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Published on: January 22, 2022
Low-grade appendiceal mucinous neoplasm encountered during risk-reducing salpingo-oophorectomy: A case of
Katsuyuki Konnai1, Hiroyuki Fujiwara2, Masakazu Kitagawa1
1Department of Gynecology, Kanagawa Cancer Center, Kanagawa, Japan.
Abstract:
Low-grade appendiceal mucinous neoplasm (LAMN) is a rare epithelial malignancy of the appendix. If it perforates the abdominal cavity, it can cause a serious clinical syndrome called pseudomyxoma peritonei. In the present case, we laparoscopically removed a LAMN encountered during risk-reducing salpingo-oophorectomy (RRSO). The patient was a 53-year-old woman who was diagnosed with hereditary breast and ovarian cancer syndrome. RRSO was planned, and magnetic resonance imaging revealed a large cystic tumor in the right lower abdomen. We expected an ovarian cyst; however, it was a primary tumor of the appendix. Partial cecal resection was performed laparoscopically by a surgical oncologist. The pathological diagnosis was LAMN. Gynecologists may encounter this disease incidentally. Mucinous appendiceal neoplasm (MAN) may be encountered during RRSO. If a right lower abdominal mass is found near a normal ovary preoperatively, gynecologists should consider MAN as well as paraovarian cyst.
Insights
Low-grade appendiceal mucinous neoplasm (LAMN), a rare appendix cancer, was incidentally found during ovarian cancer risk-reducing surgery. Early detection during gynecological procedures is crucial for managing this condition.
Area of Science:
- Gastroenterology
- Gynecologic Oncology
- Pathology
Background:
- Low-grade appendiceal mucinous neoplasm (LAMN) is a rare appendix malignancy.
- Perforation can lead to pseudomyxoma peritonei, a serious condition.
- Risk-reducing salpingo-oophorectomy (RRSO) is performed for hereditary breast and ovarian cancer syndrome.
Observation:
- A 53-year-old woman with hereditary breast and ovarian cancer syndrome underwent RRSO.
- Preoperative MRI revealed a large cystic tumor in the right lower abdomen, initially presumed to be ovarian.
- Laparoscopic surgery revealed the tumor to be a primary appendiceal neoplasm, not an ovarian cyst.
Findings:
- The incidentally discovered appendiceal tumor was diagnosed pathologically as LAMN.
- The patient underwent successful laparoscopic partial cecal resection.
- This case highlights the potential for LAMN to be mistaken for ovarian pathology.
Implications:
- Gynecologists performing RRSO may encounter incidental mucinous appendiceal neoplasms (MAN).
- Preoperative imaging of right lower abdominal masses near normal ovaries should include MAN in the differential diagnosis.
- Prompt recognition and surgical management are essential to prevent complications like pseudomyxoma peritonei.
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