Appendiceal Mucocele Research Articles

Appendiceal mucocele due to mucinous cystadenocarcinoma arising from the appendiceal stump: preoperative diagnosis based on the “onion skin sign”

Appendiceal mucocele is defined as enlargement of the appendix due to the intraluminal accumulation of mucoid material. It is an unusual lesion with variable, nonspecific clinical manifestations. Imaging plays an important role in the diagnosis and evaluation of the mucocele. Preoperative diagnosis is mandatory for proper surgical intervention to prevent perforation and spillage of the mucinous material into the peritoneal cavity, which otherwise results in pseudomyxoma peritonei [1–3]. Development of a mucocele in a patient who previously underwent an appendectomy is an extremely rare entity, with only a few case reports in the literature [2–5]. In this paper, we report a case of a mucocele due to mucinous cystadenocarcinoma in a patient with a history of previous appendectomy who presented with acute abdomen-like symptoms. Preoperative diagnosis was made based on the sonographic ‘‘onion skin sign.’’

Pseudomyxoma Peritonei: More Questions Than Answers

Pseudomyxoma Peritonei: More Questions Than Answers

Rupture of appendiceal mucocele due to endometriosis: report of a case.

We report a rare case of a mucocele of the appendix due to endometriosis which accidentally ruptured prior to surgery. A 56-year-old woman was referred to our institution for further evaluation of a cecal tumor. Colonoscopy showed a submucosal tumor at the appendiceal orifice in the cecum. Computed tomography and magnetic resonance imaging showed a well-circumscribed mass measuring 4cm in diameter in the right lower quadrant. A preoperative diagnosis of a simple mucocele of the appendix was established. At laparotomy, a mucocele was identified in the right side of the abdomen; however, part of the mucocele had ruptured and yellow mucin was seen around the cecum. An ileocecal resection was performed. Histopathological examination was consistent with a mucocele of the appendix due to endometriosis. Cytology specimens from the yellow mucin showed few proliferating epithelial cells with a mild degree of cytological and architectural atypia. Mechanical pressure due to excess anteflexion during administration of epidural anesthesia may have contributed to the rupture of the mucocele. It is important to handle a mucocele of the appendix with great care to avoid rupture at the time of operation, including during the administration of epidural anesthesia.

Xanthogranulomatous Appendicitis

A 78-years-old man presented with right lower quadrant pain for 2months. Computed tomography revealed an irregular and multicystic mass near the cecum like as appedeceal mucocle. The lesion was diagnosed xanthogranulomatous appendicitis by histopathological findings of surgical specimen. Xanthogranuloma is uncommon disease, especially in the appendix. We report an interesting case of xanthogranulomatous appendicitis mimicking appendiceal mucocele in radiological images.

Large mucocele of appendix

A 50-year-old lady presented with right-sided abdomen pain of three days duration. She had no other complaints. Her clinical assessment, hemogram, liver function tests and serum tumor markers were within normal limits. CT scan of abdomen showed a 15 cm × 5 cm × 5 cm elongated, fluid-filled, thick-walled structure, with curvilinear calcification contiguous with the base of the cecum, and extending into the pelvis on the right side of abdomen (Fig. 1). A preoperative diagnosis of appendiceal mucocele was made. Colonoscopy showed an extrinsic bulge in the ascending colon. Laparoscopy confirmed an appendiceal mucocele measuring 17 cm × 6 cm in size. She underwent laparosocopic appendicectomy. The appendix contained thick, viscid mucus, and histopathology confirmed it as a mucinous cystadenoma. Appendiceal mucocoele is characterized by cystic dilation of the lumen due to obstruction and consequent accumulation of mucus. The incidence is 0.2–0.3 % and is more common in elderly women. Only 50 % of patients are symptomatic; in the rest it is incidentally detected during surgery [1]. A preoperative diagnosis is rarely made; CT scan and ultrasonogram are valuable in establishing the diagnosis. At CT scan, mucocoele appears as a well-encapsulated, round, thin-walled cystic mass. Presence of curvilinear or punctuate wall calcification strongly suggests the diagnosis [2]. All these CT characteristics were seen in our patient as well. References

Mucinous cystadenoma of the appendix mimicking polycystic kidney disease

A 70-year-old Japanese male with auto-somal dominant polycystic kidney disease (AD-PKD) and chronic renal failure presented with abdominal distention. His family history was remarkable for ADPKD in his mother, a brother and a sister. He had been receiving hemodialysis for 10 years and his general health had other-wise been maintained. Computed tomography (CT) in the axial and coronal views showed both kidneys to have been almost completely replaced by multiple cysts and both occupied considerable space in the abdomen, consistent with ADPKD (Figure-1). It was also revealed that the largest cyst, which measured 160 mm in diameter, was located at the lower pole of the right kidney. Renal transcatheter arterial emboliza-tion was performed for both kidneys to achieve volume reduction because abdominal distention usually results from progressive dilatation of re-nal cysts and is therefore one of the most com-mon symptoms of ADPKD. Transcatheter arterial embolization is standard treatment for ADPKD at our hospital. Needle aspiration of the largest cyst was performed at the same time, and the cytological result was benign (Class II). Two years later, the patient presented again with progressive abdominal distention and pain. CT two years after embolization showed that only the largest cyst on the right side was refractory to treatment and had increased in size to 280 mm in diameter, while the other cysts had shrunk (Figure-2). Laparotomy was subsequently per-formed. During exploration of the abdominal cavity, the largest cyst, which was believed to be one of the renal cysts, was identified as be-ing completely separate from the aggregation of other cysts, instead being contiguous with the appendix. We performed an appendectomy together with resection of the largest cyst and right nephrectomy. Histological examination demonstrated mucinous cystadenoma of the ap-pendix. The postoperative course was unevent-ful. The patient has been closely followed up for one year without relapse. Mucinous cystadenoma is accounting for more than half of appendiceal mucoceles, cys-tic neoplasms characterized by distension of the appendiceal lumen with mucus. As histolgical subtypes, appendiceal mucoceles also include retention cysts, mucosal hyperplasia, and cyst-adenocarcinoma (1-4). CT scan or other imaging studies can lead to a presumptive diagnosis of an appendi-ceal mucocele. However, the differential diagno-sis can be challenging and should include cysts of other origins, especially, as in our case, when CT scan or ultrasonography is controversial, but fails to demonstrate the continuity of the lesion with the cecum (5,6). To our knowledge, this is one of the larg-est reported cases of mucinous cystadenoma of the appendix and also the first case associat-ed with ADPKD. There is a case of appendiceal mucinous cystadenoma of the same size as this case, which caused bilateral hydronephrosis and

Acute appendicitis

British Journal of Hospital MedicineVol. 73, No. sup3 Clinical Skills for Postgraduate ExaminationsAcute appendicitisHarold EllisHarold EllisSearch for more papers by this authorHarold EllisPublished Online:16 Aug 2013https://doi.org/10.12968/hmed.2012.73.sup3.C46AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Jeffrey RB, Jain KA, Ngheim HV (1994) Sonographic diagnosis of acute appendicitis; interpretive pitfalls. Am J Roentgenol 162: 55–9 Crossref, Medline, Google ScholarRao PM, Boland GWL (1998) Imaging of acute right lower abdominal quadrant pain. Clin Radiol 53: 639–9 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetailsCited byRare, Unusual Causality of Acute Appendicitis29 August 2020 | Journal of Gastrointestinal Cancer, Vol. 52, No. 2A retrospective study of histopathological features of appendectomy specimens at Amreli district-GujaratJournal of Dr. NTR University of Health Sciences, Vol. 10, No. 4Giant appendix or an appendiceal mucocele? Case report of an 11-year-old childInterventional Medicine and Applied Science, Vol. 6, No. 4Wrist pulse signal classification for inflammation of appendix, pancreas, and duodenumSingle-Incision Laparoscopic Appendectomy26 June 2014Use of blood tests in the diagnosis of acute appendicitis16 August 2013 | British Journal of Hospital Medicine, Vol. 73, No. Sup12 1 March 2012Volume 73Issue sup3ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 16 August 2013 Published in print 1 March 2012 Information© MA Healthcare LimitedPDF download

A case of appendiceal mucocele mistaken for ovarian tetaroma

Appendiceal mucocele is a rare entity that can present in a variety of ways. The incidence is estimated to be 0.2% to 0.3% of appendectomy specimens. Appendiceal mucocele refers to dilatation of the appendiceal lumen by an abnormal accumulation of mucus. It can be confused radiologically with an ovarian teratoma, which may prove to be a diagnostic challenge. Early diagnosis and prompt treatment is important to avoid unintended rupture and the development of pseudomyxoma peritonei. The diagnosis of mucocele of the appendix as well as other appendiceal neoplasms should be considered by the gynecologist in the differential diagnosis of a right-sided adnexal tumor. We report a case of appendiceal mucocele mistaken for ovarian teratoma in a 59-year-old women.

Appendiceal Mucocele Diagnosed in Patients with Inflammatory Bowel Disease Using Endoscopic Ultrasound

When a bulging appendiceal orifice is observed during surveillance colonoscopy, the possibility of appendiceal mucocele must be considered. Appendiceal mucocele is a rare group of lesions characterized by mucinous distension of the appendiceal lumen with the dangerous potential to rupture, resulting in the development of pseudomyxoma peritonei. Early recognition and diagnosis of appendiceal mucocele can prevent the dreaded complication of pseudomyxoma peritonei but it requires a high index of suspicion. Patients with inflammatory bowel disease are at increased risk for colorectal neoplasm but neoplasm of the appendix is infrequently reported. We report two of the first cases of appendiceal mucoceles diagnosed in patients with inflammatory bowel disease using endoscopic ultrasound.

腹腔鏡下回盲部切除術を施行した虫垂粘液囊腫の３例

腹腔鏡下回盲部切除術を施行した虫垂粘液囊腫の３例

巨大阑尾黏液囊肿：一例报道与诊疗分析

患者女，63岁，主诉右下腹部肿块3个月，门诊以结肠肿物收入院。查体在右下腹部触及13 cm × 8 cm × 6 cm 大小包块、质硬、活动、边界欠清。实验室检查：Hb 12.4 g/L、CEA 5.4 μg/L、CA125 24.4 U/mL、CA153 9.6 U/mL及CA19-9 < 2.0 U/mL。B超检查示下腹部条索状囊性包块(首先考虑肠道来源)；腹部CT扫描示盆腔右侧囊性占位性病变；结肠镜检查示回盲部外压性肿物。连硬麻醉下行剖腹探查，术中见右下腹部有一个15 cm × 8 cm × 5 cm腊肠样囊性肿物。术中冰冻病理组织学检查诊断为阑尾黏液囊肿。故决定行阑尾切除术，术后第4天痊愈出院。 A 63-year old female complained of right lower abdominal mass for 3 months, and she was admitted to hos- pital with a diagnosis colon tumor. On physical examination, an abdominal mass was found in her right quadrant, sized in 13 cm × 8 cm × 6 cm, hard, movable with clear margin. Laboratory examination revealed that Hb 12.4 g/L, CEA 5.4 μg/L, CA125 24.4 U/mL, CA153 U/mL and CA19-9 < 2.0 U/mL. A cord-like cystic mass in right abdominal cavity, primitive impression of gastrointestinal tumor, was detected by ultrasound examination, and CT scan demonstrated that a cystic occupation in right pelvic cavity, and exophytic tumor at cecum was found by fibrocolonoscopy. An exploratory laparotomy underwent by epidural anesthesia, a sausage-like tumor with size of 15 cm × 8 cm × 5 cm was seen at right abdominal cavity, and a diagnosis of appendiceal mucocele was made by intraoperative frozen pathological examination, then an appendectomy was performed, ad the patient recovered smoothly after operation and discharged on the 4th op- eration day.

Appendiceal Mucocele in Patients with Inflammatory Bowel Disease Diagnosed Using Endoscopic Ultrasound

Appendiceal Mucocele in Patients with Inflammatory Bowel Disease Diagnosed Using Endoscopic Ultrasound

Uncommon mimics of appendicitis: Giant mucocele

Appendiceal mucocele is an infrequent but well recognized entity that can present with a variety of clinical syndromes or can be asymptomatic and discovered incidentally. A 55 years old patient was admitted in the emergency department for acute right lower quadrant pain. A diagnosis of appendicitis was made. At operation an appendiceal mucocele was found. An appendectomy was performed. The diagnosis of appendiceal mucocele is an important one in that it can be associated with malignancies and other serious gastrointestinal, ovarian, and urological complications.

Appendiceal mucocele in a young patient – does size matter?

Appendiceal mucocele in a young patient – does size matter?

Mucocele of the vermiform appendix misdiagnosed as an adnexal mass on transvaginal sonography

Mucocele of the vermiform appendix is a rare entity that may mimic a right-sided adnexal mass. We describe a case of appendiceal mucocele in a 78-year-old woman that was initially misdiagnosed as a potentially malignant right ovarian tumor and briefly review the literature on sonographic features of this entity. It is important to improve preoperative diagnosis so as to prevent rupture of mucocele at surgery, which may lead to pseudomyxoma peritonei, and also to seek intraoperatively for the presence of synchronous colorectal neoplasms.

Mucocele of Appendix – Rare Entity –A Case Report

Appendiceal mucocele (AM) is a rare entity that can present in a variety of clinical syndrome. The prevalence is 0.2- 0.4 % among appendicectomies.1 A 48 Years old male patient came to our Centre for Nuclear Medicine and Ultrasound (CNMU), Rajshahi for abdominal ultrasound examination. He had pain with vomiting and feeling of lumpiness in right side of lower abdomen. Ultrasonography (US) showed an elongated regular outlined semi-cystic lesion in right iliac fossa. Laparotomy done, per-operative finding reveled AM. Post-operatively histopathological examination report revealed AM.&#x0D; TAJ 2011; 24(1): 54-56

Neuroendocrine Tumor (Carcinoid) of the Appendix With Mucocele

Acute right lower quadrant pain is a common emergency department presentation. Medical imaging has a main role to rule out appendicitis. Distinguishing between appendicitis and the other two major appendix pathologies, mucocele and carcinoid tumors, is not easy, but it is important for medical and surgical management planning. Appendix mobility is not usually assessed during sonography, but is it helpful? When comparing sonography and computerized tomography with histopathology findings to distinguish appendiceal pathologies, appendix mobility was found to be a key component. Appendix diameter, wall thickness, hyperemia, and surrounding echogenic fat are signs of an inflammatory process that will fix the appendix. Appendiceal carcinoids and mucoceles, on the other hand, will not initially have an inflammatory component for years, and thus patients present with only mild recurrent vague abdominal pain, normal blood work, and mild or borderline imaging findings. Sonography should be the first-choice medical imaging modality to rule out appendiceal pathologies because appendix mobility should be assessed and reported.

Appendiceal mucocele mimicking right adnexal mass: a report of 25 cases

To explore the differential diagnosis and pertinent treatment of women with right lower quadrant abdominal mass. The clinical data of 25 women patients with appendiceal mucocele at our hospital from 2000 to June 2010 were recorded. And their clinical presentations, auxiliary examinations and treatment were analyzed retrospectively with the SPSS17.0 software. Among 1157 women undergoing appdicelectomy at our hospital, 25 (2.16%) had appendiceal mucocele. Their mean age was 58.2 years old. Their presenting symptoms and signs were non-specific. Ten cases (40%) were misdiagnosed as adnexal mass. The mass could be palpable by pelvic examination in 80% cases while 66.7% by abdominal examination. For preoperative auxiliary examination, the correct rate of ultrasonogram was 54.2% and CT 60%. The positive rate of carcinoembryonic antigen (CEA) was 57.1% while that of carbohydrate antigen 19 - 9 (CA199) 18.2%. Neither had statistical significance. There were three pathological entities: mucinous cystadenoma, malignant mucinous cystadenocarcinoma and simple retention mucoceles. Because of incidental discovery, the treatment remained variable. The approaches included appendectomy, cecectomy, right hemicolectomy and debulking according to the frozen pathological examination. As a rare condition, appendiceal mucocele is usually misdiagnosed as right adnexal lesion. Because of its anatomic position, it should be considered in the differential diagnosis of adnexal masses. Auxiliary examinations such as ultrasonogram, computed tomography and serum CEA may be helpful for its diagnosis. Its optimal management is achieved through an accurate preoperative identification and subsequently careful resection.

A simple and safe technique for performing single-port laparoscopic resection of appendiceal mucocele

We report a new method of performing single-port laparoscopic surgery for appendiceal mucocele. The key points of our technique are placing a 3/4 circumferential skin incision with multiple radial splits on the confine of the umbilicus, use of a "home-made" multichannel port system, and trimming the skin incision straight through the confine of the umbilicus at the time of wound closure. A 65-year-old woman with appendiceal mucocele, 80 mm in diameter, successfully underwent ileocecal resection by this procedure. She remains in good health without any wound complications 8 months postoperatively.

A Retrospective Study on Mucocele of the Appendix Presented with Acute Abdomen or Acute Appendicitis

Objective We reported the demographic, clinical, radiologic, preoperative and postoperative characteristics and outcomes on patients of appendix mucocele that presented with or operated for acute appendicitis or acute abdomen. Methods A retrospective study. Patients who were presented or operated for acute appendicitis or acute abdomen and had an operative histopathological diagnosis as appendix mucocele (simple mucocele, mucinous cystadenoma, mucinous cystadenocarcinoma) were included. Demographic, clinical, radiologic, preoperative and postoperative data of eligible cases were evaluated. Results From January 2003 to February 2010, a total of 2120 patients with the pre-operative diagnosis of acute appendicitis were treated in our center, and nine (0.42%) patients were diagnosed to have mucocele of the appendix. Seven patients (78%) were female. Average age of the patients was 59.5 (range=25-74). Major complaint was right lower quadrant pain in eight (89%) patients. In preoperative ultrasonographic examination of the patients, appendiceal cystic masses (mucocele) were diagnosed in four (44.5%) patients. In histopathologic examination, the number of patients diagnosed to have simple mucocele was two (22%), mucinous cystadenoma was four (45%), and mucinous cystadenocarcinoma was three (33%). No postoperative morbidity or mortality was noted. Conclusion Appendix mucocele is a rare disease and it is usually diagnosed histopathologicaly in appendectomy specimens. When a cystic mass in appendix is seen during operation, appendiceal mucocele should be kept in mind to avoid iatrogenic perforation causing pseudomyxoma peritonei and possible concomitant malignancies should be searched.