Mucocele of the appendix presenting as an exacerbated chronic tubo-ovarian abscess: A case report and comprehensive review of the literature

Appendiceal mucocele masquerading as an epithelial borderline ovarian tumor: a case report and literature review

Appendiceal mucocele is a rare mucin-producing neoplasm of appendiceal origin. Due to its location and imaging findings, appendiceal mucocele is easily confused with tumors of the right adnexa. We present a rare case of a patient initially misdiagnosed with an ovarian tumor intraoperatively diagnosed as an appendiceal mucocele and successfully treated. A 66-year-old postmenopausal woman was admitted to the gynecology department for an asymptomatic pelvic mass. Preoperative pelvic imaging showed an 8-cm cystic mass. Exploratory laparoscopy for the suspected epithelial borderline tumor from the right ovary revealed a cystic mass in the right pelvic area and normal uterus, fallopian tubes, and ovaries. Intraoperative consultation with the general surgery department confirmed the appendiceal origin. Laparoscopic appendectomy was performed. Histopathological examination confirmed a low-grade mucinous neoplasm of appendiceal origin. The patient was discharged on a postoperative day 5 without complications. The outpatient follow-up performed 1 month later showed no evidence of disease progression. Despite the use of advanced diagnostic tools, appendiceal mucocele may be confused for ovarian malignancies. Because the clinical features of appendiceal mucocele are nonspecific, clinicians and radiologists know the specific imaging findings. A multidisciplinary approach including general surgery, gynecology, and radiology is required for preoperative diagnosis and treatment.

Treatment of a giant low-grade appendiceal mucinous neoplasm: A case report

BACKGROUND

Low-grade appendiceal mucinous neoplasm (LAMN) is extremely rare and easily misdiagnosed before surgery.

CASE SUMMARY

We report the treatment of an asymptomatic case of LAMN diagnosed by magnetic resonance imaging (MRI) and surgical findings. A 70-year-old woman presented with an adnexal mass found by physical examination in July 2020. Gynecologic ultrasonography revealed a cystic mass in the right adnexa, and computed tomography showed a cystic mass in the pelvic cavity. All tumor markers were normal. A further MRI examination suggested mucinous neoplasm in the right pelvic cavity, excluding the possibility of adnexal cyst. Laparoscopic exploration found a huge cystic mass of about 10 cm × 7 cm that originated from the apex of the appendix, with spontaneous rupture. LAMN was confirmed by pathological examination. As of May 2021, no disease recurrence occurred after an open appendectomy.

CONCLUSION

This case indicates that we should pay more attention to female patients who are clinically diagnosed with an adnexal mass at admission,. The physical examination should be done carefully, and the laboratory and imaging examination results should be comprehensively analyzed to avoid misdiagnosis and to ensure prompt diagnosis and treatment, and to improve prognosis. MRI may be a better option for the diagnosis of appendiceal mucinous neoplasm.

Laparoscopic Right Hemicolectomy for Appendiceal Mucocele

Appendiceal mucocele is a rare disease with an incidence of 0.07-0.63% of all appendectomies and was first described in 1842 by Carl von Rokitansky. It is defined as an abnormal intraluminal accumulation of mucin. The clinical picture of AM can vary from asymptomatic mass in the right lower quadrant to symptoms of acute appendicitis. In some cases, AM can be found accidentally on CT performed due to other reasons or during surgery. Diagnosis consists mainly of imaging methods such as ultrasound, CT, and MRI with the finding of encapsulated cystic mass with calcifications. The main goal of surgical treatment is to remove an intact mucocele and prevent spillage of mucin into the peritoneal cavity. We present a case of large mucocele treated with laparoscopic right hemicolectomy.

Endoscopic diagnosis and treatment of an appendiceal mucocele: A case report

BACKGROUND

Appendiceal mucocele is a rare disease that causes obstructive dilatation of the appendix due to the intraluminal accumulation of mucin. We report a case of endoscopic diagnosis and treatment of an appendiceal mucocele.

CASE SUMMARY

A 47-year-old man presented with a protrusion around the orifice of the appendix discovered by colonoscopy incidentally. He was admitted to our hospital for a routine checkup without any symptoms. Abdominal computed tomography showed a cystic mass approximately 3 cm in diameter with fat stranding. The preoperative diagnosis was non-neoplastic appendiceal mucocele, and endoscopic treatment was performed. The endoscopic findings and pathological results supported our preoperative diagnosis. The endoscopic treatment of appendiceal mucocele was feasible and effective, which was confirmed by repeated endoscopy and post-operative computed tomography after 7 mo.

CONCLUSION

Endoscopic therapy provides a new method for the treatment of appendiceal mucocele.

Low-grade mucinous appendiceal neoplasm mimicking an ovarian lesion: A case report and review of literature

BACKGROUND

Appendiceal tumors are rare lesions that may not be easily differentiated from primary ovarian lesions preoperatively, despite the use of advanced diagnostic methods by experienced clinicians.

CASE SUMMARY

A 59-year-old G2P2 woman, with chronic pelvic pain, underwent a pelvic ultrasound that revealed an adnexal mass measuring 58 mm × 34 mm × 36 mm, with irregular borders, heterogeneous echogenicity, no color Doppler vascularization and without acoustic shadowing. Normal ovarian tissue was visualized in contact with the lesion, and it was impossible to separate the lesion from the ovary by applying pressure with the ultrasound probe. Ascites, peritoneal metastases or other alterations were not observed. With the international ovarian tumor analysis ADNEX model, the lesion was classified as a malignant tumor (the risk of malignancy was 27.1%, corresponding to Ovarian-Adnexal Reporting Data System category 4). Magnetic resonance imaging confirmed the presence of a right adnexal mass, apparently an ovarian tumor measuring 65 mm × 35 mm, without signs of invasive or metastatic disease. During explorative laparotomy, normal morphology of the internal reproductive organs was noted. A solid mobile lesion involved the entire appendix. Appendectomy was performed. Inspection of the abdominal cavity revealed no signs of malignant dissemination. Histopathologically, the appendiceal lesion corresponded to a completely resected low-grade mucinous appendiceal neoplasm (LAMN).

CONCLUSION

The appropriate treatment and team of specialists who should provide health care to patients with seemingly adnexal lesions depend on the nature (benign vs malignant) and origin (gynecological vs nongynecological) of the lesion. Radiologists, gynecologists and other pelvic surgeons should be familiar with the imaging signs of LAMN whose clinical presentation is silent or nonspecific. The assistance of a consultant specializing in intestinal tumors is important support that gynecological surgeons can receive during the operation to offer the patient with intestinal pathology an optimal intervention.

Endoscopic Esophageal Submucosal Tunnel Dissection for Cystic Lesions Originating from the Muscularis Propria of the Gastric Cardia

OBJECTIVE

To analyze the types and properties of cystic lesions originating from the muscularis propria of the gastric cardia (CLMPGC), explore the growth pattern and anatomical characteristics, and evaluate the safety, feasibility, and clinical efficacy of endoscopic esophageal submucosal tunnel dissection (ESTD).

METHODS

From September 2013 to July 2018, we treated 6 patients with CLMPGC whom we had diagnosed using endoscopy, endoscopic ultrasound (EUS), and Computed Tomography (CT) before the operations. ESTD was the best option for treatment for all these patients. Postoperative observation and follow-ups were performed, and the operational, clinical data, and treatment results are analyzed.

RESULTS

The mean age of the patients was 50.67 ± 11.59 years (male : female = 1 : 1). The only clinical manifestations the patients exhibited were upper abdominal discomfort. The diameter of the masses was 2.05 ± 0.73 (1.1-3.0) cm. The duration of the ESTD operation was 93.5 (82-256) mins, and the length of hospital stay was 7.50 ± 1.38 days. Postoperative pathology showed 4 cases of an epithelioid cyst, and 2 cases of mucocele with xanthogranuloma. There were no complications, such as hemorrhage, pneumothorax, and pleural effusion during and after the operation. No recurrence during the follow-ups was observed.

CONCLUSION

The CLMPGC were mainly mucocele and epidermoid cyst, in an expansive growth pattern, and these lesions had no distinct borders with the muscularis propria. The muscularis propria formed a complete wall of the lesion. There was no direct blood supply to the lesions from big blood vessels. Endoscopic esophageal submucosal tunnel dissection was a safe, feasible, and effective treatment for CLMPGC.

Low grade appendiceal mucinous neoplasm mimicking an ovarian cyst: A case report

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Appendiceal mucocele defines as an intraluminal dilation of the appendix in response to mucin accumulation.

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This condition overall is very rare with a 0.2–0.3% incidence of all appendectomy specimens.

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It's more common in the females with a 4 to 1 ratio.

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Appropriate diagnosis and management of appendiceal mucocele prevent complications such as pseudomyxoma peritonei.

Introduction

Appendiceal mucocele (AM) is a very rare neoplasm with an incidence of 0.2–0.3% of all appendectomy specimens. AM usually defined as an intraluminal dilation of the appendix in response to mucin accumulation. The preoperative diagnosis is difficult and can be misdiagnosed to any of the other differential diagnosis especially in female patients. If it is suspected, imaging modalities and colonoscopy can be helpful as a guide for the right surgical approach.

Presentation of case

A 41-year-old lady who found to have an appendicular tumor discovered incidentally on magnetic resonance imaging (MRI) of the abdomen during a follow-up in the referral hospital for persistent right lower quadrant abdominal pain with enlarging right ovarian cyst for 2 years. MRI revealed a sizeable cyst measuring 7 × 4 × 3 cm in the right iliac fossa (RIF) region with high suspicion of an AM. The patient was managed with open right limited hemicolectomy. The patient was diagnosed as a well-differentiated low-grade AM neoplasm with stage 0 (pTis, pN0, M0) based on the 8th edition of the American Joint Committee on Cancer (AJCC) Staging System. The patient had an uneventful recovery and advised for regular follow-up of at least 5 years.

Discussion

AM is a very rare neoplasm. The imaging modalities that can be diagnostic methods are the abdominal ultrasonography (US), transvaginal US, abdominal computed tomography (CT) and abdominal MRI. Fine needle aspiration must be avoided as the risk of perforation is high that will lead to dissemination of the mucinous material causing a serious complication called pseudomyxoma peritonei. Laparotomy is superior on laparoscopy as the risk of perforation is lower in laparotomy.

Conclusion

The presentation of AM is usually not specific, because of its anatomic position. Physicians should consider it in the differential diagnosis of persistent enlarging ovarian cyst or adnexal mass.