65 - Preissitzung
16. Mai 2019, 13:45 - 15:15, Sopra 3, 4. OG
Mucinous appendicular neoplasia (“mucocele”): Rare observation and captivating iconography
B. Geng, F. Vitale, P. Kuczma, E. Pezzetta, O. Martinet, Presenter: B. Geng (Montreux)
Appendicular tumors are rare (about 1 case out of 100 performed appendectomies). They are generally asymptomatic and discovered incidentally during a radiological examination or histological analysis of a acute appendicitis. Neuroendocrine tumors and epithelial tumors represent the majority of cases. Among epithelial tumors, mucinous neoplasia of the appendix is associated with adenomatous glandular proliferation. The term mucocele is purely descriptive and refers to the dilation of the appendix resulting from the accumulation of mucus. Mucinous tumors are classified as non-invasive low-grade or high-grade or invasive (mucinous adenocarcinoma) depending on whether or not they penetrate the muscularis mucosae. The histological type of tumor and the degree of invasion of the appendiceal wall determine the risk of peritoneal dissemination that may result in peritoneal pseudomyxoma.
We present two cases of mucinous appendiceal neoplasia with interesting typical radiologic images. The first patient is a 71-year-old man presenting with typical signs and symptoms of an acute appendicitis. The CT scan showed an extremely distended appendix filled with heterogeneous material on the CT scan raising the suspicion of mucinous neolpasm. The appendix was removed laparoscopically. The second patient is a 49-year-old woman who underwent a CT scan in the context of chronic abdominal pain. The CT scan demonstrated a 9 cm in diameter mass attached to the caecum. A mucinous neoplasia of the appendix was suspected. Explorative laparoscopy showed a distended appendix that was removed en-bloc with the caecum.
Histological analysis of operative specimens showed a low grade appendicular mucinous neoplasia with slices of healthy tissue section. The postoperative course was uneventful and both patients were discharged 2 days after the intervention.
Mucous appendiceal neoplasia is a rare entity, most often discovered incidentally. They require surgical management. Despite their benign characteristics, they present a risk of peritoneal dissemination, which mandate cautious intraoperative manipulation of the diseased appendix in order to avoid its rupture