High risk of delayed or missed diagnosis of mucinous appendiceal neoplasm by transvaginal ultrasound: A case series

Appendiceal Neoplasm is a rare tumour with a vague and nonspecific clinical presentation. Delayed or missed diagnosis could result in mucin spill into the peritoneal cavity because of cancer infiltration or spontaneous rupture of appendix. This condition is called Psuedomyxoma Peritonei (PMP) and has a very poor prognosis if not treated properly. We present 4 cases of Appendiceal Neoplasm misdiagnosed as adnexal masses of different origin: Dermoid cyst of the right ovary; stump of the previously removed tube; ectopic pregnancy; ovarian malignancy. It is important for gynaecologists to recognize mucinous appendiceal neoplasm in the differential diagnosis of right adnexal masses in order to reduce the risk of misdiagnosis. Keywords: Appendiceal Neoplasm, Adnexal Masses, Transvaginal Ultrasound, Misdiagnosis.

Appendiceal Tumors in Adults, Findings in 1870 Specimens

PurposeThe appendiceal disease is a frequent entity, with a non-negligible number of malignancies. There is an association of synchronous appendiceal tumors with other malignancies, therefore a routine appendectomy could be considered. The aim of our study is to analyze the number of cases of non-inflammatory appendiceal disease with unusual histopathological findings of appendix samples. Secondary aims are to analyze the recurrence and mortality of appendicular tumors.Methods A retrospective cohort study of all the appendectomy specimens in a period of time of 5 years was performed.ResultsA total of 1870 appendectomies were included. Non-inflammatory disease was found in 127 cases (5.5%) and malignant neoplasm in 33 patients (1.76%). Mucinous Cystoadenoma was the most common benign tumor, representing 33.3 % of total cases. The most common appendiceal neoplasm was adenocarcinoma (11 patients) and neuroendocrine tumors (22 patients). Acute appendicitis was the most frequent surgical indications in those patients. In the adenocarcinoma group, older patients were more frequent (p=0.003), as was the presence of abscess (p=0.016). From the appendiceal neoplasm, 30% (10 patients) had a synchronous colorectal or gynecological cancer. Five-year survival for adenocarcinoma and neuroendocrine tumors was 53.6 % (95% CI 51-94) and 45.5 % (95% CI 26-72) (p=0,373).ConclusionsHistopathological assessment of the appendix will allow early diagnosis of many unusual findings of the appendix. We recommend to considered routine appendectomy due to the high incidence of appendiceal tumors and a non-negligible number of synchronous colorectal and gynecological cancers.

A retrospective analysis and literature review of neoplastic appendiceal mucinous lesions

Background At present, the term mucocele is outdated, and mucinous appendiceal neoplasm is preferred. Mucinous appendiceal neoplasm is an uncommon pathology that occurs predominantly in middle-aged women. Its classification and management have been the subject of debate in recent decades. The aim of this study was to analyse the incidence, clinical management and survival of these tumours diagnosed in our centre in the last 10 years. Methods This was a retrospective observational study of patients with a diagnosis of appendiceal neoplasms between 2009 and 2018 in our centre. Variables such as sex, age, tumour type, clinical status, diagnosis, treatment and survival were collected. All data were analysed using the statistical program IBM SPSS Statistic® version 25. Results Twenty-nine patients with a diagnosis of appendiceal neoplasm were identified, and 24 corresponded to neoplastic appendiceal mucinous lesions (85.7%). The average age was 59.7 ± 17.6 years. Most patients were women (15 cases; 62.5%). Most of them presented with chronic abdominal pain (37.5%), and the diagnosis was performed by computed tomography (CT) (50%). The treatment was surgical in all cases. The surgical technique depended on the findings and histology of the tumour. Conclusion Mucinous appendiceal neoplasms are an uncommon entity, and their pathological classification and management have recently changed.