The Varied Presentation of Appendiceal Mucinous Neoplasms: A Rural Case Series

Appendiceal mucinous neoplasms (AMNs) are a rare and heterogeneous disease. Failure to promptly recognize AMNs can lead to rupture, peritoneal seeding, and pseudomyxoma peritonei (PMP). We present five cases in rural Australia in whom AMN was suspected or identified preoperatively, intraoperatively, or via histopathology. Three of our cases were males, with an age range of 47-89 years. Intraoperative findings varied from dilated appendices with mucinous content, large well-circumscribed masses, to perforated tumors with peritoneal dissemination and PMP. Surgical interventions included laparoscopic appendicectomies, open appendicectomy via Lanz incision or midline laparotomy, and a diagnostic laparotomy for biopsy of a perforated tumor. One patient required cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, and another received palliative chemotherapy. In conclusion, familiarity with AMN treatment is pertinent to their rising incidence - we are the first to explore strategies for management of this rare but important condition in rural Australia.