Appendiceal mucocele. A case report and literature review.


COD: 239-246 Categorie: ,

Daniela Caracappa, Nino Gullà, Daniele Gentile, Chiara Listorti, Carlo Boselli, Roberto Cirocchi, Guido Bellezza, Giuseppe Noya

Ann. Ital. Chir., 2011 82: 239-245

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Appendiceal mucocele is a rare disease (0.3% of all appendectomy) and is characterized by the accumulation of mucoid
material in the appendiceal lumen. Etiopathogenesis can be inflammatory or neoplastic. Four entities can be distinguished
on the basis of histopathologic epithelial characteristics: simple appendiceal mucocele (AM), mucocele with epithelial hyperplasia,
cystadenoma and cystadenocarcinoma; the last two subgroups represent neoplastic forms. Dissemination of neoplastic
cells and mucoid material in abdominal cavity, caused by appendiceal perforation, clinically results in pseudomyxoma
peritonei which is the dramatic evolution in 10-15% of cases. Clinically it can remain either asymptomatic for
long time or it can manifest with abdominal pain that can be associated with the presence of a palpable mass. The
most common clinical manifestation is pain in the right iliac fossa. Preoperative diagnosis is rare, while it is more frequently
intraoperative. Therapy is fundamentally surgical: appendectomy is curative for simple AM, for AM with epithelial
hyperplasia and for cystadenoma with intact appendiceal base; cecum resection is indicated for cystadenoma with
larger base of implantation; right hemicolectomy has been the elective treatment in case of cystadenocarcinoma for several
years although Gonzalez-Moreno and Sugarbaker have recently demonstrated its validity as definitive treatment only
if it is performed in order to obtain complete cytoreduction, if there is lymph node involvement, or if histopathological
examination indicates non-mucinous type. We report the case of a 60-year-old woman that presented with cystic neoformation
in the right iliac fossa, that was preoperatively considered deriving from the ovary. We intraoperatively found
the presence of appendiceal mucocele that histological examination defined as mucinous cystadenoma.


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