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The appendix "mucocoele" misnomer: radiological terminology of "likely appendix mucinous neoplasm" better reflects
A Bhagwanani1, J El-Sheikha1, N Shah1
1Peritoneal Malignancy Institute, Hampshire Hospitals NHS Foundation Trust, Basingstoke and North Hampshire Hospital, Basingstoke, UK.
Aim:
To review the radiological terminology used to describe dilated mucin-containing appendiceal lesions with correlation to the histopathological diagnosis.
Materials And Methods:
Radiology and histopathology reports for all patients with an abnormally dilated appendix referred to a tertiary peritoneal malignancy centre, between January 2021 and December 2021, were reviewed.
Results:
Overall, 213 patients were included with a median appendiceal diameter of 25.5 mm (range 10-125 mm). Peritoneal disease was present in 109 patients, with the remaining 104 cases demonstrating a dilated appendix only. Local radiology reports were available for 201 cases with the appendix described in 168 cases as appendiceal mucocoele (n=104), appendiceal neoplasm (n=40), appendicitis (n=18), and dilated appendix (n=6). The appendix was not mentioned in 33/201 (15%), either misinterpreted as other pathology (n=15) or not reported (n=18). Peritoneal malignancy histopathology reports were available in 188 cases and reported as low-grade appendix mucinous neoplasm (LAMN, n=144), high-grade appendix mucinous neoplasm (HAMN, n=13), LAMN with foci of HAMN (n=2), LAMN with neuroendocrine tumour (n=2), LAMN with goblet cell adenocarcinoma (n=1), goblet cell adenocarcinoma (n=8), mucinous adenocarcinoma (n=14), non-mucinous adenocarcinoma (n=1), and benign histology (n=3). Only one case of a true inflammatory "mucocoele"/retention cyst was reported.
Conclusion:
In this cohort of patients, the overwhelming majority of dilated, mucin-filled appendices contained malignant cells and benign mucin-filled appendices were rare. The present authors advocate that the term "likely appendix mucinous neoplasm" should replace "appendix mucocoele" to represent the most likely pathology and facilitate less ambiguous interpretation in management decisions.
Insights
Most dilated, mucin-filled appendices contain malignant cells, with benign cases being rare. The term "likely appendix mucinous neoplasm" is recommended over "appendix mucocoele" for clearer diagnosis and management.
Area of Science:
- Gastroenterology
- Oncology
- Radiology
Background:
- Dilated mucin-containing appendiceal lesions are often described using varied radiological terminology.
- Accurate radiological description is crucial for differentiating benign from malignant appendiceal conditions.
Purpose of the Study:
- To review radiological terminology for dilated mucin-containing appendiceal lesions.
- To correlate radiological findings with histopathological diagnoses.
- To propose standardized terminology for improved clinical management.
Main Methods:
- Retrospective review of radiology and histopathology reports for 213 patients with dilated appendix (Jan 2021-Dec 2021).
- Analysis of appendiceal diameter, presence of peritoneal disease, and radiological descriptions.
- Correlation of radiological terms with histopathological findings, including mucinous neoplasms and adenocarcinomas.
Main Results:
- 213 patients included; median appendiceal diameter 25.5 mm.
- Radiology reports used 'appendiceal mucocoele' for 104 cases, but histopathology revealed malignancy in most.
- Only 1 of 213 cases was a benign inflammatory cyst; the majority of mucin-filled appendices showed malignant cells (LAMN, HAMN, adenocarcinomas).
Conclusions:
- The term 'appendix mucocoele' is frequently misapplied to malignant appendiceal mucinous neoplasms.
- Benign mucin-filled appendices are rare, necessitating a shift in diagnostic terminology.
- Recommend 'likely appendix mucinous neoplasm' to replace 'appendix mucocoele' for improved diagnostic clarity and patient management.
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