Oscar Josue Montes Aguilar1*, Angel Medina Andrade1*, Gerardo Perez1, Stephanie Serrano Collazos1, Brenda Ruiz1, Maria Fernanda Chein Vázquez1, Karina Yolanda Vite Pineda1, Eduardo Vidrio Duarte2, Carlos Eduardo Rodriguez Rodriguez2 and Lizette Blanco Aguilar3
1University of Quintana Roo. General Surgery Department. Mexican Social Security Institute, Regional Polytechnic Manzana 1 Lote 1 509 Region General Hospital No. 17, Av. CP 55750, Cancun, Quintana Roo, Mexico
2La Salle University, General Surgery Department. Hospital Angeles Metropolitano, Tlacotalpan # 59, Cuauhtemoc, Col. Roma, Mexico
3Autonomous University of Chiapas Manuel Velasco Suarez. Prospera Rural Hospital # 1, San Cristobal de las Casas, Chiapas, Mexico
#This authors have the same grade of responsibility as principal authors
Received: 07 December, 2015; Accepted: 08 January, 2016; Published: 09 January, 2016
Angel Medina Andrade, University of Quintana Roo, General Surgery Department. Mexican Social Security Institute, Regional Polytechnic Manzana 1 Lote 1 509 Region General Hospital No. 17, Av. CP 55750, Cancun, Quintana Roo, Tel: (+52) (55) 9981963197; E-mail:
Montes Aguilar OJ, Andrade AM, Perez G, Collazos SS, Ruiz B, et al. (2016) Giant Appendicular Mucinous Cystoadenoma: Case Report and Review of the Literature. Arch Clin Gastroenterol 2: 001-003. 10.17352/2455-2283.000009
© 2016 Montes Aguilar OJ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abdominal neoplasms; Appendiceal tumor; Appendicitis; Appendicectomy
Background: Appendix tumours present an incidence of 0.2 to 0.3% among all appendectomies. It is a rare condition, commonly found as an incidental diagnosis by imaging studies due to his lack of symptoms; nevertheless it is associated with many complications when undiagnosed like pseudomixoma peritonei a condition with high morbidity and mortality. This is the importance of recognize it to establish an opportune diagnose and treatment.
Case: A 49-year old man with abdominal pain of 6 days of evolution. He has medical history of diabetes mellitus 2 and hypertension. He presents to the emergency department complaining of pain in right lower quadrant and reports radiation to the ipsilateral renal fossa. Ultrasonography demonstrated an oblique cystic fusiform lesion suspicious of abscess. Simple computed tomography concluded probable mesenteric cyst. An exploratory laparotomy was performed finding a 12 X 8cm tumour lesion that protruded from the appendix. Tumour was dissected and a right hemicolectomy with side-end ileocolic anastomosis was performed. The histopathology study reveals an appendiceal mucinous neoplasm of low grade. After 5 days the patient was discharged without complications. After 8 months follow up the patients is asymptomatic and without evidence of tumour activity.
Conclusion: Appendix tumours are a rare pathology with an insidious presentation representing a difficult diagnosis; requiring high index of suspect and knowledge about the correct surgical management to obtain better outcomes.
Appendicular tumours are found in less than 1% of appendix pathology. Mucocele of the appendix is a rare entity, with 0.2 to 0.3% incidence, which are an obstructive appendicular dilatation of mucous material. Simple mucocele represents 29%, mucinous cystoadenoma contributes to 31 to 34% and cysatoadenocarcinoma is even less frequent, representing 22 to 23% of the malignant appendix pathology. Although cystoadenomas are a benign lesions, any proliferation or rupture of cystoadenomas have a risk of peritoneal dissemination, reason why the complete excision without rupture is important to prevent complications .
A 49-year-old man with 6 days of evolution abdominal pain presented to emergency room. He has medical history of diabetes mellitus 2 and hypertension in treatment. He presents to the emergency department complaining of pain in right lower quadrant and radiation to the ipsilateral renal fossa. Laboratories reported withe blood cells 13000/mm3, Hemoglobin 13.7 g/dL, Platelets 122000, Glucose 115 mg/dL, Cr 1 mg/dL. Gas analysis report respiratory acidosis for hyperventilation. Urinalysis report leucocytes <2μL, no red blood cells, bacteries, nitrites, glucose , proteins or ketones. An urinary infection was discarded and acute appendicitis was suspected. Ultrasonography demonstrated an oblique cystic fusiform lesion suspicious of abscess but inconclusive. Contrast computed tomography scan (CT scan) reported a tumour image of 27 Hounsfield Units that increase to 100 Hounsfield Units with the contrast medium, has extension through the left side of the abdomen with 109.7mm of longitude and concluded probable mesenteric cyst, without other abdominal disease and no colon tumour (Figures 1,2). Tumoral markers report carcino-embrionary antigen 1.77 ng/ml (normal value 0-3ng/ml), Alfa fetoproteine 4.27 ng/ml (normal value 0-10 ng/ml), Ca-125 14 ng/ml (normal value 0-35ng/ml). An exploratory laparotomy was performed finding a 12 X 8 cm tumour lesion that protruded from the appendix (Figure 3). Tumour was dissected and right hemicolectomy with side-end ileocolic anastomosis was performed. The histopathology study reports a cecal appendix of 15x7.5x6 cm, smooth and pearly colour surface, with abundant mucus inside and fibrous septum that divide his light, flattened mucosa and wall of 0.3 cm thick with fibrous aspect (Figure 4). Conclusion of this study was appendiceal mucinous neoplasm of low grade. After 5 days the patient was discharged without complications. After 8 months follow up the patients is asymptomatic and without evidence of tumour activity.
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