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Chen M, Zhang S, Xu Y, Jia X, Shi Y. Contrast-enhanced ultrasonography findings of LAMNs with peritoneal and splenic metastases: a case report and literature review. Front Oncol 2023; 13:1238042. [PMID: 37817772 PMCID: PMC10561767 DOI: 10.3389/fonc.2023.1238042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/31/2023] [Indexed: 10/12/2023] Open
Abstract
Low-grade appendiceal mucinous neoplasms (LAMNs) are rare appendiceal tumors that are primarily diagnosed using computed tomography(CT) enhancement and magnetic resonance imaging (MRI). Herein, we report the sonographic features, especially for contrast-enhanced ultrasound (CEUS), of a 70-year-old female with an unusual LAMN metastasizing to the peritoneum and spleen. The patient had a right pelvic mass 2 days prior to presentation. Two-dimensional (2D) ultrasound revealed a mixed cystic-solid mass in the right lower abdomen and spleen parenchyma; CEUS showed heterogeneous enhancement in both areas, suspected to be a mucinous mass. CT enhancement and MRI findings revealed concurrent findings. Histopathologically, LAMN lesions were confirmed in the appendix, spleen, and peritoneum of the specimens obtained during exploratory laparoscopy. No recurrences were reported at three years postoperatively. LAMN lesions may metastasize to abdominal organs, and imaging examinations are essential for diagnosis. This study presents major ultrasonography and CEUS findings for the diagnosis of LAMNs.
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Affiliation(s)
- Mei Chen
- Department of Ultrasonography, Ningbo First Hospital, Ningbo University, Ningbo, China
| | - Shengmin Zhang
- Department of Ultrasonography, Ningbo First Hospital, Ningbo University, Ningbo, China
| | - Youfeng Xu
- Department of Ultrasonography, Ningbo First Hospital, Ningbo University, Ningbo, China
| | - Xiupeng Jia
- Department of Histology, Ningbo First Hospital, Ningbo University, Ningbo, China
| | - Yijiu Shi
- Department of Surgery, Ningbo First Hospital, Ningbo University, Ningbo, China
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Maleki A, Layegh P, Seddighian SH, Khosravi M, Ariamanesh M, Dehghani M. A perforated sigmoid colon cancer initially diagnosed as a tubo-ovarian abscess: A teaching case. Clin Case Rep 2022; 10:e5982. [PMID: 35782212 PMCID: PMC9234057 DOI: 10.1002/ccr3.5982] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/27/2022] [Accepted: 06/03/2022] [Indexed: 11/08/2022] Open
Abstract
Given the wide range of differential diagnoses for adnexal masses, the key issue is the correct assessment of the initial location to rule out malignant or emergency cases. Here, we report a case of perforated sigmoid colon cancer initially diagnosed as a tubo-ovarian abscess.
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Affiliation(s)
- Asieh Maleki
- Omolbanin HospitalMashhad University of Medical SciencesMashhadIran
| | - Parvaneh Layegh
- Department of Radiology, School of MedicineMashhad University of Medical SciencesMashhadIran
| | - Seyedeh Hoda Seddighian
- Women's Reproductive Health Research CenterMashhad University of Medical SciencesMashhadIran
| | - Maedeh Khosravi
- Women's Reproductive Health Research CenterMashhad University of Medical SciencesMashhadIran
| | - Mona Ariamanesh
- Department of PathologyNeyshabur University of Medical SciencesNeyshaburIran
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Wang Z, Yin M, Shao J, Yin Z, Peng J, Lu Z. Clinicopathological Characteristics of Primary Appendiceal Mucinous Neoplasm and Recurrence After Radical Resection. Front Surg 2022; 9:902543. [PMID: 35599797 PMCID: PMC9114454 DOI: 10.3389/fsurg.2022.902543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 12/02/2022] Open
Abstract
Objective Appendiceal mucinous neoplasm (AMN) is a rare obstructive dilatation of the appendix caused by an intraluminal accumulation of mucoid material, showing an insidious onset and few specific clinical manifestations. The purpose of the study is to analyze clinicopathological characteristics of primary AMN and recurrence after radical resection. Methods A total of 50 patients were included in the retrospective cohort study of AMN. Patient data, such as demographics, tumor characteristics, surgical management, preoperative serum carcinoembryonic antigen (CEA), and carcinoembryonic antigen 19-9 (CA19-9) levels, were collected. All patients were followed-up with interval CT scans until the end of December 2021, with overall survival (OS) and progression-free survival (PFS) being calculated. Results All patients were confirmed as AMN by pathological diagnosis after surgery, including 28 cases (56.00%) of low-grade AMN (LAMN) and 22 cases (44.00%) of non-LAMN. Among 50 patients with AMN, there were 12 cases (24.00%) complicated with pseudomyxoma peritonei (PMP). Higher proportions of patients with pTis, pT3, pT4a, ruptured at presentation, and PMP were found in patients with non-LAMN patients than LAMN (p < 0.05). There was a remarkable difference about preoperative serum CA19-9 levels between patients with LAMN and non-LAMN (p = 0.044). Patients complicated with PMP had a higher proportion of patients with ruptured at presentation than those who were not (p < 0.001). The patients with PMP had increased tumor size compared with those without PMP (p = 0.031). Remarkable differences were observed in terms of preoperative serum CA19-9 (p = 0.009) levels between patients with PMP and without PMP. We performed a multivariate analysis of the presence or absence of PMP and found that ruptured at presentation was found to be a risk factor for PMP in patients with AMN (p = 0.003). The PFS in the patients with PMP and those without was 33.33% (4/12) and 2.63% (1/38), showing a significant difference (P = 0.002). Conclusion The study demonstrates that ruptured at presentation and PMP may influence the prognosis and survival of patients with AMN.
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Affiliation(s)
- Zaibiao Wang
- Department of General Surgery, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, China
| | - Manman Yin
- Department of Science and Education, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, China
| | - Jiayun Shao
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhipeng Yin
- Department of General Surgery, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, China
| | - Jie Peng
- Department of General Surgery, Bozhou Hospital Affiliated to Anhui Medical University, Bozhou, China
| | - Zhengmao Lu
- Department of General Surgery, Changhai Hospital, Naval Military Medical University of PLA, Shanghai, China
- *Correspondence: Zhengmao Lu
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Al Laham O, Albrijawy R, Adi A, Al Kurdi MF, Atia F, Hamed H. A rare case of a Low Grade Appendiceal Mucinous Neoplasm in a 46-year-old Middle Eastern female - A case report. Int J Surg Case Rep 2022; 93:106997. [PMID: 35366611 PMCID: PMC8976147 DOI: 10.1016/j.ijscr.2022.106997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction and importance Mucinous cell neoplasia are rare and conceivably fatal causes of surgical abdomen. Adult manifestations can be obscure and ill-defined, yielding misdiagnoses and wasting precious time and effort to reach the correct one. Clinical awareness ought to be present once presented with a surgical abdomen in such a patient because this neoplasm may present with misleading presentations which mask the actual diagnosis and masquerade as a different one, and in turn, may result in performing a dissimilar treatment intervention. Rapid learnt surgical judgments must be taken and put into action to diminish the morbidity and mortality consequential to this pathology. Case presentation Our case is of a 46-year-old female, who was admitted into our hospital with a 2-month-history of general fatigue. Colicky abdominal pain and discomfort developed shortly prior to admission. Multi-Slice Computed Tomography (MSCT) scan exposed cystic formation in the terminal ileum. Exploratory laparotomy was warranted, in addition to performing a right hemicolectomy. Clinical discussion We treated our patient via open surgery and performing an appendectomy with right hemicolectomy in addition to the excision of several surrounding lymph nodes. Diagnosis is traditionally reached intraoperatively relying on gross morphology and postoperatively through histopathological analysis of the excised specimens. Conclusion Low Grade Appendiceal Mucinous Neoplasm is a scarce entity and varies critically in its manifestations, hence, it is existential to thoroughly study this kind of neoplasia, document it, and consider it, so that we can construct precise decisions to reach ideal results for patients who suffer from this neoplasm.
Appendiceal primary tumors have an incidence rate of less than 2% of all excised samples of the appendix. Mucinous cell tumors of the appendix are ubiquitous in merely 0.2%–0.3% of all the excised samples of the appendix. Symptoms are ill-defined. This warrants high clinical suspicion when presented with a case of surgical abdomen. Surgery is the chief treatment method. Open surgery is favored over laparoscopic in appendiceal mucinous cell neoplasm.
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Affiliation(s)
- Omar Al Laham
- Department of Surgery, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Department of Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
| | - Reham Albrijawy
- Department of Surgery, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Department of Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
| | - Amir Adi
- Department of Radiology, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Department of Radiology, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
| | - M Fadi Al Kurdi
- Department of Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
| | - Fareed Atia
- Department of Surgery, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria; Department of Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria.
| | - Hamoud Hamed
- Department of Surgery, Al Assad University Hospital, April 17th St. Kafar Sousah, Damascus, Syria; Department of Surgery, Faculty of Medicine, Damascus University, Damascus, Syria.
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Borges AL, Reis-de-Carvalho C, Chorão M, Pereira H, Djokovic D. Low-grade mucinous appendiceal neoplasm mimicking an ovarian lesion: A case report and review of literature. World J Clin Cases 2021; 9:2334-2343. [PMID: 33869611 PMCID: PMC8026829 DOI: 10.12998/wjcc.v9.i10.2334] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/04/2021] [Accepted: 02/11/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Appendiceal tumors are rare lesions that may not be easily differentiated from primary ovarian lesions preoperatively, despite the use of advanced diagnostic methods by experienced clinicians.
CASE SUMMARY A 59-year-old G2P2 woman, with chronic pelvic pain, underwent a pelvic ultrasound that revealed an adnexal mass measuring 58 mm × 34 mm × 36 mm, with irregular borders, heterogeneous echogenicity, no color Doppler vascularization and without acoustic shadowing. Normal ovarian tissue was visualized in contact with the lesion, and it was impossible to separate the lesion from the ovary by applying pressure with the ultrasound probe. Ascites, peritoneal metastases or other alterations were not observed. With the international ovarian tumor analysis ADNEX model, the lesion was classified as a malignant tumor (the risk of malignancy was 27.1%, corresponding to Ovarian-Adnexal Reporting Data System category 4). Magnetic resonance imaging confirmed the presence of a right adnexal mass, apparently an ovarian tumor measuring 65 mm × 35 mm, without signs of invasive or metastatic disease. During explorative laparotomy, normal morphology of the internal reproductive organs was noted. A solid mobile lesion involved the entire appendix. Appendectomy was performed. Inspection of the abdominal cavity revealed no signs of malignant dissemination. Histopathologically, the appendiceal lesion corresponded to a completely resected low-grade mucinous appendiceal neoplasm (LAMN).
CONCLUSION The appropriate treatment and team of specialists who should provide health care to patients with seemingly adnexal lesions depend on the nature (benign vs malignant) and origin (gynecological vs nongynecological) of the lesion. Radiologists, gynecologists and other pelvic surgeons should be familiar with the imaging signs of LAMN whose clinical presentation is silent or nonspecific. The assistance of a consultant specializing in intestinal tumors is important support that gynecological surgeons can receive during the operation to offer the patient with intestinal pathology an optimal intervention.
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Affiliation(s)
- André Luís Borges
- Department of Obstetrics and Gynecology, Hospital de São Francisco Xavier-Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã 6201-001, Portugal
| | - Catarina Reis-de-Carvalho
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital de Santa Maria-Centro Hospitalar Universitário Lisboa Norte, Lisbon 1649-028, Portugal
| | - Martinha Chorão
- Department of Pathology, Hospital Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon 1349-019, Portugal
| | - Helena Pereira
- Department of Obstetrics and Gynecology, Hospital de São Francisco Xavier-Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
| | - Dusan Djokovic
- Department of Obstetrics and Gynecology, Maternidade Dr. Alfredo da Costa-Centro Hospitalar Universitário de Lisboa Central, Lisbon 2890-495, Portugal
- Faculdade de Ciências Médicas, Nova Medical School, Lisbon 1169-056, Portugal
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Aleter A, El Ansari W. Incidental appendiceal mucinous neoplasm mimicking a left adnexal mass: A case report. Int J Surg Case Rep 2020; 74:132-135. [PMID: 32836208 PMCID: PMC7452653 DOI: 10.1016/j.ijscr.2020.07.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/30/2020] [Accepted: 07/30/2020] [Indexed: 12/12/2022] Open
Abstract
Equivocal signs and symptoms along with anatomical position of appendiceal mucinous neoplasm (AMN) makes it difficult to diagnose. Pre-operative, findings like ‘onion skin’ sign on ultrasonography and ‘volcano sign’ on colonoscopy are specific for appendiceal mucocele. Primary AMN is rarely diagnosed before operation and histopathological examination. AMN can mimic ovarian tumors. Consider AMN in the differential diagnosis for any pelvic mass in elderly female patients. Introduction Appendiceal mucinous neoplasm is a rare type of appendiceal tumors which can present in a variety of symptoms and is difficult to diagnose. Preoperative diagnosis depends mainly on diagnostic imaging such as ultrasonography and computerized tomography (CT) scan. This uncommon case report discusses an appendiceal mucinous neoplasm mimicking a left adnexal mass on presentation, physical examination and diagnostic imaging findings. Presentation of case This is a 61-year-old female found to have a large left adnexal mass during follow up ultrasonography. The patient refused further imaging, and during laparotomy, she was found to have an appendicular mucocele with normal left and right ovaries. Discussion Appendectomy was done and the final pathology came as appendiceal mucinous neoplasm. Her post-operative course and 3 years follow up were uneventful. Conclusions The equivocal signs and symptoms along with the anatomical position of appendiceal mucocele makes it difficult to diagnose and can mimic other types of tumors. Therefore, it should be considered in the deferential diagnosis of lower abdominal and pelvic masses.
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Affiliation(s)
- Ammar Aleter
- Department of General Surgery, Hamad General Hospital, Doha, Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Doha, Qatar; College of Medicine, Qatar University, Doha, Qatar; School of Health and Education, University of Skövde, Skövde, Sweden.
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Cubro H, Cengic V, Burina N, Kravic Z, Beciragic E, Vranic S. Mucocele of the appendix presenting as an exacerbated chronic tubo-ovarian abscess: A case report and comprehensive review of the literature. Medicine (Baltimore) 2019; 98:e17149. [PMID: 31574819 PMCID: PMC6775329 DOI: 10.1097/md.0000000000017149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE Appendiceal mucocele is a rare entity of mucinous cystic dilatation of the appendix. It has no typical clinical presentation and is considered a potentially premalignant condition. PATIENT CONCERNS We present a case of accidental intraoperative finding of an appendiceal mucocele in a 54-year old woman that clinically presented with an exacerbated chronic tubo-ovarian abscess. DIAGNOSES Trans-vaginal ultrasonography showed an encapsulated, oval, unilocular mass above the uterus with a heteroechogenic structure, homogeneous fluid content, and smooth regular walls without inner proliferation. The histopathologic diagnosis was consistent with an appendiceal cystadenoma. INTERVENTIONS The patient underwent a simple appendectomy. OUTCOMES There were no clinical, biochemical or imaging signs of the disease recurrence at 6 months follow up. LESSONS To our knowledge, this is the only well-documented case of appendiceal mucocele mimicking exacerbated chronic tubo-ovarian abscess reported in the literature. Awareness of a rare entity such as an appendiceal mucocele, which is frequently misdiagnosed as a potential cause of acute abdomen, is necessary for the appropriate management strategy in order to prevent complications.
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Affiliation(s)
- Hajrunisa Cubro
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | | | | | - Zlatko Kravic
- Department of General Surgery, General Hospital “Prim.dr. Abdulah Nakas”, Sarajevo, Bosnia and Herzegovina
| | | | - Semir Vranic
- College of Medicine, Qatar University Health, Qatar University, Doha, Qatar
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Pan J, Fan Z. Mucinous adenocarcinoma of the abdomen. Int Wound J 2019; 16:1045-1046. [PMID: 30900376 PMCID: PMC6849774 DOI: 10.1111/iwj.13117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 03/03/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jiyong Pan
- Department of General Surgery, the Third People's Hospital of DalianDalian Medical UniversitDalianChina
| | - Zhe Fan
- Department of General Surgery, the Third People's Hospital of DalianDalian Medical UniversitDalianChina
- Department of General Surgery, Zhongda Hospital, Medical SchoolSoutheast UniversityNanjingChina
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Giant mucinous adenocarcinoma of the appendix: a case report. J Med Case Rep 2017; 11:206. [PMID: 28756772 PMCID: PMC5535295 DOI: 10.1186/s13256-017-1385-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 07/10/2017] [Indexed: 11/13/2022] Open
Abstract
Background Appendiceal mucinous adenocarcinoma is an extremely rare disease in clinical practice. Here, we report a case of unprecedented size that occupied the entire abdomen of a man. Case presentation A 49-year-old Chinese Han man presented with symptoms of abdominal distension. During a computed tomography imaging examination, a cystic-solid mass that occupied his entire abdominal cavity was detected. During exploratory laparotomy, an appendiceal tumor in his abdominal-pelvic cavity measuring 27.6 × 14.2 cm was found, and he underwent tumor resection. The pathology of the tumor identified a well-differentiated appendiceal mucinous adenocarcinoma with mucin infiltrating into the soft tissue of the lump edge and omentum tissue. After surgery, our patient accepted intraperitoneal infusion chemotherapy. At present, he has had no recurrence for 15 months. Conclusions To the best of our knowledge, the present case is the largest appendiceal mucinous adenocarcinoma reported. Surgical tumor resection is the preferred treatment for appendiceal mucinous adenocarcinoma. This is supplemented by chemotherapy which can further prolong survival.
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