Presentation
Right lower abdominal pain.
Patient Data
There is a non-compressible blind-ending cystic structure in the right iliac fossa of retrocecal location with a variable internal echogenicity as well as a small mural nodule (20 x 15 mm).
On MRI sequences this cystic structure measures (10 x 6 x 5 cm) with lobulated contours, and arising from the appendix. It elicits a low signal on T1, high signal on T2 with peripheral enhancement and with no restricted diffusion. The mural nodule shows an intermediate signal on both T1/T2 with enhancement on postcontrast sequences and restricted diffusion.
Bilateral well-defined ovarian masses measuring (3 x 2.8 x 2.2 cm) on the right, and (1.6 x 1.3 x 1 cm) on the left, of intermediate signal on T1, low signal on T2 with punctate areas of high signal, and mild heterogeneous enhancement on postcontrast sequences, suggestive of an ovarian fibrothecoma (incidental findings).
Conclusion (pathological report):
- low-grade appendiceal mucinous neoplasm
- ovarian fibrothecoma
Case Discussion
MRI features of an appendiceal mucocele with enhanced mural nodule which suggest a malignant process, pathologically proven as low-grade appendiceal mucinous neoplasm (LAMN).
Ovarian fibrothecomas (incidental findings)
Additional contributor: Salah Temarni, general surgeon, Touggourt, Algeria