Morelli C, Villanova I, Lorusso G, Cozzi M, Greco S, Calbi R, Maggialetti N, Calabrese A. Imaging of appendiceal mucinous epithelial neoplasms: A narrative review. World J Gastroenterol 2026; 32(37): 120384 [DOI: 10.3748/wjg.120384]
Corresponding Author of This Article
Giovanni Lorusso, DM, Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari 70124, Puglia, Italy. lorussogiovannimd@gmail.com
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Gastroenterology & Hepatology
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review-article
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Morelli C, Villanova I, Lorusso G, Cozzi M, Greco S, Calbi R, Maggialetti N, Calabrese A. Imaging of appendiceal mucinous epithelial neoplasms: A narrative review. World J Gastroenterol 2026; 32(37): 120384 [DOI: 10.3748/wjg.120384]
World J Gastroenterol. Oct 7, 2026; 32(37): 120384 Published online Oct 7, 2026. doi: 10.3748/wjg.120384
Imaging of appendiceal mucinous epithelial neoplasms: A narrative review
Chiara Morelli, Ilaria Villanova, Giovanni Lorusso, Mariacristina Cozzi, Sara Greco, Roberto Calbi, Nicola Maggialetti, Angela Calabrese
Chiara Morelli, Ilaria Villanova, Giovanni Lorusso, Mariacristina Cozzi, Sara Greco, Nicola Maggialetti, Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Bari 70124, Puglia, Italy
Roberto Calbi, Department of Radiology, General Regional Hospital “F. Miulli”, Acquaviva delle Fonti 70021, Italy
Angela Calabrese, Radiology Unit, Cancer Institute “Giovanni Paolo II”, Bari 70124, Puglia, Italy
Co-first authors: Chiara Morelli and Ilaria Villanova.
Author contributions: Morelli C, Villanova I, Lorusso G, Cozzi M, Greco S, Calbi R, Maggialetti N, and Calabrese A contributed equally to the conception and design of the article, writing, and editing of the manuscript, and review of the literature; Morelli C and Villanova I contributed equally as co-first authors. All the authors approved the final version of the article to be published.
AI contribution statement: AI tools (specifically ChatGPT) were used only for language editing and proofreading prior to review by a native English speaker. No part of the data analysis was performed using artificial intelligence. The images included in the manuscript are derived from clinical cases reported by the last author and were not generated by AI.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Giovanni Lorusso, DM, Section of Radiology and Radiation Oncology, Interdisciplinary Department of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare, 11, Bari 70124, Puglia, Italy. lorussogiovannimd@gmail.com
Received: February 25, 2026 Revised: April 21, 2026 Accepted: July 13, 2026 Published online: October 7, 2026 Processing time: 188 Days and 13.7 Hours
Abstract
Appendiceal mucinous epithelial neoplasms are uncommon tumors of the gastrointestinal tract, yet they pose a relevant clinical challenge because of their diverse pathological spectrum, unpredictable biological behavior, and frequent incidental detection. Despite their rarity, these lesions are of particular importance due to their tendency to produce mucin and, in some cases, to disseminate within the peritoneal cavity, resulting in pseudomyxoma peritonei, a condition associated with substantial morbidity and complex treatment pathways. Clinical presentation is often vague or misleading, with symptoms that may resemble acute appendicitis or other right lower quadrant diseases, leading to delayed recognition and suboptimal initial management. Imaging therefore plays a decisive role throughout the diagnostic process. Computed tomography is the primary modality for initial assessment and surgical planning, especially in acute settings, whereas magnetic resonance imaging provides a more accurate evaluation of peritoneal spread and overall tumor burden, particularly when diffusion-weighted imaging and the signal characteristics of mucin are considered. Although radiological findings do not allow reliable grading of these tumors, specific features such as mural abnormalities, calcifications, and extra-appendiceal mucin are critical for assessing disease extent and supporting appropriate multidisciplinary decision-making.
Core Tip: Appendiceal mucinous epithelial neoplasms are rare but clinically significant tumors with heterogeneous behavior and frequent nonspecific presentation, often leading to delayed diagnosis. Their major complication is pseudomyxoma peritonei, caused by mucin dissemination within the peritoneal cavity. Imaging plays a central role in detection, characterization, and staging: Computed tomography is the diagnostic cornerstone, while magnetic resonance imaging provides superior assessment of peritoneal disease. Recognizing key imaging features is essential for appropriate classification, prognostic stratification, and guiding multidisciplinary management.
