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Case Report

Mucinous cystadenoma of the appendix

Vudutha Srihari, Janga Jayaram, Golla Baleswari, Shaik Sabira, M. Naveen Kumar, N. Mallikarjuna
Department of Surgery and Pathology, Kurnool Medical College, Government General Hospital, Kurnool,
Andhra Pradesh, India

ABSTRACT
We present a case of 50-year-old man came with abdominal pain for 3 months who was investigated and found to be suffering from
mucinous cystadenoma of the appendix for which who have done appendicectomy and ileotransverse anastomosis. Surgical specimen
sent to pathology for histopathological examination revealed mucinous cystadenoma of the appendix.

Key words: Appendicectomy, mucinous cystadenoma of the appendix, pseudomyxoma peritonii

INTRODUCTION On clinical examination, his vitals are stable. His

abdomen was flat and soft with a firm sausage-
Tumors of the appendix are emerging as diseases of shaped nontender and nonmobile mass in the right
increasing concern due to a rising incidence. Primary iliac fossa. The clinical diagnosis was ileocecal mass
neoplastic lesions presenting with a mucocele of the and differential diagnosis of ileocecal tuberculosis.
appendix are very rare and can be divided into benign Abdominal ultrasonography revealed a 10 cm ×
variants of mucinous adenomas or cystadenomas, 6 cm × 4 cm cystic mass in the right iliac fossa.
mucinous tumors of uncertain malignant potential Contrast-enhanced computed tomography abdomen
or mucinous cystadenocarcinomas. Most of these shows 10 cm × 6 cm × 4 cm cystic lesion suggestive
tumorous mucoceles are asymptomatic and are found of mucocele of the appendix [Figure 1]. He was
incidentally. The major complication of neoplastic subsequently prepared for an exploratory laparotomy.
mucinous appendiceal tumors is the development
Intra-operative findings included a sausage shaped,
of a pseudomyxoma peritonii due to spreading of
firm appendiceal tumor, which was not attached to the
mucin-producing cells within the abdominal cavity.
surrounding structures [Figures 2 and 3].
We present a case of mucinous cystadenoma of the
appendix in an elderly patient.
Patient underwent laparotomy and diagnosis of
mucocele of the appendix confirmed. He underwent
CASE REPORT
appendicectomy along with a rim of cecal wall
A 55-year-old man presented with a history of pain
in the lower abdomen on the right side for 3 months.

Address for correspondence

Dr. V. Srihari,
H. No: 46-1M-1-4, Aditya Nagar, A-Camp, Kurnool,
Andhra Pradesh, India.
E-mail: vuduthasrihari@yahoo.in

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10.4103/2277-8632.165405 Figure 1: Computed tomography abdomen contrast scan showing

a localized hypodense mass in the cecum (arrow)

182 Journal of Dr. NTR University of Health Sciences 2015;4(3) 182-184

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Srihari, et al.: Mucinous cystadenoma of the appendix

around the base of appendix and ileotransverse It is a rare entity found in 0.3% of appendiceal
anastomosis. The tumor weighed 150 g. The specimens,[3,4] with a slight female predominance and
histology of the appendix was reported as showing an average age at diagnosis of over 50 years.[5]
extensive pools of mucin in a cystic cavity lined
by tall columnar epithelium with an apical mucin The term mucocele is usually used to describe a
[Figures 4 and 5]. Features are those of mucinous dilatation of the lumen of the appendix due to mucosal
cystadenoma of the appendix. His postoperative secretions. There are four groups that can be identified:
recovery was uneventful. 1. Simple mucocele or retention mucocele, which is
due to obstruction of the lumen of the appendix by
a fecolith and characterized by normal epithelium
DISCUSSION
with dilatation of the lumen up to 1 cm
2. Mucosal hyperplasia that constitutes 5-25% of
Mucinous cystadenoma of the appendix is a rare
mucoceles
cystic neoplasm characterized by villous adenomatous 3. Mucinous cystadenoma, the most common type
changes of the appendiceal epithelium associated with an incidence of 63-84%; intraluminal dilatation
with marked distension of the appendiceal lumen reaches up to 6 cm and the appendicular perforation
with mucin. The most common presentation is pain up to 20%
in right iliac fossa, similar to an acute appendicitis; 4. Cystadenocarcinoma representing <1%.[6.7]
however, about 25% of patients are asymptomatic and
the condition is found incidentally on imaging or at The symptoms are nonspecific. The most common
the time of surgery.[1,2] form of presentation is pain in the right iliac fossa

Figure 2: Intra-operative images of mucinous cyst adenoma of Figure 3: Intra-operative images of mucinous cyst adenoma of
appendix appendix

Figure 4: Histopathological image showing mucin in cystic cavities Figure 5: Histopathological image showing mucin in cystic cavities
lined by columnar epithelium lined by columnar epithelium

Journal of Dr. NTR University of Health Sciences 2015;4(3) 183

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Srihari, et al.: Mucinous cystadenoma of the appendix

and palpable mass in 50% of cases, which may and a right hemicolectomy recommended for a
be complicated by lower gastrointestinal bleeding, cystadenocarcinoma. In cases of disseminated
intussusception, or intestinal obstruction as well pseudomyxoma peritonei, an ultrasonic surgical
as genitourinary symptoms. [8] The most serious aspirator can be used.[3,13]
complication is a pseudomyxoma peritonii, which
is caused by peritoneal dissemination caused by a REFERENCES
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by laparotomy is advised for focal or diffuse How to cite this article: Srihari V, Jayaram J, Baleswari G, Sabira S,
mucosal hyperplasia and cystadenoma when the Kumar MN, Mallikarjuna N. Mucinous cystadenoma of the appendix. J
NTR Univ Health Sci 2015;4:182-4.
appendiceal base is intact. Cecal resection is
performed for a cystadenoma with a large base, Source of Support: Nil. Conflict of Interest: None declared.

184 Journal of Dr. NTR University of Health Sciences 2015;4(3)