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Kaneko M, Kawai K, Nozawa H, Hata K, Tanaka T, Nishikawa T, Shuno Y, Sasaki K, Emoto S, Murono K, Ishii H, Sonoda H, Watadani T, Takao H, Abe O, Ishihara S. Utility of computed tomography and 18 F-fluorodeoxyglucose with positron emission tomography/computed tomography for distinguishing appendiceal mucocele caused by mucinous adenocarcinoma from other pathologies. Colorectal Dis 2020; 22:1984-1990. [PMID: 32780478 DOI: 10.1111/codi.15308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 08/04/2020] [Indexed: 02/08/2023]
Abstract
AIM Differentiating appendiceal mucocele with mucinous adenocarcinoma from other pathologies before surgery is difficult. The objective of this study was to evaluate the utility of CT and 18 F-fluorodeoxyglucose (FDG) with positron emission tomography (PET)/CT for differentiating mucinous adenocarcinoma of appendiceal mucocele from other pathologies. METHOD The study included 25 patients who underwent surgery for clinically diagnosed appendiceal mucoceles detected on CT at the University of Tokyo Hospital. Among these patients, 19 underwent FDG-PET/CT preoperatively. We compared features of the CT imaging findings and maximum standard uptake values (SUVmax ) detected by FDG-PET/CT between mucocele with mucinous adenocarcinoma and other pathologies. RESULTS A total of 13 men (52%) and 12 women (48%) were included in this study, with a median age of 65 years (range 34-83). There were six patients (24%) with pathologically confirmed mucinous adenocarcinoma, 15 patients (60%) with appendiceal mucinous neoplasm and four patients (16%) with simple mucocele caused by chronic inflammation. On the CT findings, wall irregularity was the only significant feature for the two groups in this study (83.3% vs 0.0%, P < 0.01). There was a significant difference in the SUVmax levels on PET/CT between the two groups (100.0% vs 20.0%, P < 0.01). CONCLUSION Distinguishing between mucocele with mucinous adenocarcinoma and other pathologies using imaging modalities is challenging. Our results suggest that wall irregularity on CT and elevated SUVmax on PET/CT are useful factors that can be employed for such discrimination.
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Affiliation(s)
- M Kaneko
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - K Kawai
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - H Nozawa
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - K Hata
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - T Tanaka
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - T Nishikawa
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - Y Shuno
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - K Sasaki
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - S Emoto
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - K Murono
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - H Ishii
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - H Sonoda
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - T Watadani
- Department of Radiology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - H Takao
- Department of Radiology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - O Abe
- Department of Radiology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
| | - S Ishihara
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Bunkyo-ku, Japan
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McKenna M, Suárez-Bonnet A, Smith K, Stewart S. Diagnosis and treatment of a caecal mucocoele in a dog. J Small Anim Pract 2020; 62:305-309. [PMID: 32974903 DOI: 10.1111/jsap.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 07/25/2019] [Accepted: 08/09/2019] [Indexed: 11/28/2022]
Abstract
An 11-year-old male intact Staffordshire Bull terrier was referred for diabetic ketoacidosis. Abdominal ultrasonographic examination revealed a 5 cm × 2 cm intraluminal caecal mass-like structure. Exploratory laparotomy and typhlectomy were subsequently performed. Histopathology of the caecal mass-like structure was consistent with a caecal mucocoele, defined as a cystic dilation of the caecal lumen with stasis of mucus. This lesion has been previously described in humans, where it is termed an appendiceal mucocoele. The patient was euthanased 58 days post-operatively due to unrelated diabetic complications.
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Affiliation(s)
- M McKenna
- Department of Clinical Science and Services, Royal Veterinary College, North Mymms, Hertfordshire, AL9 7TA, UK
| | - A Suárez-Bonnet
- Department of Pathobiology and Population Sciences, Royal Veterinary College, North Mymms, Hertfordshire, AL9 7TA, UK
| | - K Smith
- Department of Pathobiology and Population Sciences, Royal Veterinary College, North Mymms, Hertfordshire, AL9 7TA, UK
| | - S Stewart
- Department of Clinical Science and Services, Royal Veterinary College, North Mymms, Hertfordshire, AL9 7TA, UK
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Shiihara M, Ohki T, Yamamoto M. Preoperative Diagnosis and Surgical Approach of Appendiceal Mucinous Cystadenoma: Usefulness of Volcano Sign. Case Rep Gastroenterol 2017; 11:539-544. [PMID: 29033775 PMCID: PMC5637000 DOI: 10.1159/000480374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 08/15/2017] [Indexed: 02/03/2023] Open
Abstract
We report a case of appendiceal mucinous cystadenoma that was successfully diagnosed preoperatively and treated by laparoscopic resection. We could find volcano sign on colonoscopy and cystic lesion without any nodules at the appendix on computed tomography (CT). Without any malignant factors in preoperative examinations, we performed laparoscopic appendectomy including the cecal wall. We could avoid performing excessive operation for cystadenoma with accurate preoperative diagnosis and intraoperative finding and pathological diagnosis during surgery. Appendiceal mucocele is a rare disease that is divided into 3 pathological types: hyperplasia, cystadenoma, and cystadenocarcinoma. The surgical approaches for it remain controversial and oversurgery is sometimes done for benign tumor, because preoperative diagnosis is difficult and rupturing an appendiceal tumor results in dissemination. Based on our study, volcano sign on colonoscopy and CT findings were important for the preoperative diagnosis of appendiceal mucocele. Furthermore, we think that laparoscopic resection will become a surgical option for the treatment of appendiceal mucocele.
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Affiliation(s)
- Masahiro Shiihara
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takeshi Ohki
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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Idris LO, Olaofe OO, Adejumobi OM, Kolawole AO, Jimoh AK. Giant mucocele of the appendix in pregnancy: A case report and review of literature. Int J Surg Case Rep 2015; 9:95-7. [PMID: 25744561 PMCID: PMC4392372 DOI: 10.1016/j.ijscr.2015.02.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Mucocoele of the appendix is an obstructive dilatation of the appendix by intraluminal accumulation of mucoid material. Mucocoeles may develop by one of four processes: Retention cysts, Mucosal hyperplasia, Cystadenomas, and Cystadenocarcinomas. The clinical presentation of a mucocele is nonspecific and often an incidental finding at operation for acute appendicitis. If mucocoele is allowed to rupture either spontaneously or during surgery, the escape of mucin and epithelial cells into the peritoneal cavity - Pseudomyxoma Peritonei - may occur. PRESENTATION OF CASE We present the case of a 35 years old pregnant woman, who was admitted to the accident and emergency department with history and ultrasound findings suggestive of acute appendicitis. The ultrasound scan also confirmed a viable fetus at about 23week's gestational age. She had an open appendectomy. The intra-operative findings were an enlarged, tense, cystic retro-caecal appendix which was about 14cm×5cm×3cm in dimensions. Histopathological examination confirmed mucocoele of the appendix. She had normal vaginal delivery at term and postoperative follow up for 1 year was uneventful. DISCUSSION Mucocele of the appendix is an uncommon disorder with nonspecific presentation ranging from asymptomatic disease diagnosed incidentally to clinical features of appendicitis. The treatment is surgery. CONCLUSION Appendiceal mucocoele is difficult to diagnose preoperatively, and a giant size of the simple mucocoele may be connected to hormonal influence of pregnancy. In the index case, as in majority of cases, the definitive diagnosis is made at surgery.
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Affiliation(s)
- Lateef O Idris
- Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.
| | - Olaniyi O Olaofe
- Department of Pathology, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.
| | - Olaniyi M Adejumobi
- Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.
| | - Adedayo O Kolawole
- Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.
| | - Ademola K Jimoh
- Department of Surgery, Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria.
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Kameda T, Kawai F, Taniguchi N, Omoto K, Kobori Y, Arakawa K. Evaluation of whether the ultrasonographic onion skin sign is specific for the diagnosis of an appendiceal mucocele. J Med Ultrason (2001) 2014; 41:439-43. [DOI: 10.1007/s10396-014-0527-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/30/2014] [Indexed: 12/27/2022]
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Use of FDG/PET CT to diagnose malignancy as the cause of mucocele of the appendix. Indian J Gastroenterol 2014; 33:79-81. [PMID: 23982705 DOI: 10.1007/s12664-013-0381-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 07/30/2013] [Indexed: 02/04/2023]
Abstract
Mucocele of the appendix is an uncommon condition characterized by luminal distension and accumulation of a mucoid material. Occasionally, it can be caused due to malignancy like cystadenocarcinoma, and the preoperative diagnosis of which is very rare. We report a case of a 64-year-old lady presenting with intermittent abdominal pain diagnosed on ultrasonography as a mucocele where preoperative (18)F-flurodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT) findings raised a strong suspicion of malignancy. FDG PET/CT findings brought about a change in therapeutic plan, and the patient was considered for a more extensive surgical resection. The final histopathology revealed cystadenocarcinoma as the cause of appendicular mucocele, a finding hitherto undescribed on FDG PET/CT.
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Wakui N, Fujita M, Yamauchi Y, Takeda Y, Ueki N, Otsuka T, Oba N, Nishinakagawa S, Takezoe T, Hiroyoshi J, Kono Y, Katahira S, Minagawa M, Takeda Y, Shiono S, Kojima T. Mucinous cystadenocarcinoma of the appendix in which contrast-enhanced ultrasonography was useful for assessing blood flow in a focal nodular lesion in the tumor cavity: A case report. Exp Ther Med 2013; 6:3-8. [PMID: 23935709 PMCID: PMC3735569 DOI: 10.3892/etm.2013.1094] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/25/2013] [Indexed: 12/19/2022] Open
Abstract
A 63-year-old woman was admitted to hospital with pain in the right lower quadrant. Abdominal computed tomography (CT) revealed a 60-mm cystic mass at a site corresponding to the appendix. The mass wall on the appendicular ostium was thickened and enhanced by contrast, while calcification was observed in the mass wall on the appendicular tip. No projection was observed in the mass cavity. On abdominal ultrasonography (US), the mass wall on the appendicular ostium was thickened and projections were observed at two sites in the mass cavity. On contrast-enhanced US (CEUS), only one of these projections was enhanced. Based on the thickened and contrast-enhanced wall of the mass on the appendicular ostium on CT and US, as well as the contrast enhancement of a projection on US, the mass was diagnosed as mucinous cystadenocarcinoma of the appendix. Ileocecal resection was subsequently performed on day 10. A detailed examination of the surgical specimen revealed carcinoma cells in the mass wall on the appendicular ostium. The contrast-enhanced projection was identified as granulation tissue that had grown to come into contact with the tumor, while the non-contrast-enhanced projection was identified as solidified mucus. US enabled successful visualization of projections in the mass cavity that were not visible on abdominal CT. CEUS also proved useful for assessing blood flow in these projections.
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Affiliation(s)
- Noritaka Wakui
- Departments of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan
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Karakaya K, Barut F, Emre AU, Ucan HB, Cakmak GK, Irkorucu O, Tascilar O, Ustundag Y, Comert M. Appendiceal mucocele: Case reports and review of current literature. World J Gastroenterol 2008; 14:2280-3. [PMID: 18407611 PMCID: PMC2703862 DOI: 10.3748/wjg.14.2280] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The mucocele of the appendix is an uncommon disorder which is often asymptomatic but sometimes causes acute appendicitis-like symptoms. Sometimes, patients with mucocele can present with confusing symptoms. Preoperative suspicion and diagnosis of appendiceal mucocele are important. Ultrasonography and computed tomography are useful tools for the diagnosis of appendiceal mucocele. It may be also recognised by colonoscopy as a smooth submucosal lesion of the cecum. Optimal management of the mucocele could be achieved through accurate preoperative diagnosis. Preoperative diagnosis is a major component for minimizing intra-operative and post-operative complications. We herein report five cases and discuss the diagnostic methods and surgical treatment.
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Massive mucinous cystadenoma of the appendix with intussusception in an adult: usefulness of reconstructed computed tomography images. ACTA ACUST UNITED AC 2008; 26:88-91. [PMID: 18301985 DOI: 10.1007/s11604-007-0201-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2007] [Accepted: 10/17/2007] [Indexed: 10/22/2022]
Abstract
We present an adult patient with a massive mucinous cystadenoma of the appendix that induced intussusception. Multiplanar reconstruction images and maximum intensity projection images enabled us to assess the tumor accurately and characterize the intussusception. Thus, reconstructed computed tomographic images proved highly useful for diagnosis.
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10
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Bartlett C, Manoharan M, Jackson A. Mucocele of the appendix - a diagnostic dilemma: a case report. J Med Case Rep 2007; 1:183. [PMID: 18093329 PMCID: PMC2245959 DOI: 10.1186/1752-1947-1-183] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2007] [Accepted: 12/19/2007] [Indexed: 11/17/2022] Open
Abstract
Introduction Mucocele of the appendix secondary to mucinous cystadenoma is a rare clinical finding. Clinical presentation is varied with more than half being asymptomatic. Case presentation We report such a case presenting to the surgeons where initial clinical findings and investigations suggested an ovarian cyst. The patient was subsequently referred to the Gynaecologists for further management. In spite of extensive preoperative investigations, the diagnosis was only made at the time of surgery. Conclusion In women presenting with a right iliac fossa mass and clinical features not indicative of gynaecological pathology, an appendiceal origin should be considered in the differential diagnosis.
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Affiliation(s)
- Ciprian Bartlett
- Department of Obstetrics and Gynaecology, Homerton University NHS Foundation Trust, London, UK.
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11
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Abstract
Mucocele of the appendix is a rare lesion, characterized by distension of the lumen due to accumulation of mucoid substance. This disease is often asymptomatic and pre-operative diagnosis is rare. If untreated, one type of mucocele may rupture producing a potentially fatal entity known as pseudomyxoma peritonei. The type of surgical treatment is related to the dimensions and to histology of the mucocele. Appendectomy is used for simple mucocele or for cystadenoma. Right hemi-colectomy is recommended for cystadenocarcinoma. In this paper, we report a case of a 51-year-old woman with a mobile, painless mass in the right lower quadrant of abdomen caused by a giant appendiceal mucocele. Imaging showed a large, tubular, cystic structure extending below from the inferior wall of the cecum. Surgery revealed a giant retro-cecal appendix measuring 17 cm in length and 4 cm in diameter. The final pathologic diagnosis was mucocele caused by mucinous cystadenoma.
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Affiliation(s)
- Bernardino Rampone
- Department of General Surgery and Surgical Oncology, University of Siena, Italy
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Kitamura T, Nakase H, Kobayashi T, Osawa T, Tsuchiya SI. Recovery from idiopathic thrombocytopenic purpura (ITP) following right hemicolectomy for mucocele of appendix. J Gastroenterol 2005; 40:752-5. [PMID: 16082593 DOI: 10.1007/s00535-005-1620-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Accepted: 02/04/2005] [Indexed: 02/04/2023]
Abstract
A 61-year-old woman with a 2-year medication-free history of idiopathic thrombocytopenic purpura was referred to our hospital complaining of right lower abdominal pain. The platelet count was about 3-4x10(4)/mm3. This patient was diagnosed with mucocele of the appendix on computed tomography and colonoscopy. We performed only right hemicolectomy without splenectomy. The pathological diagnosis was mucinous cystadenoma of the appendix. The platelet count increased to 18.1x10(4)/mm3 on postoperative-day 7, and remained stable, at 20-24x10(4)/mm3, for 14 months after the operation. Platelet-associated immunoglobulin G decreased remarkably after the operation, to 30.2 ng/10(7) cells, from 240 ng/10(7) cells preoperatively. We describe the first case of recovery from idiopathic thrombocytopenic purpura following right hemicolectomy performed for mucocele of the appendix. Considering our patients clinical course, it is possible that mucinous cystadenoma of the appendix may have influenced the thrombocytopenia. Findings in this patient suggest that mucocele of the appendix may be associated with a new diagnosis and idiopathic thrombocytopenic purpura treatment.
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13
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Kalu E, Croucher C. Appendiceal mucocele: a rare differential diagnosis of a cystic right adnexal mass. Arch Gynecol Obstet 2004; 271:86-8. [PMID: 15316825 DOI: 10.1007/s00404-004-0663-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2004] [Accepted: 06/08/2004] [Indexed: 10/26/2022]
Abstract
CASE REPORT We present the case of a 42-year-old woman with an incidental finding of a large right adnexal mass during pelvic ultrasound scan for a spontaneous miscarriage. Ultrasound suggested the mass was ovarian in origin and serum Ca125 was normal. Laparotomy, however, revealed normal ovaries with no ovarian pathology. The right adnexal mass was appendiceal in origin and was delivered intact with no spillage. Histology confirmed a diagnosis of mucinous cystoadenoma of the appendix. DISCUSSION Pre-operative diagnosis of this condition is difficult. Various radiological tools including CT scans, MRI, and ultrasound scans have been used with poor results. Pre-operative diagnosis would be useful, as extra measures could be taken to avoid intra-peritoneal rupture during surgery with the consequent development of pseudomyxoma peritonei. For a similar reason, needle aspiration should be avoided. In malignant cases co-existing ovarian neoplasm must be excluded as this will be present in 2-24% of cases. Simple appendicectomy is curative in uncomplicated, unruptured cases. CONCLUSION Although relatively rare, appendiceal tumours should be considered in women who present to gynaecologists with a right adnexal mass.
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Affiliation(s)
- Emmanuel Kalu
- Colchester General Hospital, Turner Road, Colchester CO4 5YL, UK.
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Zagrodnik DF, Rose DM. Mucinous cystadenoma of the appendix: diagnosis, surgical management, and follow-up. ACTA ACUST UNITED AC 2004; 60:341-3. [PMID: 14972272 DOI: 10.1016/s0149-7944(02)00728-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE To review the diagnostic examination and clinical presentation of mucinous cystadenoma of the appendix. METHODS Case report from experience at an Air Force tertiary care hospital in a 66-year-old woman with chronic right lower quadrant pain. RESULTS After extensive preoperative evaluation and subsequent diagnostic laparoscopy, a right hemicolectomy was performed for a mucinous cystadenoma of the appendix. CONCLUSIONS Appendiceal mucinous cystadenoma is a rare entity found in only 0.3% of appendiceal specimens. Preoperative evaluation with radiologic and endoscopic methods is helpful but not always diagnostic. Although a benign disease process, complications from rupture, invasion into adjacent organs, or recurrence warrant adherence to strict oncologic principles for resection.
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Abstract
A 78-year-old man was incidentally discovered to have an asymptomatic right lower quadrant abdominal mass during physical examination for influenza. CT scan of the abdomen revealed a cystic sausage-shaped lesion arising from the cecum. Diagnostic laparoscopy revealed an appendiceal mucocele. There was no ascites or metastatic peritoneal nodules. Laparoscopic excision of the unruptured appendiceal mucocele was achieved. Histopathologic examination of the mucocele showed epithelial dysplasia, a feature diagnostic of a mucinous cystadenoma. The patient was discharged on postoperative day one and recovered uneventfully. No analgesic was required after surgery. The patient remained well and symptom-free during the follow-up period. The laparoscopic approach allows diagnostic laparoscopy and appendectomy to be performed, and confers the advantages of minimal-access surgery, including the avoidance of a large incision, a better cosmetic outcome, and a short convalescent period.
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Affiliation(s)
- Hung Lau
- Department of Surgery, University of Hong Kong Medical Center, Tung Wah Hospital, Hong Kong SAR, China.
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Affiliation(s)
- S L Khan
- Department of Surgery, Luton and Dunstable Hospital, Luton LU4 0DY, UK.
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17
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Abstract
Pseudomyxoma peritonei is a clinical entity that has lead to much confusion about its etiology, clinical manifestations, treatment, and prognosis. Pseudomyxoma peritonei is currently defined as a grade I mucinous adenocarcinoma that arises from a primary appendiceal adenoma. The clinical entity is defined by a redistribution phenomenon. This means that cancer cells from the appendix tumor are found localized at predetermined sites within the abdomen and pelvis but that the primary tumor may be small and inconspicuous. The small bowel is spared of mucinous tumor, while spaces beneath the hemidiaphragms and within the pelvis are filled by disease. The omentum is massively replaced by tumor in most patients. The disease, when treated by multiple surgical procedures, presents a median survival of approximately 2 years. Good results depend on early diagnosis and treatment before large volumes of disease and multiple surgical procedures lead to small bowel entrapment by tumor. In modern therapy using peritoneotomy procedures and intraperitoneal chemotherapy with mitomycin C and 5-fluorouracil, the long-term survival at 10 years approaches 80 percent.
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Affiliation(s)
- P H Sugarbaker
- Cancer Institute, Washington Hospital Center, DC 20010, USA
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Fallon MJ, Low VH, Yu LL. Mucinous cystadenoma of the appendix with unusual sonographic appearances. AUSTRALASIAN RADIOLOGY 1994; 38:339-41. [PMID: 7993267 DOI: 10.1111/j.1440-1673.1994.tb00214.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A case of an appendiceal cystadenoma resulting in a large mucocele in a 35 year old man presenting with abdominal pain is reported. On ultrasonography, an unusual appearance of strand-like layers of varying echo-texture suggesting a solid lesion was seen. On computed tomography, calcification and contrast enhancement of the rim was noted. The spectrum of imaging appearances of appendix mucoceles is reviewed.
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Affiliation(s)
- M J Fallon
- Department of Radiology, Sir Charles Gairdner Hospital, Nedlands, Australia
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Blair NP, Bugis SP, Turner LJ, MacLeod MM. Review of the pathologic diagnoses of 2,216 appendectomy specimens. Am J Surg 1993; 165:618-20. [PMID: 8488947 DOI: 10.1016/s0002-9610(05)80446-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A retrospective review of 2,216 patients surgically treated for a clinical diagnosis of acute appendicitis was performed. In 80% of cases, histologic acute appendicitis was found; 57% of these patients were male. The rate of normal appendectomy was 16%, and females comprised 68% of that group. The remaining 102 cases (4%) were designated as the alternate diagnosis group. Apart from histologic diagnoses that could be considered variants of normal (57) or acute inflammation (20), the alternate diagnosis group included such entities as neoplasm, parasitic infection, mucocele, and diverticulitis.
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Affiliation(s)
- N P Blair
- Department of General Surgery, Royal Columbian Hospital, New Westminster, British Columbia, Canada
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Smith JW, Kemeny N, Caldwell C, Banner P, Sigurdson E, Huvos A. Pseudomyxoma peritonei of appendiceal origin. The Memorial Sloan-Kettering Cancer Center experience. Cancer 1992; 70:396-401. [PMID: 1319813 DOI: 10.1002/1097-0142(19920715)70:2<396::aid-cncr2820700205>3.0.co;2-a] [Citation(s) in RCA: 108] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pseudomyxoma peritonei is a rare clinical entity in which the peritoneal surfaces and omentum are involved with diffuse gelatinous mucinous implants. It originates from ruptured mucinous tumors of the appendix or ovary. METHODS The authors examined the experience with 34 patients with pseudomyxoma peritonei seen at Memorial Sloan-Kettering Cancer Center from 1952-1989. Of these, 17 cases were identified to be of appendiceal origin. RESULTS All patients underwent celiotomy and cytoreduction. The median survival time from diagnosis was 75 months. It was found that long-term survival can be achieved by operation alone. When conditions do recur, chemotherapy may be valuable. CONCLUSIONS Pseudomyxoma peritonei of appendiceal origin is a rare low-grade malignancy. Initial treatment consists of cytoreduction in an attempt to render the patient locally disease-free. Long-term survival can be obtained by operation alone, even if gross disease is present at the end of the procedure. Systemic chemotherapy should be reserved for patients with proven recurrence.
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Affiliation(s)
- J W Smith
- Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021
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21
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Abstract
We discussed the proper management of patients with asymptomatic lesions incidentally found during laparotomy for other problems. For common or important lesions, information about the natural history, significance, treatment guidelines, and possible risks or complications related to operations on such incidentalomas were given. Thus, we discussed gallstones, masses of the upper and lower gastrointestinal tract, and masses in solid organs, such as liver, ovaries, and pancreas.
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Affiliation(s)
- M C Soteriou
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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22
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Corder AP, Masters A, Heald RJ. Sigmoid invasion as a late complication of mucinous cystadenoma of the appendix. Report of a case. Dis Colon Rectum 1990; 33:619-20. [PMID: 2361433 DOI: 10.1007/bf02052220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
A cystic mass arising from the right iliac fossa was an incidental finding at laparotomy and was treated conservatively after a biopsy had shown no evidence of malignancy. Nine years later the patient presented with shock and colonic bleeding. A large cystic lesion arising from the vermiform appendix and invading the sigmoid colon was found and excised. Histologic examination indicated that the underlying lesion was an inflamed mucinous cystadenoma of the appendix. Frank invasion of viscera by such lesions has not previously been described. Complications of such lesions and their association with other colonic neoplasms are discussed.
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Affiliation(s)
- A P Corder
- Department of Surgery, Basingstoke District Hospital, Hants, United Kingdom
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23
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Yoshida Y, Kamegawa T, Sugio K, Haraguchi Y, Kitagawa S. Mucocele of the appendix accurately diagnosed using computer tomography. Clin Imaging 1990; 14:61-3. [PMID: 2322886 DOI: 10.1016/0899-7071(90)90122-r] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Mucocele of the appendix is rare so an accurate preoperative diagnosis is very difficult. We report, using computer tomography (CT) in combination with other diagnostic methods, one such correct preoperative diagnosis.
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Affiliation(s)
- Y Yoshida
- Department of Gastrointestinal Clinic, Sawara Hospital, Fukuoka, Japan
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24
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Sugarbaker PH, Kern K, Lack E. Malignant pseudomyxoma peritonei of colonic origin. Natural history and presentation of a curative approach to treatment. Dis Colon Rectum 1987; 30:772-9. [PMID: 2820671 DOI: 10.1007/bf02554625] [Citation(s) in RCA: 116] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Pseudomyxoma peritonei is an unusual malignancy arising from the goblet cells of the large bowel or appendix. Its characteristic clinical features are low histologic grade of malignancy and widespread dissemination throughout the abdominal cavity. In a clinical study of 14 patients, the most common initial symptoms were abdominal distention or right lower quadrant pain suggestive of appendicitis. All patients underwent radical procedures in an attempt to surgically remove all gross disease from the abdomen. Six patients had small-bowel obstruction and five of these had bowel function restored. All of eight patients had relief from bulky intra-abdominal tumors. Six cycles of intraperitoneal 5-FU and three doses of mitomycin C were used following cytoreductive surgery in seven patients. Five of these seven patients are disease free following staging by celiotomy with two- to four-year follow-up. This new treatment strategy, designed to cure some patients with pseudomyxoma peritonei, has given favorable results in a disease that previously had a uniformly lethal outcome.
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Affiliation(s)
- P H Sugarbaker
- Emory University School of Medicine, Atlanta, Georgia 30322
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25
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Abstract
A case of a huge, self-contained cyst of pseudomyxoma peritonei arising from the rupture of a benign cystadenoma of the appendix is reported. Curative surgical removal involved both small bowel and right colon resection. The pathologic spectrum of the appendiceal mucoceles, from mucosal hyperplasia to benign cystadenoma and malignant cystadenocarcinoma, is presented. The variants of pseudomyxoma peritonei (benign-malignant, localized-diffuse) are discussed and correlated with the appendiceal lesions. Clinicopathologic relationships and treatment options also are covered.
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26
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Hoag GN, Thompson D, Chochinov H. Mucinous cystadenoma of the appendix: a case report of the diagnoses and management. J Surg Oncol 1983; 24:205-8. [PMID: 6632907 DOI: 10.1002/jso.2930240312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Cystadenoma of the appendix as a factor in the formation of mucous cysts (mucocele) of the appendix is well recognized. The diagnosis can be made in patients prior to surgery if appropriate investigations are utilized. A 66-year-old white woman with a complaint of increased frequency of bowel movements was investigated and a primary diagnosis of mucocele of the appendix was made preoperatively. As cecal involvement was suggested by these studies, a limited cecal resection was planned. These findings were confirmed at surgery. The appendectomy and limited cecal resection was curative for mucinous cystadenoma of the appendix.
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