Large Mucocele of the Appendix at Laparoscopy Presenting as an Adnexal Mass in a Postmenopausal Woman: A Case Report

Abstract

A 79-year-old female was referred to our Gynecologic Department presenting with a pelvic magnetic resonance imaging (MRI), showing an adnexal mass, later confirmed at the pelvic examination. The patient's routine laboratory tests were normal. A sonographic examination was performed with inconclusive results. Although the ultrasonography excluded the presence of vascularization and malignant degeneration, the adnexal localization appeared to be dubious. The laparoscopy and the subsequent histologic examination revealed the presence of a mucocele of the appendix. The following case report focuses the attention on a misdiagnosis of appendiceal mucocele. The misdiagnosis caused no negative impact on the treatment that in this case was adequate and successful.

What you see might not be what you get: Discrepancies between intraoperative findings and preoperative diagnosis of ovarian tumors. Appendicular mucocele presenting as an adnexal mass - Case report and review of literature

“…Our patient's tumor markers were normal, and pelvic US and MRI both suggested an ovarian tumor that subsequently turned out to be appendiceal in orgin. Such situation is rare, although others reported similar possible uncertainty [ 6 , 9 ]. It is important to enhance the preoperative diagnosis of AM in order to increase the probability of anticipating it, and hence appropriate management, prevention of rupture at surgery, which may lead to pseudomyxoma peritonei; and also to prompt the intra-operative search for the presence of any synchronous colorectal neoplasm/s [ 4 ].…”

“…Hence, AM should be considered in the differential diagnosis of women presenting with adnexal mass on ultrasound in order to choose the best surgical approach [ 6 ]. The gynaecologist might benefit from more accurate investigational methods (e.g.…”

“…Although AM may present traditionally as acute appendicitis, preoperative diagnosis remains difficult [ 4 ], and > 70% of AMs are discovered incidentally during laparotomy or laparoscopy [ 3 ]. AM may have a sonographic appearance of adnexal mass, but subsequent exploration shows no evidence of ovarian tumor [ 6 ].…”

Clinicopathological analysis of patients operated with appendiceal mucocele

“…In our study, mucinous cystadenoma was identified in 61.4% of the patients. [4,29] Mucinous cystadenoma is at the benign end of the spectrum with no risk of recurrence.…”

“…[3] Mucocele of the appendix can be categorized in four histological types, including retention cyst, mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma. [4,5] The affected patients are usually above the age of 50 years. [6] Clinical signs include ab- USG showed a dilated tubular structure in the right iliac fossa, and CT revealed a long tubular structure distended with hypodense material with or without calcification in the wall of the appendix, together with mass effect in six cases.…”