It is characterized by mucoid accumulation in theappendix lumen and can present with diverse clinical features or just as an asymptomatic mass. It affects preferably adults with an average age between 50 and 60 years 6,7, but can also affect children. The term mucocele is simply a macroscopic description of an appendix that is grossly distended by mucus 7,12. Appendiceal mucocele is a rare but wellrecognized entity that can mimic several common clinical syndromes or present as an incidental surgical or radiological finding. Appendicular mucocele is a rare welldescribed clinicopathological. An appendiceal mucocele is a wellknown but rare entity, where the appendiceal lumen is distended with mucinous material. Preoperative diagnosis of appendiceal mucocele, a rare disease of the vermiform appendix and an important item in the differential diagnosis of the appendiceal mass, is essential 7 to avoid the risk of rupture at surgery, with subsequent development of pseudomyxoma peritonei 8. For that reason, cases identified to have appendiceal mucocele should be assessed carefully with regards to colon neoplasms. Mucocele of the appendix is a descriptive term of a distended, mucusfilled appendix. A simple mucocele or retention cyst exhibits degenerative changes of the epithelium with no epithelial atypia. Appendiceal mucocele is a very rare disease and found in only 0.
They are thought to typically present in middleaged individuals, particularly considering the epidemiology of. Appendicular mucocele am is the chronic transformation of the appendix into a mucusfilled sac. The course and prognosis of appendiceal mucoceles relate to their histologic subtypes. Another rare cause found in literature is endometriosis, which may be established on the wall of the appendix, causing lumen obstruction 8. We examined 38 appendectomies with diagnoses of mucocele, diverticulum, or adenoma to study the coincidence of appendiceal diverticula and appendiceal lowgrade mucinous neoplasms and to. Appendiceal mucoceles are rare and are characterized by a distended, mucusfilled appendix. Mucocele of the appendix is a term used to describe a dilated, mucinfilled appendix. Appendiceal mucocele is a rare entity with a nonspecific preoperative presentation and is diagnosed intraoperatively in a majority of cases.
Discussion appendiceal mucocele is an uncommon affection accounting for 0. The epithelial lining of the appendix consists of abundant exocrine goblet cells, and thus most tumour types seen in appendiceal samples are mucus producing. Pdf on mar 24, 2020, akitoshi inoue and others published letter to editor about a case of appendiceal mucocele due to lowgrade appendiceal mucinous neoplasm correctly differentiated from. Appendiceal mucocele surgical pathology criteria stanford.
Lowgrade appendiceal mucinous neoplasm and endometriosis of. Appendiceal mucocele is a relative rare disease, but appropriate management is critical. Ct of appendiceal mucocele surgical approach may have to be altered to avoid rupture of the mucocele and resultant pseudomyxoma peritonei and for resection of a malignant lesion 6. The frequency of primary appendiceal tumours is reported to be 0. Mucus containing cystic lesions mucocele of the appendix. A gross or clinical descriptive term for dilation of the appendiceal lumen by mucus. This article is from case reports in gastroenterology, volume 5.
Only 12 cases of nonneoplastic appendiceal mucoceles caused by endometriosis have been previously described. The presence of calcifications, internal septations, softtissue thickening, periappendiceal fat stranding, intraperitoneal free fluid and pseudomyxoma peritonei. Two case reports abstract the term of appendiceal mucocele refers to the cystic dilatation of the appendiceal lumen due to obstruction and consequent accumulation of mucus. Appendiceal mucoceles occur when there is an abnormal accumulation of mucin causing abnormal distention of the vermiform appendix due to various. A red herring for mucocele of the appendiceal stump.
Mucocele in the enlarged appendix cancer survivors network. Pdf the mucocele of the appendix is an uncommon disorder which is often asymptomatic but sometimes causes acute. Dec 19, 2017 a distended, mucousfilled appendix is known as an appendiceal mucocele. May 25, 2007 appendiceal mucocele is a rare but wellrecognized entity that can mimic several common clinical syndromes or present as an incidental surgical or radiological finding. Mar 24, 2020 pdf on mar 24, 2020, akitoshi inoue and others published letter to editor about a case of appendiceal mucocele due to lowgrade appendiceal mucinous neoplasm correctly differentiated from. An appendiceal mucocele refers to any lesion that is characterized by a distended, mucusfilled appendix. Management of appendiceal masses in a peripheral hospital in. Most commonly, it is the result of epithelial proliferation, but it can also be caused by inflammation or obstruction of the appendix. Incidental diagnosis of appendiceal mucocele with vaginal ul. The case presented was correctly diagnosed preoperatively. Appendiceal mucocele am is a rare entity that can present. The patients manifest a variety of symptoms, but can also be asymptomatic.
Following informed consent, surgical exploration revealed a cystic mass arising from the body of the appendix with inflamed walls with no evidence of perforation. Does it matter if it is appendix mucocele instead of appendicitis. Pdf mucocele of the appendix and pseudomyxoma peritonei. Patients all cases of primary appendiceal mucoceles simple mucocele, cystadenoma. Pdf mucocele of appendix develops due to obstructive dilatation of the appendix leading to intraluminal accumulation of. The coexistence of lowgrade mucinous neoplasms of the. Three weeks later, he returned to the urgent care centre with diffuse abdominal.
An appendiceal mucocele is a macroscopic description of an appendix abnormally distended by mucin 3. Appendiceal mucoceles occur when there is an abnormal accumulation of mucin causing abnormal distention of the vermiform appendix due to various neoplastic or nonneoplastic causes. Appendiceal mucocele, first described by rokitansky 1, is a. Indeed, the intact removal of a mucocele represents a curative treatment. Surgical treatment of appendiceal mucocele colorectal surgery. It mentionsenlarged appendix suspicious of mucocele our doctor had mentioned an enlarged appendix the last time we were there 6 months ago and didnt seem concerned.
The degenerative changes are brought on by obstruction, which can be caused by an appendicolith, postoperative scarring following appendicitis, appendiceal carcinoma, carcinoma of cecum, or appendiceal volvulus. Mucocele of the appendix is a descriptive term that implies a dilated appendiceal lumen caused by abnormal accumulation of mucus. After undergoing sphenopalatine artery ligation, his hemoglobin dropped from 5 gl at presentation to 100 gl postligation. Up to 50% of patients with an appendiceal mucocele may be asymptomatic. The typical ct appearance of appendiceal mucocele is a cystic, round, or tubular wellencapsulated mass, sometimes with calcifications in the expected location of the appendix. Mar 21, 2020 create a personal account to register for email alerts with links to free fulltext articles. Appendix mucocele may come as a consequence of obstructive or inflammatory processes. The appropriate management of an appendiceal mucocele bmj. We examined 38 appendectomies with diagnoses of mucocele, diverticulum, or adenoma to study the coincidence of appendiceal diverticula and appendiceal lowgrade mucinous neoplasms and to examine. Surgical treatment of appendiceal mucocele colorectal. The treatment modalities we adopted depended on the circum. While older literature on appendiceal mucoceles often failed to distinguish between benign and neoplastic lesions, the classification of appendiceal epithelial tumors of the appendix peritoneal mucin that is associated with a ruptured lamn or, less commonly, a ruptured benign appendiceal mucocele.
To report on our management of appendiceal mucocele, highlighting the pitfalls and possible means for avoiding them. While the incidence of ovarian and uterine neoplasms might be explained in part by the high number of gynecologic procedures reported, the association between appendiceal mucocele and colonic neoplasms is well established. The objective of our study was to assess the use of ct for imaging of appendiceal mucoceles and to evaluate potential ct features that can be used to dif. They are a rare form of an appendiceal mass and develop from both benign and malignant processes. Mucocele of the appendix can also result from alterations in the cecum, such as fecal impaction, polyps or malignant neoplasms, which, in theory, can obstruct the appendiceal ostium. Hypothesis clinical presentation of appendiceal mucocele is related to malignancy and can influence surgical approach. Appendiceal mucoceles can be caused by nonneoplastic entities or mucinsecreting epithelial neoplasms fig 3. Symptoms range from right iliac fossa pain to mass per abdomen. Oct, 2016 appendiceal mucocele am, first described in 1842 by rokitansky, is a rare dilation of the appendiceal lumen secondary to the accumulation of mucinous secretions 1. However, the ability to differentiate malignant and benign mucoceles with ct has been rarely reported in the literature. The main role of medical imaging is to provide presurgical diagnosis so that all precautions may be taken to avoid peroperative rupture and peritoneal seeding. Appendiceal mucocele am is a descriptive term for dilated appendiceal lumen, occasionally observed in either symptomatic or asymptomatic patients during colonoscopy. Rupture, the most severe complication, leads to pseudomyxoma peritonei pmp which frequently is associated with a poor prognosis.
Appendiceal mucocele am is a descriptive term for dilated appendiceal lumen, caused by abnormal accumulation of mucus. Appendix mucocele mimicking a complex ovarian cyst. Preoperative assessment and treatment of appendiceal mucocele. Appendiceal mucocele am is a rare pathology, and its reported incidence is 0. Laparoscopic treatment of an appendiceal mucocele journal. The term mucocele refers to the dilatation of the appendix due to mucus, and it is an uncommon disorder with an estimated incidence of 0. Panton full text pdf, 366kb case a previously healthy 49yearold man presented to the emergency department with massive epistaxis. An update on the diagnosis, grading, and staging of appendiceal mucinous neoplasms reet pai, md university of pittsburgh medical center pittsburgh, pa. Simple appendectomy was performed as the caecum and the mesenteric nodes were free of pathological involvement. Image of the operative piece showing appendiceal mucocele yellow arrow. Following an annual gynecologic checkup in a healthy 63yearold woman, vaginal ultrasonography along with a subsequent computed tomographic study raised the possibility that an incidental appendiceal mucocele was present. Abstractappendiceal mucoceles are rare cystic lesions with an incidence of 0.
Mucocele of the appendix is a rare condition, the pathological classification and management strategy of which have not been standardized yet. In patients with free mucinous fluid in the abdominal cavity, the peritoneum would work as a defense against. Pdf letter to editor about a case of appendiceal mucocele. An update on the diagnosis, grading, and staging of. Appendiceal mucocele, first described by rokitansky, is a morphologic entity referring to localized or diffuse dilatation of the appendiceal lumen by abnormal accumulation of mucus. Journal of clinical imaging science dilated appendix. Ruptured mucocele of appendix volume 2 issue 4 2015 sushila ladumor, adham darwish, ala. We had a ct scan, xrays, and bloodwork about a week ago and got a clean bill of health from our oncologist. Appendiceal mucocele is an obstructive dilatation of the appendix caused by intraluminal accumulation of mucoid material. It is most commonly the result of epithelial proliferation, but can be caused.
The presence of wall calcification strongly supports a diagnosis of appendiceal mucocele, but this characteristic is seen in less than 50% of cases 5, 6. The most common nonneoplastic cause is a simple mucus retention cyst due to luminal obstruction. Mucoceles can develop secondarily to an obstruction, such as from a fecalith, scarring or, rarely, endometriosis. Though carcinoid tumor is the most common primary appendiceal neoplasm in surgical pathology series, mucoceles due to neoplasms are the most common appendiceal tumors detected on imaging 7.
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