Presentation
Right iliac fossa pain.
Patient Data
Right iliac fossa cystic lesion of mixed echogenicity with no internal flow in the color duplex ultrasound.
Right iliac fossa oblong-shaped cystic lesion is seen centered at the anatomical location of the appendix eliciting inhomogeneous fluid-like density with marginal calcifications suggestive of appendical mucocele.
The patient was subjected to a right hemicolectomy.
The histopathological report:
MACROSCOPY:
The specimen consists of Right hemicolectomy measured as:
Ascending colon segment measuring 20 cm long & 2 cm in diameter, ileal segment measuring 6 cm long & 1 cm in diameter & cecum measuring 9 cm long & 7 cm in diameter, with attached dilated appendicular mass measuring 9 cm & 7 cm in diameter.
On opening: filled with mucoid material. The dissection of pericolic fat revealed 17 nodules ranging from 0.2 to 0.7 cm in diameter with a grayish firm cut section.
Representative sections were taken in 8 cassettes.
MICROSCOPY:
Sections from appendix revealed cystic lesion lined by single layer of mucin-secreting epithelium with tufts, vaguely resemble serrations with mucin in the lumen & calcification. The wall lining showed inflammatory cellular infiltrate, with no mucin in the wall.
Sections examined from both resected & appendicular margins were free of tumor.
Examination of the seventeen dissected lymph nodes revealed reactive lymphoid hyperplasia, with surrounding fat showed hemorrhage & congestion.
DIAGNOSIS:
Right hemicolectomy:
Low-grade appendiceal mucinous neoplasm (Mucinous cystadenoma).
Margins negative for mucinous neoplasm. There is no invasion into the appendiceal wall.
Case Discussion
Appendiceal mucocele can be secondary to benign causes like an appendicolith or serrated polyp obstructing the appendix with subsequent mucus collection. However, it can also be secondary to mucinous neoplasm of varying degrees of neoplasia: low-grade appendiceal mucinous neoplasm, high-grade appendiceal mucinous neoplasm, and mucinous adenocarcinoma.
Rupture of this lesion either spontaneously or during intervention can lead to widespread peritoneal lesions (pseudomyxoma peritonei).
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