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Published on: August 24, 2019
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.
Insights
Appendiceal mucocele, a rare condition causing appendix dilation, requires tailored surgical management based on lesion characteristics. Accurate preoperative diagnosis, often challenging, is crucial for effective treatment and patient outcomes.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Radiology
Background:
- Appendiceal mucocele involves appendix dilation due to mucoid substance accumulation.
- This rare condition occurs in 0.07-0.63% of appendectomies.
Observation:
- A 70-year-old male presented with right lower abdominal pain.
- CT revealed an appendicular mass suggestive of mucocele, with peritoneal mucinous material and a cecal perforation.
- A 1.5 cm parietal nodule was identified within the peritoneal cavity.
Findings:
- The patient underwent right hemicolectomy with excision of peritoneal lesions.
- Pathologic terminology and preoperative diagnosis present clinical dilemmas in management.
- Surgical approach for appendiceal mucinous neoplasms depends on lesion size and location.
Implications:
- Accurate preoperative diagnosis is essential for appropriate surgical planning.
- Computed tomography (CT) is the preferred diagnostic tool for appendiceal mucinous neoplasms.
- Management strategies range from simple appendectomy to right hemicolectomy based on pathological findings.
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