Mucocele of the appendix due to endometriosis:A rare case report

Mucocele of the appendix due to endometriosis is extremely rare,and there are only 10 previously reported cases in the English literature.We report a case of mucocele of the appendix due to endometriosis and provide the first review of the literature.A 43-year-old woman was admitted to the hospital because of recurrent right lower abdominal pain during her menstrual periods.Colonoscopy revealed submucosal tumorlike elevations of the appendiceal orifice.Computed tomography and magnetic resonance imaging of the abdomen suggested cystic lesions near the appendix.Consequently,mucocele of the appendix was suspected preoperatively.An open ileocecal resection was performed.Multiple cystic lesions were observed around the appendix.The cystic lesions contained mucus.Histopathological examination was consistent with a mucocele of the appendix due to endometriosis.The postoperative course was uneventful.We present the first review of the literature to clarify the clinical features.     

Giant appendiceal mucocele： Report of a case and brief review

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.     

Suture granuloma of the abdominal wall with intraabdominal extension 12 years after open appendectomy

Most complications after appendectomy occur within ten days; however, we report the unusual case of a suture granuloma 12 years after open appendectomy. The afebrile 75-year-old woman presented with a slightly painful palpable mass in the right lower abdomen. There was no nausea or vomiting and bowel movements were normal. She lost 10 kg during the 3 mo before presentation. The patient had undergone an appendectomy 12 years previously. Physical examination revealed a tender mass, 10 cm in diameter, under the appendectomy scar. The preoperative laboratory findings, tumor markers and plain abdominal radiographs were normal. Multi-slice computed tomography scanning showed an inhomogenous abdominal mass with minimal vascularization in the right lower abdomen 8.6 cm × 8 cm ×9 cm in size which communicated with the abdominal wall. The abdominal wall was thickened, weak and bulging. The abdominal wall mass did not communicate with the cecum or the ascending colon. Complete excision of the abdominal wall mass was performed via median laparotomy. Histopathological examination revealed a granuloma with a central abscess. This case report demonstrates that a preoperative diagnosis of abdominal wall mass after open appendectomy warrants the use of a wide spectrum of diagnostic modalities and consequently different treatment options.     

Mucocele of the appendix： An unusual cause of lower abdominal pain in a patient with ulcerative colitis-. A case report and review of literature

The authors report the case of a 60-year-old male patient. In November 2001 he developed intestinal symptoms of bloody diarrhea and abdominal pain. Colononoscopy and biopsy established the diagnosis of ulcerative colitis (proctosigmoiditis). The disease activity was moderate at the beginning. No significant laboratory alterations were found (including CEA, CA19-9), and mesalazine was started orally. He was in remission until November 2003, when he was admitted to our Outpatient Clinic for upper and right lower abdominal pain and bloody diarrhea. Colonoscopy found proctosigmoiditis with a moderate activity, gastroscopy revealed chronic gastritis, laboratory data was normal. Treatment was amended with mesalazine clysma and methylprednisolone (16 mg) orally. Symptoms ameliorated; however, right lower abdominal pain persisted. US and CT examinat'on demonstrated a pericecal cystic mass (11 cm×3.5 cm). At first pericecal abscess was suspected, as the previous US examination (6 mo earlier) had revealed normal findings. Fine needie aspiration was performed. Cytology confirmed the diagnosis of mucocele. The patientunderwent partial cecum resection and extirpation of the mucocele. He recovered well and the final histology revealed a cystadenoma of the appendix. Follow up was started. The pati雗t is now free of symptoms. Although primary adenocarcinoma of the appendix is uncommon, the authors emphasize that preoperative diagnosis of an underlying malignancy in a mucocele is important for pati雗t management; however, it is difficult on imaging studies.     

Diagnosis and treatment of benign multicystic peritoneal mesothelioma

Benign multicystic peritoneal mesothelioma(BMPM)is a rare cystic mesothelial lesion that occurs predominantly in reproductive aged women.A 56-year-old Caucasian male was admitted to our surgical department with a chief complaint of a painful mass in his right lower abdomen for almost 2 years.The physical examination revealed a palpable painful mass.Computed tomography demonstrated an irregular,cystic tumor in his right lower abdomen.There was no obvious capsule or internal septations.No enhancement after intravenous administration of contrast was noted.An exploratory laparotomy was performed,and a multicystic tumor and adherent to the caecum was noted.The walls of the cysts were thin and smooth,filled with clear fluid,and very friable.An en bloc resection of the tumor,including appendix and caecum,was performed.Histological examination revealed multiple cysts lined with flattened simple epithelial cells,and the capsule walls of the cysts were composed of fibrous tissue.Immunohistochemical analysis documented positive expression of mesothelial cells and calretinin.The final diagnosis was BMPM.The patient was well at 6-mo follow-up.BMPM is exceedingly rare lesion.A complete resection of the tumor is required.The diagnosis of BMPM is based on pathological analysis.     

Adult intussusception caused by cystic lymphangioma of the colon： A rare case report

We experienced a case of intussusception caused by cystic lymphangioma of the colon in a 32 years old female who was admitted to our hospital for the chief complaint of bloody stool. In the colonoscopic examination, cystic mass with stalk which had smooth mucosal surface was noted at the descending colon. Abdominal ultrasonography and computed tomography revealed left colon intussusception with a multilocular cystic tumor as a leading point. Emergent operation was performed. On the histopathologic examination, the cystically dilated spaces lined by endothelium and septated by fibrous septa were present. The pathological diagnosis was cystic lymphangioma of the colon. Although intussusception due to lymphangioma in an adult are rare, it should be taken into consideration that it is possible diagnosis.     

Colonic sarcoidosis:Unusual onset of a systemic disease

Sarcoidosis is a multisystem chronic inflammatory condition of unknown etiology that has the potential to involve every tissue in the body.Sarcoidosis in the gastrointestinal system,and particularly the colon,is very rare.Here,we report the case of a 57-yearold man with no previous diagnosis of sarcoidosis who presented with new onset of abdominal pain and constipation.A colonoscopy revealed that the abdominal pain was caused by an obstructing lesion in the cecum-ascending colon and lacked a clear histologic diagnosis.Radiologic investigation revealed concentric wall thickening of the cecum-ascending colon with multiple satellite lymphadenopathies,highly suggestive of a malignancy.The patient underwent a laparotomy and a right hemicolectomy was performed.A diagnosis of colonic sarcoidosis was made after the resected specimen was examined.Additionally,a chest computed tomography scan revealed lung involvement with atypical radiologic features in the absence of respiratory symptoms.Only histologic examination of the surgical specimen can yield a diagnosis of gastrointestinal sarcoidosis due to the non-specificity of endoscopic and radiologic findings.     

Lymphangitic spread from appendiceal adenocarcinoma to ileocecal valve,mimicking Crohn’s disease

Due to the anatomical peculiarity of the appendix,diagnosis of tumors arising from this area can be challenging by clinicoradiologic means.We report a case of a rare primary appendiceal signet ring carcinoma with an uncommon presentation.An 86-year-old woman was admitted toour hospital with subacute epigastric pain.Computed tomography demonstrated bowel wall thickening with fat stranding in the ileocecal region.The leading diagnostic consideration was inflammatory bowel disease.Upon colonoscopy,a swollen,distorted ileocecal valve was identified.The remaining colon was otherwise unremarkable.Extensive biopsy sampling of the ileocecal region and colon was performed.A lymphangitic signet ring carcinoma within the ileocecal region was diagnosed on biopsy;there was no dysplasia or carcinoma of the remaining biopsies.By cytomorphology and immunoprofile,a lymphangitic signet ring carcinoma of appendiceal origin was the primary consideration,further confirmed upon subsequent laparotomy.This case represents an unusual pattern of appendiceal tumor spread with localized,lymphangitic involvement,creating a milieu which closely simulates Crohn’s disease on imaging modalities.     

Granular cell tumor of colon:Report of a case and review of literature

Granular cell tumor (GCT) is uncommon in the colon andrectum.Here we report a case of GCT in the transversecolon.A 48-year-old male patient underwent a screeningcolonoscopy.A yellowish sessile lesion,about 4 mm indiameter,was found in the transverse colon.An endoscopicsnare resection was performed without complication.Histological examination revealed the tumor consisted ofplump neoplastic cells with abundant granular eosinophiliccytoplasm containing acidophilic periodic acid Schiff-positive,diastase-resistant granules.Immunohistochemicalanalysis showed the tumor cells expressed S-100 proteinand neuron-specific enolase.Thus,the resected tumor wasdiagnosed as a GCT.Since GCTs are usually benign,endoscopicresection constitutes an easy and safe treatment.Colonoscopists should consider the possibility of GCT inthe differential diagnosis of submucosal tumors of the colon.     

Intraperitoneal metastasis of hepatocellular carcinoma after spontaneous rupture： A case report

Rupture of hepatocellular carcinoma （HCC） is a lifethreatening complication. Peritoneal metastasis of HCC after spontaneous rupture was seldom noted. We report a case of intraperitoneal metastasis of HCC after spontaneous rupture. A previously asymptomatic 72-yearold man was admitted due to dull abdominal pain with abdominal fullness. He had a history of HCC rupture 10 mo ago and transarterial embolization was performed at that time. Abdominal computer tomograghy （CT） scan showed a huge peritoneal mass over the right upper quadrant area. Surgical resection was arranged and subsequent microscopic examination confirmed a diagnosis of moderately-differentiated HCC.     

Mucocele of the appendix: a report of five cases

Abstract. Mucocele of the appendix is an uncommon disorder, characterized by a cystic dilatation of the lumen. It is often diagnosed clinically from signs and symptoms of acute appendicitis or, if it is asymptomatic, as an incidental finding during ultrasonography, computed tomography, and radiographic examinations of the gastrointestinal tract, or laparotomy. The incidence of mucocele ranges from 0.2% to 0.3% of all appendectomy specimens. We report five cases of appendiceal mucocele (all women, aged 19–90 years), who were admitted from January 1993 to January 2003 to our hospital. These cases represent 0.29% of the 1720 appendectomies performed during this period. Three of the patients were symptomatic and had appendectomies. The final diagnosis for mucocele was given at laparotomy. No colon neoplasms were identified during surgery, and subsequent colonoscopic examinations were also negative. The other two patients were asymptomatic of appendiceal tumor. Colonoscopy revealed two colonic malignant tumors in one patient and an adenocarcinoma of the sigmoid colon in the other. Mucocele of the appendix was diagnosed pre–operatively by ultrasound and computed tomography. One of the two patients underwent a right hemicolectomy and sigmoidectomy; the other one underwent an appendectomy, cecostomy and sigmoidectomy. Four of the patients recovered and are doing well today; one patient died on the twenty–fifth postoperative day. The most common symptom of mucocele is abdominal pain, although many patients may be asymptomatic. Mucocele is often associated with concomitant colon cancer, thus patients with this tumor should be systematically checked for other colonic lesions.     

Nonrotation of the midgut with appendiceal mucocele in an adult

Nonrotation of the midgut in adults and appendiceal mucocele are both rare pathological conditions. We report here the first case of nonrotation of the midgut associated with appendiceal mucocele. The patient was a 51-year-old man admitted to hospital with ileus. An upper gastrointestinal series and a barium enema revealed nonrotation of the midgut without midgut volvulus and with a mass in the ileocecal area. Laparotomy revealed an appendiceal mucocele adhering to the urinary bladder and the rectum. The mucocele had partly ruptured; yellowish mucinous material had entered the abdominal cavity, resulting in pseudomyxoma peritonei. Histological examination revealed a mucinous tumor of the appendix with borderline malignancy. In this patient, the ileus was caused by the appendiceal mucocele rather than being caused by nonrotation of the midgut. Received: November 10, 1999 / Accepted: April 28, 2000     

Perforated appendiceal diverticulitis associated with appendiceal neurofibroma in neurofibromatosis type 1

An appendiceal neurofibroma(ANF) is a rare neoplasm associated with neurofibromatosis type 1(NF-1),an inheritable neurocutaneous disorder that involves multiple systems including the intraabdominal organs.Appendiceal diverticulitis occasionally ruptures in the absence of intense abdominal pain,which can lead to serious consequences.Recent reports highlight the association between appendiceal diverticulum and appendiceal neoplasms; however,there is still little information on the association between appendiceal diverticulitis and ANF in NF-1.A 51-year-old Japanese male with NF-1 was referred to the division of surgery for mild right lower quadrant pain.It was suspected he had perforated acute appendicitis with periappendiceal abscess based on clinical manifestations and findings of computed tomography.An emergency appendectomy was conducted.The pathological examination revealed diffusely proliferated tumor cells of a neurofibroma,coexistent with multiple appendiceal diverticulums,leading to the diagnosis ofperforated appendiceal diverticulitis associated with ANF.Although he developed a remnant abscess,he recovered with the conservative treatments of antibiotics and drainage.This case suggests that appendiceal diverticulitis might be a complication of appendiceal involvement of NF-1,and that it occasionally ruptures in the absence of intense abdominal pain.Clinicians should recognize that NF-1 can cause various abdominal manifestations.     

Giant appendiceal mucocele: Report of a case and brief review

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.     

Colonoscopic diagnosis of mucocele of the appendix

BACKGROUND: Appendiceal mucoceles are uncommon cystic neoplasms characterized by distension of the appendiceal lumen with mucus. There have been no reported series of colonoscopically diagnosed mucoceles with clinicopathologic correlation. METHODS: A retrospective review of colonoscopies performed at our institution over the past 14 years was undertaken with patient demographics, clinical data, surgical outcomes, and histopathology obtained from hospital records. OBSERVATIONS: Seven patients (6 women) with mucocele of the appendix were identified at colonoscopy. Three had complained of right lower quadrant pain. All 7 patients underwent surgical resection. Histopathology demonstrated mucinous cystadenoma in all. No cases revealed carcinoma, and there have been no deaths related to the mucocele. CONCLUSIONS: Appendiceal mucoceles may be recognized at colonoscopy as a smooth bulbous submucosal lesion of the cecum with an impression formed by the appendiceal orifice. Recognition at colonoscopy is important because it enables accurate diagnosis and directs management. Surgery is recommended in all cases given the risk of malignancy or perforation with resultant pseudomyxoma peritonei.     

Abdominal actinomycosis: Barium enema and computed tomography findings

A case of abdominal actinomycosis is described in a woman with recurrent right lower abdominal pain and low-grade fever without history of appendectomy. Past history included the use of an intrauterine device (IUD) until 10 years before manufestation of these symptons. We followed up the patient, via diagnostic imaging, for 7 months. On initial barium enema, a polypoid lesion was visualized at the bottom of the cecum and there was constriction of the sigmoid colon; the appendix was not seen. Seven months later, poor extension at the cecum, severe constriction in the sigmoid colon, and narrowing of the terminal ileum were also visualized. On computed tomography (CT), the lesion was initially localized only in the ileocecal region adjacent to the sigmoid colon. After 7 months, the lesion had infiltrated adjacent anatomic components and showed direct infiltration of the pelvic space. Differential diagnosis was difficult, as it was not obvious whether this was a pelvic abscess due to inflammation or appendiceal carcinoma. Laparotomy was performed. Macroscopically, the lesion was not limited to the ileocecal region, but involved the right ureter, tubes the Fallopian and ovary, bladder, psoas muscle, and abdominal wall. Pathology findings showed, chronic inflammatory tissue with evidence of actinomycosis. Although previous reports have described a lack of specific findings in this disease. When actinomycosis is suspected, CT is recommended to define its extent.     

The simultaneous occurrence of mucinous cystadenomas in liver and pancreas

The occurrence of mucinous cystadenomas localized to the liver and pancreas simultaneously and treated with a single surgical procedure has been described for the first time in this report. A 47-year-old woman attended the outpatient clinic complaining of abdominal pain and the appearance of an abdominal mass. On clinical examination, hepatomegaly was found. An abdominal computed tomography scan showed a large cystic lesion of the left lobe of the liver, thus causing the hepatomegaly. Moreover, the computed tomography scan showed a cystic lesion of the pancreas. Both lesions had thick walls and septa. Magnetic resonance imaging of the liver and pancreas confirmed the presence of septa within the cysts. Surgery was performed owing to the suspected malignancy. It should be emphasized that the patient had preoperatively received prophylactic treatment for hydatosis. A hepatic pericystectomy and enucleation of the pancreatic lesion were performed during the surgery. Pathology showed a mucinous cystadenoma without sign of malignancy. At the 4-year follow-up, no recurrence was found. This case is of interest for several reasons: the unusual double presentation, the treatment, and the follow-up. This case report confirms the common origin of mucinous cystic tumours of liver and pancreas.     

Mucinous cystadenocarcinoma of the appendix. The controversy persists: a review

Mucinous cystic neoplasms of the appendix continue to engender considerable debate in their diagnosis, management, and role in pseudomyxoma peritonei. This review addresses ongoing controversies with these unique neoplasms. Case reports and institutional series of mucinous cystadenocarcinoma were retrieved from the literature using Medline Search (1985-1996) using the following key words: appendix; mucinous cystadenocarcinoma; pseudomyxoma peritonei. 284 patients with mucinous cystadenocarcinoma were identified. Abdominal pain was the most common presenting symptom and objective preoperative diagnosis was difficult. There were 22 patients with concomitant appendiceal and ovarian mucinous neoplasms. Sixty-seven patients presented with mucinous cystadenocarcinoma and pseudomyxoma peritonei. However, a unified definition of pseudomyxoma peritonei was lacking. The recurrence rate was higher when an appendiceal neoplasm was associated with pseudomyxoma peritonei. In the reported literature, about an equal number of patients were subjected to appendectomy alone or right hemicolectomy. However, there was a survival advantage for right hemicolectomy versus appendectomy alone. Management of disseminated pseudomyxoma peritonei remains controversial. Mucinous cystadenocarcinoma appears to be a spectrum of low-grade malignant tumors. For correct diagnosis, a high index of suspicion must be maintained. The appropriate treatment for a patient with mucinous cystadenocarcinoma should be a right hemicolectomy. Aggressive debulking may improve survival when associated with pseudomyxoma peritonei. A better definition of pseudomyxoma peritonei is needed. In evaluation of different treatment modalities and prognosis, patients should be grouped according to underlying primary pathology.