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CASE REPORT
Year : 2015  |  Volume : 4  |  Issue : 3  |  Page : 182-184

Mucinous cystadenoma of the appendix


Department of Surgery and Pathology, Kurnool Medical College, Government General Hospital, Kurnool, Andhra Pradesh, India

Date of Web Publication15-Sep-2015

Correspondence Address:
Vudutha Srihari
H. No: 46-1M-1-4, Aditya Nagar, A-Camp, Kurnool, Andhra Pradesh
India
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Source of Support: Nil., Conflict of Interest: None declared.


DOI: 10.4103/2277-8632.165405

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  Abstract 

We present a case of 50-year-old man came with abdominal pain for 3 months who was investigated and found to be suffering from mucinous cystadenoma of the appendix for which who have done appendicectomy and ileotransverse anastomosis. Surgical specimen sent to pathology for histopathological examination revealed mucinous cystadenoma of the appendix.

Keywords: Appendicectomy, mucinous cystadenoma of the appendix, pseudomyxoma peritonii


How to cite this article:
Srihari V, Jayaram J, Baleswari G, Sabira S, Kumar M N, Mallikarjuna N. Mucinous cystadenoma of the appendix. J NTR Univ Health Sci 2015;4:182-4

How to cite this URL:
Srihari V, Jayaram J, Baleswari G, Sabira S, Kumar M N, Mallikarjuna N. Mucinous cystadenoma of the appendix. J NTR Univ Health Sci [serial online] 2015 [cited 2020 Apr 5];4:182-4. Available from: http://www.jdrntruhs.org/text.asp?2015/4/3/182/165405


  Introduction Top


Tumors of the appendix are emerging as diseases of increasing concern due to a rising incidence. Primary neoplastic lesions presenting with a mucocele of the appendix are very rare and can be divided into benign variants of mucinous adenomas or cystadenomas, mucinous tumors of uncertain malignant potential or mucinous cystadenocarcinomas. Most of these tumorous mucoceles are asymptomatic and are found incidentally. The major complication of neoplastic mucinous appendiceal tumors is the development of a pseudomyxoma peritonii due to spreading of mucin-producing cells within the abdominal cavity. We present a case of mucinous cystadenoma of the appendix in an elderly patient.


  Case Report Top


A 55-year-old man presented with a history of pain in the lower abdomen on the right side for 3 months. On clinical examination, his vitals are stable. His abdomen was flat and soft with a firm sausage-shaped nontender and nonmobile mass in the right iliac fossa. The clinical diagnosis was ileocecal mass and differential diagnosis of ileocecal tuberculosis. Abdominal ultrasonography revealed a 10 cm × 6 cm × 4 cm cystic mass in the right iliac fossa. Contrast-enhanced computed tomography abdomen shows 10 cm × 6 cm × 4 cm cystic lesion suggestive of mucocele of the appendix [Figure 1]. He was subsequently prepared for an exploratory laparotomy. Intra-operative findings included a sausage shaped, firm appendiceal tumor, which was not attached to the surrounding structures [Figure 2] and [Figure 3].
Figure 1: Computed tomography abdomen contrast scan showing a localized hypodense mass in the cecum (arrow)

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Figure 2: Intra-operative images of mucinous cyst adenoma of appendix

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Figure 3: Intra-operative images of mucinous cyst adenoma of appendix

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Patient underwent laparotomy and diagnosis of mucocele of the appendix confirmed. He underwent appendicectomy along with a rim of cecal wall around the base of appendix and ileotransverse anastomosis. The tumor weighed 150 g. The histology of the appendix was reported as showing extensive pools of mucin in a cystic cavity lined by tall columnar epithelium with an apical mucin [Figure 4] and [Figure 5]. Features are those of mucinous cystadenoma of the appendix. His postoperative recovery was uneventful.
Figure 4: Histopathological image showing mucin in cystic cavities lined by columnar epithelium

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Figure 5: Histopathological image showing mucin in cystic cavities lined by columnar epithelium

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  Discussion Top


Mucinous cystadenoma of the appendix is a rare cystic neoplasm characterized by villous adenomatous changes of the appendiceal epithelium associated with marked distension of the appendiceal lumen with mucin. The most common presentation is pain in right iliac fossa, similar to an acute appendicitis; however, about 25% of patients are asymptomatic and the condition is found incidentally on imaging or at the time of surgery.[1],[2]

It is a rare entity found in 0.3% of appendiceal specimens,[3],[4] with a slight female predominance and an average age at diagnosis of over 50 years.[5]

The term mucocele is usually used to describe a dilatation of the lumen of the appendix due to mucosal secretions. There are four groups that can be identified:

  1. Simple mucocele or retention mucocele, which is due to obstruction of the lumen of the appendix by a fecolith and characterized by normal epithelium with dilatation of the lumen up to 1 cm
  2. Mucosal hyperplasia that constitutes 5-25% of mucoceles
  3. Mucinous cystadenoma, the most common type with an incidence of 63-84%; intraluminal dilatation reaches up to 6 cm and the appendicular perforation up to 20%
  4. 4. Cystadenocarcinoma representing <1%.[6].[7]


The symptoms are nonspecific. The most common form of presentation is pain in the right iliac fossa and palpable mass in 50% of cases, which may be complicated by lower gastrointestinal bleeding, intussusception, or intestinal obstruction as well as genitourinary symptoms.[8] The most serious complication is a pseudomyxoma peritonii, which is caused by peritoneal dissemination caused by a ruptured appendix iatrogenically or spontaneously,[9] a condition involving the spread of adenoma cells throughout the peritoneal cavity in the form of multiple mucinous deposits.

Diagnostic methods include X-rays, abdominal ultrasound, computed tomography scan that allows visualization of the extent of disease, and colonoscopy, which shows an image with "volcano sign" with a central opening from which discharge of mucus can be appreciated.[10]

Differential diagnosis should be established with benign pathologies of the appendix like leiomyoma, neuroma, fibroma and lipoma and other conditions such as mesenteric cysts, hydrosalpinx, carcinoid, lymphoma, intussusception, endometriosis and adenocarcinoma of the appendix.[11]

Although a proper preoperative diagnosis is recommended, fine needle biopsy should not be performed because of the risk of pseudomyxoma dissemination. For the same reason, though the diagnostic therapy should be surgical, a laparoscopic approach is not always advised.[12] Appendectomy by laparotomy is advised for focal or diffuse mucosal hyperplasia and cystadenoma when the appendiceal base is intact. Cecal resection is performed for a cystadenoma with a large base, and a right hemicolectomy recommended for a cystadenocarcinoma. In cases of disseminated pseudomyxoma peritonei, an ultrasonic surgical aspirator can be used.[3],[13]

 
  References Top

1.
Rampone B, Roviello F, Marrelli D, Pinto E. Giant appendiceal mucocele: Report of a case and brief review. World J Gastroenterol 2005;11:4761-3.  Back to cited text no. 1
    
2.
Zanati SA, Martin JA, Baker JP, Streutker CJ, Marcon NE. Colonoscopic diagnosis of mucocele of the appendix. Gastrointest Endosc 2005;62:452-6.  Back to cited text no. 2
    
3.
Zagrodnik DF 2nd, Rose DM. Mucinous cystadenoma of the appendix: Diagnosis, surgical management, and follow-up. Curr Surg 2003;60:341-3.  Back to cited text no. 3
    
4.
Zullo A, Botto G, Pastormerlo M. A case of appendiceal mucocele associated with cancer of the colon. Minerva Chir 1995;50:1095-8.  Back to cited text no. 4
    
5.
Emmi S, Galasso MG, Ursino V, Scala R, Guastella T. Appendiceal mucoceles. A case report. Minerva Chir 1998;53:807-10.  Back to cited text no. 5
    
6.
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. 6
[PUBMED]    
7.
Landen S, Bertrand C, Maddern GJ, Herman D, Pourbaix A, de Neve A, et al. Appendiceal mucoceles and pseudomyxoma peritonei. Surg Gynecol Obstet 1992;175:401-4.  Back to cited text no. 7
    
8.
Pureti M, Hollingworth J, Palaniappan M. Appendiceal mucocele misdiagnosed as an ovarian tumour. J Obstet Gynaecol 2006;26:484-5.  Back to cited text no. 8
    
9.
Stevens KJ, Dunn WK, Balfour T. Pseudomyxoma extraperitonei: A lethal complication of mucinous adenocarcinoma of the appendix. Am J Gastroenterol 1997;92:1920-2.  Back to cited text no. 9
    
10.
Kim SH, Lim HK, Lee WJ, Lim JH, Byun JY. Mucocele of the appendix: Ultrasonographic and CT findings. Abdom Imaging 1998;23:292-6.  Back to cited text no. 10
    
11.
Echenique-Elizondo M, Liron de Robles C, Amondarain Arratíbel JA, Aribe X. Mucocele of the appendix. Cir Esp 2007;82:297-300.  Back to cited text no. 11
    
12.
González Moreno S, Shmookler BM, Sugarbaker PH. Appendiceal mucocele. Contraindication to laparoscopic appendectomy. Surg Endosc 1998;12:1177-9.  Back to cited text no. 12
    
13.
Keating JP, Frizelle FA. Use of ultrasonic surgical aspirator in operative cytoreduction of pseudomyxoma peritonei. Dis Colon Rectum 2000;43:559-60.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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