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Fujii Y, Hida K, Sugimoto A, Nishijima R, Fujimoto M, Hoshino N, Maekawa H, Okamura R, Itatani Y, Obama K. Appendiceal neoplasms derived from appendiceal tip remnants following appendectomy: a report of two cases. Surg Case Rep 2024; 10:144. [PMID: 38867137 PMCID: PMC11169428 DOI: 10.1186/s40792-024-01936-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/25/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Neoplasms derived from remnant appendix are rarely described, with most cases arising from the appendiceal "stump". Here, we present two surgical cases of appendiceal neoplasms derived from appendiceal "tip" remnants. CASE PRESENTATION The first patient was a 71-year-old man who had undergone laparoscopic appendectomy for acute appendicitis 12 years prior. During appendectomy, the appendiceal root was ligated, but the appendix was not completely removed due to severe inflammation. At the most recent presentation, computed tomography (CT) was performed to examine choledocholithiasis, which incidentally revealed a cystic lesion of approximately 90 mm adjacent to the cecum. A retrospective review revealed that the cystic lesion had increased in size over time, and laparoscopic ileocecal resection was performed. Pathology revealed no continuity from the appendiceal orifice to the cyst, and a diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) was made from the appendiceal tip remnant. The patient was discharged without complications. The second patient was a 65-year-old man who had undergone surgery for peritonitis due to severe appendicitis 21 years prior. During this operation, the appendix could not be clearly identified due to severe inflammation; consequently, cecal resection was performed. He was referred to our department with a chief complaint of general fatigue and loss of appetite and a cystic lesion of approximately 85 mm close to the cecum that had increased over time. CT showed irregular wall thickening, and malignancy could not be ruled out; therefore, laparoscopic ileocecal resection with D3 lymph node dissection was performed. The pathological diagnosis revealed mucinous adenocarcinoma (TXN0M0) arising from the remnant appendiceal tip. The patient is undergoing follow-up without postoperative adjuvant chemotherapy, with no evidence of pseudomyxoma peritonei or cancer recurrence for 32 months postoperatively. CONCLUSIONS If appendicitis-associated inflammation is sufficiently severe that accurate identification of the appendix is difficult, it may remain on the apical side of the appendix, even if the root of the appendix is ligated and removed. If the appendectomy is terminated incompletely, it is necessary to check for the presence of a residual appendix postoperatively and provide appropriate follow-up.
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Affiliation(s)
- Yusuke Fujii
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Koya Hida
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Akihiko Sugimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
- Department of Diagnostic Pathology, Shiga General Hospital, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan
| | - Ryohei Nishijima
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Nobuaki Hoshino
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Hisatsugu Maekawa
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Ryosuke Okamura
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yoshiro Itatani
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Kazutaka Obama
- Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
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From Diagnosis to Management; Mucocele of Stump Appendicitis, Extremely Rare Finding in an Uncommon Surgical Disease: Literature Review. Int J Surg Oncol 2021; 2021:8816643. [PMID: 33628502 PMCID: PMC7892232 DOI: 10.1155/2021/8816643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 01/08/2021] [Accepted: 01/29/2021] [Indexed: 11/17/2022] Open
Abstract
Mucocele of the appendix is the accumulation of mucoid material in the appendiceal lumen. Although the terminology is imprecise, as it does not differentiate between the benign and malignant nature of the condition, preoperative recognition is imperative as spillage of the mucus during surgical handling can result in grave complications like pseudomyxoma peritonei. Mucocele developing in a stump of the appendix, i.e., a remnant of appendiceal tissue after surgical removal of an inflamed organ, is an extremely uncommon phenomenon, as not many cases are reported in the literature. In this review, all cases reported in English literature are discussed.
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Tomida H, Hashimoto S, Hayashi M, Koyama M. Mucus-filled lesion of a distal viable remnant tip of an appendix that developed 23 years after appendectomy. Int J Surg Case Rep 2020; 72:112-116. [PMID: 32534413 PMCID: PMC7298332 DOI: 10.1016/j.ijscr.2020.05.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/23/2020] [Accepted: 05/23/2020] [Indexed: 11/28/2022] Open
Abstract
Appendectomy is currently the most common surgical operation worldwide. Post-appendectomy mucus-filled lesions are a rare clinical phenomenon. It is vital to perform appendectomy completely, without leaving appendiceal tissue. This prevents late complication of mucus-filled lesion formation.
Introduction Post-appendectomy mucus-filled lesions, arising from appendiceal remnant tissue, are an exclusively rare clinical entity. We report a rare case of a mucus-filled lesion rising from a distal viable remnant appendiceal tip as a late complication of appendectomy. Presentation of case A 48-year-old man presented with a 2-week history of right buttock and right lower quadrant abdominal pain. He had previously undergone appendectomy 23 years ago. Radiological examination showed a cystic lesion lateral to the colon with a prominent tubular structure. According to the past operative note, the appendiceal tip was lost accidentally. Surgical resection was performed. Pathologic examination revealed a mucus-filled lesion lateral to the cecum, with no communication between them. There was no evidence of malignancy. The prominent structure had muscular layer, suggestive of distal appendiceal remnant. Discussion Surgical resection of appendiceal mucus-filled lesion is recommended, because there are no reliable criteria to exclude malignant lesions. Although appendiceal mucus-filled lesion is rare, it is extremely rare in patients with previous appendectomy. In our case, the mucinous material secreted from the remnant appendix might be enclosed by the surrounding tissue. Conclusion In patient with previous appendectomy who show a cystic mass close to the cecum, the possibility of lesion derived from the appendiceal stump or distal appendiceal remnant should be considered. In such cases, it is important to review the medical records for a definitive diagnosis. Complete appendectomy, without leaving appendiceal tissue, remains mandatory to prevent the development of late complications of mucus-filled lesions.
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Affiliation(s)
- Hidenori Tomida
- Department of General Surgery, Asama Nanroku Komoro Medical Center, 3-3-21 Aioicho, Komoro, Nagano, 384-8588, Japan.
| | - Shinichi Hashimoto
- Department of General Surgery, Asama Nanroku Komoro Medical Center, 3-3-21 Aioicho, Komoro, Nagano, 384-8588, Japan.
| | - Masahiro Hayashi
- Department of General Surgery, Asama Nanroku Komoro Medical Center, 3-3-21 Aioicho, Komoro, Nagano, 384-8588, Japan.
| | - Masamichi Koyama
- Department of Pathology, Asama Nanroku Komoro Medical Center, 3-3-21 Aioicho, Komoro, Nagano, 384-8588, Japan.
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Bajcurová K, Novák P, Korčáková E, Mírka H, Geiger J, Rajal P, Daum O, Podolcová M. Submucosal mucoid as a late complication after appendectomy-A case report. Int J Surg Case Rep 2019; 58:37-40. [PMID: 31003092 PMCID: PMC6475718 DOI: 10.1016/j.ijscr.2019.03.051] [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: 01/22/2019] [Revised: 03/20/2019] [Accepted: 03/26/2019] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Shortly after an operation infection, intraabdominal abscess, seroma, haemorrhage or development of paralytic ileus may occur. Postoperative adhesions, nonspecific abdominal pain without signs of obstruction, incisional hernia and appendicitis or mucocele in appendiceal stump present common late complications. We present a unique case of a late complication after appendectomy. PRESENTATION OF CASE The case report describes a unique expansion in the ascending colon of a young athlete with long-lasting abdominal pain in the lower right quadrant. Colonoscopy showed a lesion in a wall of the ascending colon. Computed tomography (CT) confirmed a cystoid formation of high content density in a wall of the caecum. A right hemicolectomy was performed. Histology showed a lesion located in the submucosa with intestinal lining and stroma rich in lymphoid cells. These are the typical attributes of the wall of the appendix. Other parts of the wall were not demonstrated, and there was no communication with the lumen of the native bowel. CONCLUSION A submucosal cavity filled with acellular matter, which were probably disintegrated epithelioid structures, and calcifications were found in the ascending colon, while no intestinal cell atypia or dysplasia was found. The case cannot be classified under any previously presented diagnosis.
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Affiliation(s)
- Kristýna Bajcurová
- Department of Imaging Methods, Charles University Medical School and Teaching Hospital in Pilsen, Alej Svobody 923/80, 304 60, Pilsen, Czech Republic; Biomedical Centre, Charles University Medical School in Pilsen, Alej Svobody 1655/76, 323 00, Pilsen, Czech Republic.
| | - Petr Novák
- Department of Surgery, Charles University Medical School and Teaching Hospital in Pilsen, Alej Svobody 923/80, 304 60, Pilsen, Czech Republic
| | - Eva Korčáková
- Department of Imaging Methods, Charles University Medical School and Teaching Hospital in Pilsen, Alej Svobody 923/80, 304 60, Pilsen, Czech Republic; Biomedical Centre, Charles University Medical School in Pilsen, Alej Svobody 1655/76, 323 00, Pilsen, Czech Republic
| | - Hynek Mírka
- Department of Imaging Methods, Charles University Medical School and Teaching Hospital in Pilsen, Alej Svobody 923/80, 304 60, Pilsen, Czech Republic; Biomedical Centre, Charles University Medical School in Pilsen, Alej Svobody 1655/76, 323 00, Pilsen, Czech Republic
| | - Jan Geiger
- Department of Surgery, Charles University Medical School and Teaching Hospital in Pilsen, Alej Svobody 923/80, 304 60, Pilsen, Czech Republic
| | - Petr Rajal
- Department of Internal Medicine, Klatovy Hospital, Plzeňská 929, 339 01, Klatovy II, Czech Republic
| | - Ondřej Daum
- Pathological-anatomical Šikl Institute, Charles University Medical School in Pilsen, Teaching Hospital in Pilsen, Dr. E. Beneše 13, 305 99, Pilsen, Czech Republic
| | - Marcela Podolcová
- Radiological Department, Klatovy Hospital, Plzeňská 929, 339 01, Klatovy II, Czech Republic
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Handler M, Anand N, Wei L, Snieckus P. Adenocarcinoma of the Appendix Presenting as a Palpable Right Thigh Mass. J Radiol Case Rep 2017; 11:20-29. [PMID: 28567182 DOI: 10.3941/jrcr.v11i4.3087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Intra-abdominal and intra-pelvic pathologies initially presenting in extra-abdominal/pelvic locations is unusual. This spread predominantly occurs with infectious processes to sites including the buttock, thigh, and calf. The routes of extension into adjacent anatomically weak compartments include the pelvic outlet, greater sciatic foramen, obturator foramen, inguinal or femoral canal, weak bones, or along nerves and blood vessels. Malignant neoplasms of the appendix, while extremely rare and accounting for only 0.4% of all gastrointestinal cancers, is one of the intra-abdominal pathologies that can spread via these routes. Adenocarcinoma of the appendix accounts for 10-20% of primary appendiceal tumors. They usually present as acute appendicitis or as a right lower quadrant abdominal mass when associated with a mucocele. We report the unique case of mucinous appendiceal adenocarcinoma in a 57-year-old male who initially presented with a right thigh mass secondary to extension of the neoplasm from the right lower quadrant through the femoral canal. A similar presentation of a mucinous appendiceal cystadenoma has been previously reported, however, to our knowledge, this is the first case of a malignant appendiceal tumor extending into the thigh. We review the literature and discuss imaging findings and treatment of this tumor.
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Affiliation(s)
- Marci Handler
- Department of Radiology, Morristown Medical Center, Morristown, NJ, USA
| | - Neil Anand
- Department of Radiology, Morristown Medical Center, Morristown, NJ, USA
| | - Lawrence Wei
- Sidney Kimmel Medical College, Jefferson University, Philadelphia, PA, USA
| | - Peter Snieckus
- Department of Radiology, Overlook Medical Center, Summit, NJ, USA
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Akagi I, Yokoi K, Shimanuki K, Satake S, Takeda K, Shimizu T, Kondo R, Kanazawa Y, Uchida E. Giant appendiceal mucocele: report of a case. J NIPPON MED SCH 2015; 81:110-3. [PMID: 24805099 DOI: 10.1272/jnms.81.110] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Mucoceles of the appendix are a group of mucus-filled lesions causing obstructive dilation of the ileocecal appendix. We report a rare case of giant appendiceal mucocele. A 48-year-old woman, with no discomfort, was admitted to our hospital after a mass was detected in the right lower quadrant of the abdomen. The patient underwent right hemicolectomy on the basis of the clinical diagnosis of a possible appendiceal tumor. The final pathologic diagnosis was mucocele of the appendix.
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Affiliation(s)
- Ichiro Akagi
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School
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Appendiceal mucocele due to mucinous cystadenocarcinoma arising from the appendiceal stump: preoperative diagnosis based on the "onion skin sign". Jpn J Radiol 2012; 30:684-7. [PMID: 22836903 DOI: 10.1007/s11604-012-0104-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 06/19/2012] [Indexed: 11/27/2022]
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