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Table of Contents
CASE REPORT
Year : 2018  |  Volume : 15  |  Issue : 2  |  Page : 116-117

Mucinous cystadenoma of the appendix


1 Department of General Surgery, School of Medicine, Kirikkale University, Kirikkale, Turkey
2 Department of Anesthesiology and Reanimation, School of Medicine, Kirikkale University, Kirikkale, Turkey

Date of Web Publication5-Jul-2018

Correspondence Address:
Oktay Aydin
Department of General Surgery, School of Medicine, Kirikkale University, 71000 Yahsian, Kirikkale
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/am.am_32_18

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  Abstract 

Mucocele is a rare condition caused by the collection of mucus with in the lumen of the appendix. It accounts for 0.2%–0.3% of patients undergoing appendectomy procedure. In this article, we describe the case of a 53-year-old female patient who presented with pain in the right lower quadrant of the abdomen and a clinical pattern likely to a appendicitis. The patient was treated with appendectomy while avoiding perforation of the cyst. The histological specimen revealed mucinous cystadenoma with clear resection lines. The patient was discharged on the second day after surgery without any complications.

Keywords: Acute appendicitis, mucinous cystadenoma, mucocele


How to cite this article:
Aydin O, Pehlivanli F, Karaca G, Aydin G, Özler &, Daphan &E. Mucinous cystadenoma of the appendix. Apollo Med 2018;15:116-7

How to cite this URL:
Aydin O, Pehlivanli F, Karaca G, Aydin G, Özler &, Daphan &E. Mucinous cystadenoma of the appendix. Apollo Med [serial online] 2018 [cited 2022 Dec 1];15:116-7. Available from: https://apollomedicine.org/text.asp?2018/15/2/116/235998


  Introduction Top


Mucocele is a rare condition caused by the collection of mucus with in the lumen of the appendix. It accounts for 0.2%–0.3% of patients undergoing appendectomy procedure.[1] Appendiceal mucocele should not be considered as a single disease. Histological examination of this rare tumor differentiates benign subgroups as retention cyst, mucosal hyperplasia, and cystadenoma, and malignant subgroups as cystadenocarcinoma.[2],[3] Appendiceal mucinous cystadenomas (AMC) account for 63%–84% of all mucoceles.[4] Approximately half of the appendiceal mucoceles are asymptomatic and incidentally detected during radiological investigations or detected during abdominal interventions. Other half manifest with gastrointestinal symptoms including appendicitis.[5]


  Case Report Top


A 53-year-old female patient, who presented to our emergency room due to pain in the right lower quadrant of the abdomen a day before, was referred to our clinic for consultation. The patient had right lower quadrant abdominal pain that started a day before admission and accompanying lack of appetite. On physical examination, the abdomen was distended due to obesity, and there was a 1 cm × 1 cm fascial umbilical defect. There was marked tenderness in the right lower quadrant without guarding or rebound tenderness. Laboratory values: Hgb: 11 g/dl, plt: 314.000/μL, and WBC: 12.600/μL. Direct X-ray was not remarkable. Abdominal ultrasonography revealed a 3 cm × 3 cm focal structure inferoposterior to the caecum in the right lower quadrant and surrounded by fat tissue, which was thought to be suggestive of acute appendicitis or inflammation due to appendiceal mucocele. Computed tomography of the abdomen revealed air-fluid level with a diameter of 35 mm located inferioposterior to the caecum in the right lower quadrant, and proximal diameter of the appendix appeared normal. The results were considered to be mainly suggestive of focal appendicitis. The patient underwent an operation with the prediagnosis of acute appendicitis. During exploration, there was 3 cm × 3 cm cystic lesion distal to the appendix and 1.5 cm proximal portion appeared normal, and appendectomy was performed while avoiding perforation of the cyst [Figure 1] and [Figure 2]. The patient was discharged on postoperative day 2. Pathological examination revealed mucinous cystadenoma.
Figure 1: Mucinous cystadenoma of the appendix

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Figure 2: Specimen of appendiceal mucinous cystadenoma

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  Discussion Top


Appendiceal mucocele is a rare cause of acute abdominal pain and accounts for 0.2%–0.3% of all patients undergoing appendectomy.[1] AMC also represents 63%–84% of all cases with mucocele.[4] Of patients with mucinous cystadenoma, 20% develop into colon adenocarcinoma.[3] Appendiceal mucocele can be asymptomatic, but patients commonly present with a clinical picture resembling acute appendicitis and some patients may also present with abdominal mass, rectal bleeding, ureteral obstruction, hematuria, and intussusception.[6]

Computed tomography and magnetic resonance imaging are useful additional methods in visualizing appendiceal mucocele.[7] The present case underwent abdominal computed tomography in addition to ultrasonography, the findings of which were suggestive of focal appendicitis.

The treatment of unruptured appendiceal mucocele is definitely appendectomy; however, right hemicolectomy can be performed (i) in conditions where complete excision of the primary tumor or complete cyst reduction is required, (ii) in cases with the involvement of lymph nodes, or (iii) in cases in which histopathological examination suggests nonmucinous cysts.[8]

Appendiceal cystadenoma may be complicated by intussusception, intestinal bleeding, urethral or intestinal obstruction, hematuria, rupture, and pseudomyxoma peritonei, which is a result of rupture that could lead to fatality.[9] The prevention of rupture and intra-abdominal dissemination of the mucinous cyst content is very important in avoiding development pseudomyxoma peritonei.[10]

Preoperative diagnosis of mucinous cystadenoma is particularly important for the selection of the surgical method to be employed.[11],[12]

This condition could commonly appear with the clinical presentation of acute appendicitis, and to prevent the development of pseudomyxoma peritonei which is a fatal condition developing as a result of intra-abdominal spread of cyst content, it is important to make a careful preoperative diagnosis, to select open appendectomy by the surgeon. It is also important to have a careful pathological follow-up because both appendix mucocele is a subtype of cystadenoma and also cystadenocarcinoma might develop in 20% of cystadenoma.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Woodruff R. Benign and malignant cystic tumors of the appendix. Surg Gynecol Obstet 1940;71:750-5.  Back to cited text no. 1
    
2.
Aho AJ, Heinonen R, Laurén P. Benign and malignant mucocele of the appendix. Histological types and prognosis. Acta Chir Scand 1973;139:392-400.  Back to cited text no. 2
    
3.
Higa E, Rosai J, Pizzimbono CA, Wise L. Mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma of the appendix. A re-evaluation of appendiceal “mucocele”. Cancer 1973;32:1525-41.  Back to cited text no. 3
    
4.
Park KJ, Choi HJ, Kim SH. Laparoscopic approach to mucocele of appendiceal mucinous cystadenoma: Feasibility and short-term outcomes in 24 consecutive cases. Surg Endosc 2015;29:3179-83.  Back to cited text no. 4
    
5.
Stocchi L, Wolff BG, Larson DR, Harrington JR. Surgical treatment of appendiceal mucocele. Arch Surg 2003;138:585-9.  Back to cited text no. 5
    
6.
Jha NK, Sinha DK, Anand A, Rai MK, Gandhi A, Yadav J, et al. Mucinous cystadenoma of the appendix with enterocutaneous fistula: A therapeutic dilemma. Gastroenterol Rep (Oxf) 2015;3:86-9.  Back to cited text no. 6
    
7.
Connor SJ, Hanna GB, Frizelle FA. Appendiceal tumors: Retrospective clinicopathologic analysis of appendiceal tumors from 7,970 appendectomies. Dis Colon Rectum 1998;41:75-80.  Back to cited text no. 7
    
8.
Caracappa D, Gullà N, Gentile D, Listorti C, Boselli C, Cirocchi R, et al. Appendiceal mucocele. A case report and literature review. Ann Ital Chir 2011;82:239-45.  Back to cited text no. 8
    
9.
Rudek B, von Herbay A, Schmidt J. Intussusception of the appendix secondary to mucinous cystadenoma. Dig Surg 2001;18:422-6.  Back to cited text no. 9
    
10.
Çalışkan K, Yildirim S, Bal N. Mucinous cystadenoma of the appendix: A rare cause of acute abdomen. Turk J Trauma Emerg Surg 2008;14:303-7.  Back to cited text no. 10
    
11.
Bennett GL, Tanpitukpongse TP, Macari M, Cho KC, Babb JS. CT diagnosis of mucocele of the appendix in patients with acute appendicitis. AJR Am J Roentgenol 2009;192:W103-10.  Back to cited text no. 11
    
12.
Karakaya K, Barut F, Emre AU, Ucan HB, Cakmak GK, Irkorucu O, et al. Appendiceal mucocele: Case reports and review of current literature. World J Gastroenterol 2008;14:2280-3.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]



 

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