Presentation
Right sided abdominal pain that has been increasing in intensity. Described as a sharp pain with fullness localized to the right lower quadrant and back.
Patient Data
Extensive inflammatory changes in the right lower quadrant right paracolic gutter surrounding a well-circumscribed gas and fluid collection up to 7.8cm, which appears to originate from the cecum and is thought to be intraluminal fluid within a markedly distended appendix.
There are two simple cysts seen within the left lobe of the liver. A small hypodensity is seen on the spleen. Large degenerated uterine fibroid.
Additionally, coarse calcifications within the right adnexa likely represent migrated appendicoliths. Less likely, this could represent a benign ovarian dermoid tumor.
Histopathology:
- Low-grade appendiceal mucinous neoplasm associated with acute and chronic appendicitis, extravasation of mucin with associated foreign body giant cell reaction, and rupture with mural necrosis and mucin present at the serosal surface.
- Negative for high-grade dysplasia or malignancy.
- Proximal resection margin negative for low-grade appendiceal mucinous neoplasm.
Case Discussion
Primary appendiceal neoplasms are rare, occurring in 1% of all appendiceal specimens. Mucinous neoplasms tend to be seen in imaging more often due to their large size 1.
Case contributions by Samuel Patterson MD, Roger Rozzi DO, and Allison Griffiths MD.
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