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Ward P, Collignon T, Florio T, Barwari S, Miller G. Appendiceal Mucinous Neoplasm: A Case of an Incidental Finding. Cureus 2024; 16:e59540. [PMID: 38826949 PMCID: PMC11144036 DOI: 10.7759/cureus.59540] [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: 04/05/2024] [Accepted: 05/01/2024] [Indexed: 06/04/2024] Open
Abstract
Appendiceal mucinous neoplasms (AMNs) are uncommon gastrointestinal tumors characterized by mucus accumulation in the appendix. Patients may complain of acute appendicitis-like symptoms with other alarming features, but approximately half of the cases of AMNs are found incidentally on imaging. Early diagnosis and management of these neoplasms are important to prevent malignant progression and complications such as bowel obstruction and pseudomyxoma peritonei. We report a case of a 28-year-old female who initially presented with vomiting and acute left lower abdominal pain radiating to the left flank. Computed tomography (CT) revealed a 1.5 mm stone in the left ureteral vesicular junction and a 2.3 x 2.4 x 5.2 cm cystic tubular mass at the base of the cecum, suspicious of an appendiceal mucocele. An elective laparoscopic appendectomy was performed on this admission, which was converted to a right hemicolectomy due to the pathologic finding of a focally high-grade AMN on intraoperative frozen specimen pathology. This report aims to provide an example of a case of an incidental AMN and how it was diagnosed and managed surgically. AMNs are rare tumors that originate from the appendix and can pose diagnostic and therapeutic challenges due to their diverse clinical presentations and variable histopathological features. The majority of cases of AMNs are discovered in middle-aged individuals (40-50 years of age) after an appendectomy is performed and examined by pathology. This case report aims to describe a rare presentation of a 28-year-old female patient with an incidental finding of AMN on a CT scan of the abdomen while being worked up for suspected nephrolithiasis. We will provide a comprehensive overview of a unique presentation of AMN, highlighting its clinical manifestations, diagnostic approach, and management strategies. We present the case of a 28-year-old female patient who presented to the emergency department with complaints of acute left lower quadrant abdominal pain radiating to the left flank and vomiting. After an initial assessment and workup, which included lab investigations and imaging, a diagnosis of unilateral hydronephrosis due to a calculus of the ureterovesical junction was made. However, there was also suspicion of an appendiceal mucocele, as evidenced by a CT scan of the abdomen and pelvis. On admission day one, under the care and management of the urology team, she passed the stone with complete resolution of the presenting symptoms. On hospital day two, she underwent an elective laparoscopic appendectomy followed by a right hemicolectomy due to findings of high-grade mucinous neoplasm on the resected frozen specimen near the base of the appendix. AMN was an incidental finding based on CT imaging and macroscopic findings, which was later confirmed by histopathological assessment and report.
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Affiliation(s)
- Patricia Ward
- General Surgery, St. George's University School of Medicine, St. George's, GRD
- General Surgery, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | - Taylor Collignon
- General Surgery, Lake Erie College of Osteopathic Medicine, Bradenton, USA
- General Surgery, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | - Taylor Florio
- Plastic and Reconstructive Surgery, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | - Shivon Barwari
- Urology, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
| | - Glenn Miller
- General Surgery, Larkin Community Hospital Palm Springs Campus, Hialeah, USA
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Mannarini M, Maselli F, Giannotta G, Cioeta M, Giovannico G. Low back pain as main symptom in Low-grade Appendiceal Mucinous Neoplasm (LAMN): A case report. Physiother Theory Pract 2024:1-9. [PMID: 38381198 DOI: 10.1080/09593985.2024.2315517] [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: 08/29/2023] [Accepted: 01/03/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Low back pain is the leading cause of disability worldwide. It is also the main cause of the limitation of activities and absence from work in much of the world and a cause of great economic burden. The greatest percentage of low back pain is classified as nonspecific (i.e. not attributable to a defined pathology), while the others may concern specific pathologies of the lumbar region or suggest pathologies of non-musculoskeletal origin. Consequently, evaluating any signs and symptoms mimicking musculoskeletal conditions is crucial. CASE DESCRIPTION This case report describes a 64-year-old female patient who first presented to the physiotherapist with two weeks of low back pain, complaining of a different clinical presentation than the previous episodes. The patient's pain started spontaneously and was located in the lumbar region over a diffuse area. Symptoms were constant throughout the day and did not change with movement. Based on the examination findings, the physiotherapist decided to make an urgent referral to the patient's General Practitioner. OUTCOMES Following ultrasound examination and Computed Tomography scan, an 8.5 cm mass was confirmed in the abdominal region. It was surgically removed, and a histological diagnosis of Low-grade Appendiceal Mucinous Neoplasm (LAMN) was made. CONCLUSION The physiotherapist's evaluation and decision-making process was fundamental in the patient's referral due to suspected pathology not within the scope of practice. This revealed a rare condition, which, according to the existing literature, is usually diagnosed in the event of collateral imaging findings or upon presentation of complex and/or emergency clinical pictures.
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Affiliation(s)
- Michele Mannarini
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Filippo Maselli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Gabriele Giannotta
- Scientific Institute IRCCS "E. Medea" - Unit for Severe disabilities in developmental age and young adults (Developmental Neurology and Neurorehabilitation) - Piazza "Antonio Di Summa", Brindisi, Italy
| | - Matteo Cioeta
- Department of Neurological and Rehabilitation Sciences, IRCCS San Raffaele Roma, Rome, Italy
| | - Giuseppe Giovannico
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
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Lavecchia M, Dubey A, Jimenez W, Reade CJ, Salehi A, Yang I, Eiriksson LR. Intraoperative predictors of appendiceal abnormalities in patients with mucinous ovarian neoplasms. Int J Gynaecol Obstet 2024; 164:249-254. [PMID: 37485684 DOI: 10.1002/ijgo.15008] [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: 03/05/2023] [Revised: 06/13/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To evaluate intraoperative factors predicting appendiceal pathology during gynecologic oncology surgery for suspected mucinous ovarian neoplasms. METHODS We conducted a retrospective study on 225 patients with mucinous ovarian neoplasms who underwent surgery for an adnexal mass with concurrent appendectomy between 2000 and 2018. Regression analyses were used to evaluate intraoperative factors, such as frozen section of the ovarian mass and surgeon's impression of the appendix in predicting appendiceal pathology. RESULTS Most patients (77.8%) had a normal appendix on final pathology. Abnormal appendix cases (n = 26) included: metastasis from high-grade adenocarcinoma of the ovary (n = 1), neuroendocrine tumor of the appendix (n = 4), and low-grade appendiceal mucinous neoplasms (n = 26; 23 associated with a mucinous ovarian adenocarcinoma, 2 with a benign mucinous ovarian cystadenoma, and 1 with a borderline mucinous ovarian tumor). Combining normal intraoperative appearance of the appendix with benign or borderline frozen section yielded a negative predictive value of 85.1%, with 14.9% of patients being misclassified, and 6.0% having a neuroendocrine tumor or low-grade appendiceal neoplasm. CONCLUSION Benign or borderline frozen section of an ovarian mucinous neoplasm and normal appearing appendix have limited predictive value for appendiceal pathology. Appendectomy with removal of the mesoappendix should be considered in all cases of mucinous ovarian neoplasm, regardless of intraoperative findings.
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Affiliation(s)
- Melissa Lavecchia
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
- Juravinski Hospital & Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Anisha Dubey
- Department of Obstetrics and Gynecology, Queens University, Kingston, Ontario, Canada
| | - Waldo Jimenez
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
- Juravinski Hospital & Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Clare J Reade
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
- Juravinski Hospital & Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Amir Salehi
- Juravinski Hospital & Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Ilun Yang
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lua R Eiriksson
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
- Juravinski Hospital & Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada
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Tavra A, Quien D, Barcot O. Oncological aspect of incidental appendectomy with regard to histopathological findings: A retrospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107013. [PMID: 37597285 DOI: 10.1016/j.ejso.2023.107013] [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: 02/13/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION The aim of this retrospective cohort study was to describe the findings on histopathological examination of removed, macroscopically non-diseased, vermicular appendix during another primary surgical procedure (incidental appendectomy (IA)). Previous studies disapproved IA but were based on the possibility of complicated appendicitis. We observed the prevalence of neoplasms of the appendix in IA versus the appendectomy performed due to acute appendicitis (AA). METHODS The database of histopathology reports of the Surgery Department, University Hospital of Split was reviewed in the period from January 1, 2017, to December 31, 2021. A total of 2832 histopathology reports were reviewed. RESULTS There was no difference in gender distribution between these two groups, but AA had a statistically significantly lower median patient age compared to the group IA (40 vs. 68 years; P < 0.001). In the AA group, there were 84.5% acute appendicitis, 11.1% normal appendiceal reports, 3.2% appendiceal neoplasms, and 1.2% other pathologies. The group IA had 89.5% normal findings of the appendix, 7.2% appendiceal neoplasms, and 0.5% other pathology. The difference in neoplasm prevalence between IA and AA groups was 4.0% (95%CI: 2.2 to 5.8), P < 0.001. The number of incidental appendectomies needed to detect one neoplasm of the appendix is 25. CONCLUSION Incidental appendectomies in patients undergoing abdominal surgery revealed a relatively high prevalence of appendiceal neoplasms above the age of 60 years. Prospective studies about incidental appendectomies, their clinical consequences, and impact on prognosis should be performed to define the value of incidental appendectomy in those patients.
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Affiliation(s)
- Ante Tavra
- University of Split School of Medicine, Split, Croatia.
| | - Damir Quien
- Surgery Department, University Hospital of Split, Split, Croatia.
| | - Ognjen Barcot
- University of Split School of Medicine, Split, Croatia; Surgery Department, University Hospital of Split, Split, Croatia.
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McNamee MM, Stolz MP, Gibson BH, Brown C. Incarcerated Amyand Hernia Associated With Acute Appendicitis and Incidental Finding of Serrated Adenoma. Am Surg 2023:31348231157828. [PMID: 36799729 DOI: 10.1177/00031348231157828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Amyand hernias are rare as they represent 0.5% of all hernias. An Amyand hernia that is discovered due to acute appendicitis is even rarer, accounting for approximately 0.11% of cases. Furthermore, appendiceal neoplasms are infrequently encountered in only 0.7-1.7% of appendectomy specimens. PURPOSE This paper presents the case of an 85 year-old man presenting with acute appendicitis located within an amyand hernia as well as a serrated adenoma noted on final pathology. CONCLUSIONS An Amyand hernia is a rare diagnosis. We proceeded with laparoscopic appendectomy and interval inguinal hernia repair. Pathology should be reviewed for all patients and proper follow up ensured for all incidental findings.
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Affiliation(s)
- Molly M McNamee
- 21055Northeast Georgia Medical Center and Health System, Gainesville, GA, USA
| | - Michael P Stolz
- 21055Northeast Georgia Medical Center and Health System, Gainesville, GA, USA
| | - Brian H Gibson
- 21055Northeast Georgia Medical Center and Health System, Gainesville, GA, USA
| | - Cecil Brown
- 21055Northeast Georgia Medical Center and Health System, Gainesville, GA, USA
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Sun CC, Li L, Tao HQ, Jiang ZC, Wang L, Wang HJ. The role of NLRP3 inflammasome in digestive system malignancy. Front Cell Dev Biol 2022; 10:1051612. [PMID: 36619871 PMCID: PMC9816811 DOI: 10.3389/fcell.2022.1051612] [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: 09/23/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
Digestive system malignancies, the most common types of cancer and a major cause of death in the worldwide, are generally characterized by high morbidity, insidious symptoms and poor prognosis. NLRP3 inflammasome, the most studied inflammasome member, is considered to be crucial in tumorigenesis. In this paper, we reviewed its pro-tumorigenic and anti-tumorigenic properties in different types of digestive system malignancy depending on the types of cells, tissues and organs involved, which would provide promising avenue for exploring new anti-cancer therapies.
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Affiliation(s)
- Cen-Cen Sun
- Basic Medical Experimental Teaching Center, Zhejiang University, Hangzhou, China
| | - Li Li
- Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China,Cancer Center, General Surgery, Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Hou-Quan Tao
- Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China,Cancer Center, General Surgery, Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Zhi-Chen Jiang
- Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China
| | - Liang Wang
- Center for Plastic and Reconstructive Surgery, Department of Hand and Reconstruction Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China,*Correspondence: Hui-Ju Wang, ; Liang Wang,
| | - Hui-Ju Wang
- Key Laboratory of Gastroenterology of Zhejiang Province, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China,Cancer Center, General Surgery, Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, China,*Correspondence: Hui-Ju Wang, ; Liang Wang,
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Ray MD, Gaur MK, Kumar C, Deo SVS. A proposal for changing nomenclature from pseudomyxoma peritonei (PMP) to abdomino-peritoneal mucinous carcinoma (APM) based on its long journey and experience from tertiary oncology center in India. World J Surg Oncol 2022; 20:171. [PMID: 35641982 PMCID: PMC9158346 DOI: 10.1186/s12957-022-02639-6] [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: 01/05/2022] [Accepted: 04/19/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Pseudomyxoma peritonei (PMP) is a generalized term, usually known as “jelly belly” since 1884. Incidence is very low, 1–3 per million people per year. Because of its indolent nature, it is usually diagnosed at an advanced stage, thereby impacting the quality of life. The 5-year survival rate varies from 23 to 86% in world literature. Even 10 years and 20 years of survival have been described. With our experience, we like to propose rename of PMP as abdomino-peritoneal mucinous carcinoma (APM) as we strongly feel the time has come to specify the term and standardize the management strategy. Methodology In the premier institute of India and as a tertiary referral center, we experienced the maximum number of advanced cases of APM. From 2012 to 2021, we analyzed all the APM patients based on a prospectively maintained computerized database in the department of surgical oncology and found the reasons for renaming from this traditional one. Results We included a total of 87 patients who underwent surgical intervention. Thirty-five patients underwent cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC), and 52 patients underwent debulking. In CRS-HIPEC patients, CC-0 was achieved in 28 patients (80%), CC-1 in 4 patients (11.4%), and CC-2 in 3 patients (8.6%). Palliative intent HIPEC was done in 3 patients (8.6%). Clavien-Dindo grade III and IV morbidity was observed in 18.8% of patients with 90 days mortality of 5.7%. Conclusion With our long-term experience and advancement of scientific evidence, we like to propose a new name for PMP as APM. We strongly believe this paper will give a clear picture of this rare disease and standard management outlines.
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Affiliation(s)
- M D Ray
- Department of Surgical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India.
| | - Manish Kumar Gaur
- Department of Surgical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan Kumar
- Department of Surgical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India
| | - S V S Deo
- Department of Surgical Oncology, DR BRA-IRCH, All India Institute of Medical Sciences, New Delhi, India
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Santos SF, Horta M, Rosa F, Rito M, Cunha TM. Mucocele of the appendix: what to expect. Radiol Bras 2022; 55:193-198. [PMID: 35795599 PMCID: PMC9254708 DOI: 10.1590/0100-3984.2021.0075] [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: 05/02/2021] [Accepted: 08/16/2021] [Indexed: 11/21/2022] Open
Abstract
Mucoceles of the appendix are rare and can have quite variable imaging and
clinical presentations, sometimes mimicking an adnexal mass. The underlying
cause can be neoplastic or non-neoplastic. The typical imaging appearance of a
mucocele of the appendix is that of a cystic structure with a tubular
morphology. This structure is defined by having a blind-ending and being
contiguous with the cecum. Radiologists should be familiar with key anatomical
landmarks and with the various imaging features of mucoceles of the appendix, in
order to provide a meaningful differential diagnosis of a lesion in the right
lower abdominal quadrant. In addition, a neoplastic mucocele can rupture,
resulting in pseudomyxoma peritonei, which will change the prognosis
dramatically. Therefore, prompt diagnostic imaging is crucial.
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Affiliation(s)
- Sofia Frade Santos
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Portugal
| | - Mariana Horta
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Portugal; Universidade de Lisboa, Portugal
| | - Filipa Rosa
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Portugal
| | - Miguel Rito
- Instituto Português de Oncologia de Lisboa Francisco Gentil (IPOLFG), Portugal
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Yang Y, Jia D, Jiang C. Multiple intestinal hemangioma concurrent with low-grade appendiceal mucinous neoplasm presenting as intussusception-a case report and literature review. World J Surg Oncol 2022; 20:44. [PMID: 35193589 PMCID: PMC8864818 DOI: 10.1186/s12957-022-02519-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/28/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cases with intussusception caused by either intestinal hemangiomas or appendiceal mucinous neoplasms are extremely rare. CASE PRESENTATION In this study, we reported a 47-year-old male presented with paroxysmal abdominal pain and postprandial bloating for 3 days. CT results indicated a high possibility of secondary intussusception in ascending colon. Histopathology indicated a mixed type of cavernous and capillary hemangioma, combined with low-grade appendiceal mucinous neoplasms (LAMNs) and intestinal obstruction. The patient underwent laparotomy and right hemicolectomy. Finally, the patient was followed up for 4 months with no disease progression. CONCLUSIONS Rare studies reported the intestine hemangiomas coincided with appendix low-grade mucinous tumor. Its manifestations are not specific, which is a challenge in the preoperative diagnosis. For cases with intussusception that was not observed in time, it may lead to intestinal necrosis and diffuse peritonitis. Additionally, the ruptured mucinous tumor in the appendix may lead to pathogenesis of pseudomyxoma peritonei. Therefore, accurate diagnosis and appropriate surgery-based treatment contribute to the improvement of prognosis and severe outcomes among these patients.
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Affiliation(s)
- Yanhua Yang
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, 266071, China
| | - Dongmei Jia
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, 266071, China
| | - Chen Jiang
- Department of Pathology, Qingdao Municipal Hospital, Qingdao, 266071, China.
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Incidental neuroendocrine tumor of a complete subserosal appendix: an unusual presentation of a rare anatomical variation. A case report and review of literature. BMC Surg 2021; 21:421. [PMID: 34915872 PMCID: PMC8680036 DOI: 10.1186/s12893-021-01429-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/12/2021] [Indexed: 01/21/2023] Open
Abstract
Background Appendix’ anatomical variations are a rare occurrence which can mislead diagnosis and delay appropriate treatment.
Case presentation We present a 9-year-old female patient that came with a clinical picture compatible with acute appendicitis. However, a cecal mass was identified instead of an inflamed appendix during surgery. Therapeutic decisions were extremely challenging due to clinical deterioration and an uncertain etiology. Only the histopathology report revealed the presence of a complete subserosal appendix which was responsible for the entire symptomatology. Here, we review all case reports regarding intramural, intracecal or subserosal appendixes. A discussion of the general approach to this specific case and the importance of consensual diagnostic criteria for these specimens are also presented. At last, an incidental finding is exposed and final treatment options are discussed given the overall presentation. Conclusions Considering these variants would guide physicians towards a more accurate approach to similar clinical pictures and hence an improved long-term prognosis.
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Rising incidence of appendiceal neoplasms over time: Does pathological handling of appendectomy specimens play a role? Ann Diagn Pathol 2021; 52:151724. [PMID: 33667971 DOI: 10.1016/j.anndiagpath.2021.151724] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 02/14/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Appendectomy is the most common emergent surgical procedure. Primary appendiceal neoplasms are rare entities that are usually detected incidentally in less than 2% of all appendectomies. The increase in the incidence rates of appendiceal neoplasms over time raises the question whether there is an actual change in the disease occurrence or is it a matter of increased recognition and reporting of what would have been previously missed and undiagnosed. OBJECTIVES In our study, we aimed to review the archived tissue specimens of patients who were diagnosed with appendiceal neoplasms during the past decade at our institution and compare our clinical experience with published data to identify possible reasons that contribute to the increase in incidence rates of such neoplasms over the past few years. METHODS Using a pathological database of surgical specimens from patients who underwent appendectomies between January 01, 2010 and September 30, 2020 at a large academic medical center, a single-center retrospective cohort analysis was performed, and medical charts of patients were reviewed. RESULTS Of the total 1568 patients included, 102 (6.5%) had appendiceal neoplasms divided between primary (79.4%) and secondary/metastatic (20.6%) neoplasms. Annual incidence of appendiceal neoplasms over the past 10 years in our institution demonstrated an increasing trend from 5.6% in 2010 to 12.7% in 2020, which we hypothesize might be attributed to submitting more representative sections of the appendix for pathological examination than we had previously. Our results also showed that 2.8% of patients initially presenting with a typical clinical picture of acute appendicitis had appendiceal neoplasms as a truly incidental finding, while 20.3% of patients who underwent elective appendectomies for a suspicious appendiceal mass were found to be neoplastic. Interestingly, among the 80 cases of epithelial neoplasms, more non-carcinoid neoplasms were detected than carcinoid tumors. CONCLUSION Based on our results and what has been published recently, we confirm an additional increase in incidental appendiceal neoplasms found in appendectomies performed for a clinical picture of acute appendicitis, which may be related to more thorough specimen assessment. Whether this is clinically impactful remains to be determined. However, these data support a modification in the way appendectomy specimens are handled in pathology labs post-operatively.
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Matias-García B, Mendoza-Moreno F, Blasco-Martínez A, Busteros-Moraza JI, Diez-Alonso M, Garcia-Moreno Nisa F. A retrospective analysis and literature review of neoplastic appendiceal mucinous lesions. BMC Surg 2021; 21:79. [PMID: 33573654 PMCID: PMC7877070 DOI: 10.1186/s12893-021-01091-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 02/05/2021] [Indexed: 12/25/2022] Open
Abstract
Background At present, the term mucocele is outdated, and mucinous appendiceal neoplasm is preferred. Mucinous appendiceal neoplasm is an uncommon pathology that occurs predominantly in middle-aged women. Its classification and management have been the subject of debate in recent decades. The aim of this study was to analyse the incidence, clinical management and survival of these tumours diagnosed in our centre in the last 10 years. Methods This was a retrospective observational study of patients with a diagnosis of appendiceal neoplasms between 2009 and 2018 in our centre. Variables such as sex, age, tumour type, clinical status, diagnosis, treatment and survival were collected. All data were analysed using the statistical program IBM SPSS Statistic® version 25. Results Twenty-nine patients with a diagnosis of appendiceal neoplasm were identified, and 24 corresponded to neoplastic appendiceal mucinous lesions (85.7%). The average age was 59.7 ± 17.6 years. Most patients were women (15 cases; 62.5%). Most of them presented with chronic abdominal pain (37.5%), and the diagnosis was performed by computed tomography (CT) (50%). The treatment was surgical in all cases. The surgical technique depended on the findings and histology of the tumour. Conclusion Mucinous appendiceal neoplasms are an uncommon entity, and their pathological classification and management have recently changed.
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Affiliation(s)
- Belén Matias-García
- Surgery Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, 28005, Spain
| | - Fernando Mendoza-Moreno
- Surgery Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, 28005, Spain
| | - Ana Blasco-Martínez
- Pathology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, 28805, Spain
| | | | - Manuel Diez-Alonso
- Surgery Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, 28005, Spain
| | - Francisca Garcia-Moreno Nisa
- Surgery and Medical Sciences Deparment, GIBIT-UAH CIBER-BBN, Alcala University, Campus Universitario, 28805, Alcalá de Henares, Madrid, Spain.
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