively.

RESULTS

Two of six patients were respectively misdiagnosed as hydatid cyst and simple cyst pre-operatively. The histopathologic examination showed HBCA in four patients and hepatobiliary cystadenocaiconoma (HBCAC) in two patients. Three HBCA patients and two HBCAC patients had undergone total excision treatment. In a median of 37.5 months follow-up visit, four have no evidence of recurrence and one HBCAC patient experienced a recurrence 31 months after surgery. Another HBCA patient who underwent fenestration initially with subsequent recurrence, died 15 months after the therapy.

CONCLUSIONS

Owing to its potential for malignant transformation into HBCAC, along with the consideration that it tends to recur after incomplete resection, radical excision treatment with adequate surgical margins is regarded as the most suitable mode of therapy for the HBCA.

A massive ovarian mucinous cystadenoma: a case report

OBJECTIVES

To report the occurrence of a rare case of a huge benign ovarian tumour (mucinous cystadenoma) in Jazan city, Saudi Arabia.

PATIENTS

Our reported case was a middle-aged Saudi woman presented with marked abdominal distension and discomfort at the gynaecology clinic of Jazan General Hospital, Jazan city, Saudi Arabia.

METHODS

The data were collected by history-taking, clinical examination, laboratory investigations, transabdominal ultrasonographic examination, and by histo-pathological study of the excised surgical specimen.

RESULTS

The case was reported as a rare massive ovarian mucinous cystadenoma.

CONCLUSIONS

This case report emphasizes the significance of thorough evaluation of all women presented with vague abdominal pains. Although the condition is extremely rare, it is a potentially dangerous in its massive form if not timely diagnosed and managed properly. With the increasing awareness of such conditions, more and more cases could be detected and reported early.

Torus hyperplasia of the pyloric antrum

Primary or idiopathic hypertrophy of the pyloric muscle in adult, so called torus hyperplasia, is an infrequent but an established entity. It is caused by a circular muscle hypertrophy affecting the lesser curvature near the pylorus. Since most of the lesions are difficult to differentiate from tumor, distal gastrectomy is usually preformed to rule out most causes of pyloric lesions including neoplastic ones through a pathological study. A 56-yr-old man with a family history of gastric cancer presented with abdominal discomfort of 1 month duration. Upper gastrointestinal endoscopy showed a 1.0 cm sized irregular submucosal lesion proximal to the pylorus to the distal antrum on the lesser curvature. On colonoscopy examination, a 1.5 cm sized protruding mass was noticed on the appendiceal orifice. Gastrectomy and cecectomy were done, and histological section revealed marked hypertrophy of the distal circular pyloric musculature and an appendiceal mucocele. To the best of our knowledge, this is the first case of torus hyperplasia with appendiceal mucocele which is found incidentally.

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.

Mucinous cystic neoplasm of the pancreas: a case report

Cystic neoplasms of the pancreas account for only a small percentage of pancreatic tumours. They include mucinous cystic tumours, which have a higher incidence in females in their forties or fifties. Cystic neoplasms of the pancreas can present in a benign, borderline or malignant form. These tumours have a natural evolution from a benign (mucinous cystadenoma) to a malignant form (cystadenocarcinoma). It is not always easy to diagnose cystic tumours, including mucinous cystic tumours of the pancreas, and the final diagnosis is often reached only after the surgical procedure, which is the gold standard treatment of this disease. We present the case of a 56-year-old woman affected by a mucinous cystic tumour of the body-tail of the pancreas, who underwent distal splenopancreasectomy. She was discharged on postoperative day 12. After an 18-month followup, she is in good general condition and disease-free.

Cystic tumors of the biliary tract: a complete excision is crucial

Intrahepatic cystic tumors are rare liver tumors whose diagnosis is based on a wide range of imaging modalities. Surgical management and prognosis are not clearly defined. The medical records of patients with a diagnosis of intrahepatic cystic tumor managed in our unit were reviewed. Two patients were successfully treated by surgery. One of these two patients had to undergo a second laparotomy to obtain complete removal of the tumor. Another patient developed tumor recurrence after an incomplete incision of the cystic lesion previously performed abroad. She was referred to our unit but was deemed unresectable and therefore was referred for a liver transplantation. We report 3 cases of hepatic cystic tumors, showing some difficult issues related to the diagnosis and management of this condition and underlining the importance of performing a complete surgical excision to avoid early recurrence of the tumor.