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(10): 2334-2343 [PMID: 33869611 DOI: 10.12998/wjcc.v9.i10.2334]
Corresponding Author of This Article
Dusan Djokovic, PhD, Surgical Oncologist, Department of Obstetrics and Gynecology, Maternidade Dr. Alfredo da Costa-Centro Hospitalar Universitário de Lisboa Central, R. Viriato 1, Lisbon 2890-495, Portugal. dusan.djokovic@nms.unl.pt
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Apr 6, 2021; 9(10): 2334-2343 Published online Apr 6, 2021. doi: 10.12998/wjcc.v9.i10.2334
Low-grade mucinous appendiceal neoplasm mimicking an ovarian lesion: A case report and review of literature
André Luís Borges, Catarina Reis-de-Carvalho, Martinha Chorão, Helena Pereira, Dusan Djokovic
André Luís Borges, Helena Pereira, Department of Obstetrics and Gynecology, Hospital de São Francisco Xavier-Centro Hospitalar Lisboa Ocidental, Lisbon 1449-005, Portugal
André Luís Borges, 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
Dusan Djokovic, Department of Obstetrics and Gynecology, Maternidade Dr. Alfredo da Costa-Centro Hospitalar Universitário de Lisboa Central, Lisbon 2890-495, Portugal
Dusan Djokovic, Faculdade de Ciências Médicas, Nova Medical School, Lisbon 1169-056, Portugal
Author contributions: All authors participated in the medical care offered to the patient; Borges AL, Pereira H and Djokovic D performed the surgery; Borges AL and Djokovic D conceptualized the case report; Borges AL and Reis-de-Carvalho C collected data and wrote the manuscript draft; Chorão M performed the histopathological analysis and provided the histological images; Djokovic D and Pereira H reviewed and edited the manuscript; all authors approved the final manuscript.
Informed consent statement: Consent was obtained from the patient for publication of this report and all accompanying images. The host institution ruled that the approval of the Ethics Committee was not required for this project.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dusan Djokovic, PhD, Surgical Oncologist, Department of Obstetrics and Gynecology, Maternidade Dr. Alfredo da Costa-Centro Hospitalar Universitário de Lisboa Central, R. Viriato 1, Lisbon 2890-495, Portugal. dusan.djokovic@nms.unl.pt
Received: November 20, 2020 Peer-review started: November 20, 2020 First decision: December 21, 2020 Revised: January 4, 2021 Accepted: February 10, 2021 Article in press: February 10, 2021 Published online: April 6, 2021 Processing time: 129 Days and 12.4 Hours
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.
Core Tip: Low-grade mucinous appendiceal neoplasm is one of the rarest intestinal tumors. Our case highlights how this neoplasm can mimic the behavior of a gynecological (adnexal) lesion in terms of clinical and imaging presentation, while the management and teams of professionals offering treatment significantly differ from those appropriate in the case of adnexal pathology.
