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Simultaneous giant mucinous cystadenoma of the appendix and intestinal schistosomiasis: 'case report and brief review'.

Lin C, Li X, Guo Y, Hu G, Zhang Y, Yang K, Gan Y, Zhou J, Lv L, Gao K, Du J - World J Surg Oncol (2014)

Bottom Line: A 64-year-old man from China presented with a one-year history of pain in the right lower quadrant of the abdomen.We deduced that the pathogenesis of appendiceal mucinous cystadenoma in our case was Schistosome eggs causing luminal obstruction, finally resulting in intraluminal accumulation of mucoid material.Postoperatively, the patient recovered well.

View Article: PubMed Central - PubMed

Affiliation: Department of General surgery, The Third XiangYa Hospital of Central South University, Tongzipo Road, Changsha 410013 Hunan, PR China. lixiaorong@medmail.com.cn.

ABSTRACT
Both mucinous cystadenoma of the appendix and intestinal schistosomiasis are rare lesions. We report a rare case of simultaneous giant mucinous cystadenoma of the appendix and intestinal schistosomiasis. A 64-year-old man from China presented with a one-year history of pain in the right lower quadrant of the abdomen. There were no other pertinent historical findings, other than schistosomiasis. Imaging showed a large, tubular, mesenteric cystic structure extending downwards from the inferior wall of the cecum. Right hemicolectomy was performed for the appendiceal tumor. The final pathological diagnosis was mucinous cystadenoma with calcified Schistosome eggs within the mucosa and submucosa of the appendix, small intestine, colon, and lymph nodes. We deduced that the pathogenesis of appendiceal mucinous cystadenoma in our case was Schistosome eggs causing luminal obstruction, finally resulting in intraluminal accumulation of mucoid material. Postoperatively, the patient recovered well.

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Intraoperative finding of giant appendiceal mucocele. Note the plastic bag that was placed on the tumor to prevent epithelial cells from escaping into the peritoneal cavity (arrow).
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Fig2: Intraoperative finding of giant appendiceal mucocele. Note the plastic bag that was placed on the tumor to prevent epithelial cells from escaping into the peritoneal cavity (arrow).

Mentions: The patient was a 64-year-old man who was born in Yueyang City, Hunan Province, in Southern China, one of the most heavily endemic areas with schistosomiasis over the past five decades. The patient was admitted to our department with a one-year history of intermittent pain in the lower right quadrant of the abdomen. When the lower right quadrant of the abdomen was palpated, the patient felt pain, but his muscles were not rigid and there was no rebound tenderness. On physical examination, there was no palpable mass in the right lower abdomen. No liver or spleen enlargement was noted. Abdominal ultrasonography revealed a well-encapsulated hypoechoic process measuring 103 × 43 mm (Figure 1B). Computed tomography of the abdomen showed a large, hypodense, tubular, cystic structure measuring 96 × 49 × 48 mm. Moreover, the mass extended below the inferior wall of the cecum (Figure 1A). Colonoscopy revealed a submucosal elevation on the appendiceal orifice (Figure 1C). The patient was diagnosed with mucocele of the appendix, and open surgery was performed. During surgery, a plastic bag was placed on the tumor to prevent epithelial cells from escaping into the peritoneal cavity (Figure 2). At the time of surgery, intraoperative frozen section analysis could not exclude the possibility of malignancy, and the appendiceal base was large. Therefore, right hemicolectomy was performed. The resected right hemicolectomy specimen revealed a dilated appendix, 11 cm in length and 6 cm in diameter, and showed thin fibrous tissue that was distended with intraluminal thick, mucinous material (Figure 3). The final pathological diagnosis was mucinous cystadenoma of the appendix. Moreover, histologic examination revealed numerous calcified, nonoperculated Schistosome eggs within the mucosa, submucosa of the appendix, small intestine, colon, and lymph nodes, associated with surrounding fibrosis (Figure 4). Given the absence of dysplasia in the appendiceal mucosa, we deduced that the mucocele had developed because of fibrosis formed as a result of the obstruction by the Schistosome eggs to the appendiceal outflow of mucin. The patient did not undergo chemotherapy following surgery, recovered uneventfully, and has remained well.Figure 1


Simultaneous giant mucinous cystadenoma of the appendix and intestinal schistosomiasis: 'case report and brief review'.

Lin C, Li X, Guo Y, Hu G, Zhang Y, Yang K, Gan Y, Zhou J, Lv L, Gao K, Du J - World J Surg Oncol (2014)

Intraoperative finding of giant appendiceal mucocele. Note the plastic bag that was placed on the tumor to prevent epithelial cells from escaping into the peritoneal cavity (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4300777&req=5

Fig2: Intraoperative finding of giant appendiceal mucocele. Note the plastic bag that was placed on the tumor to prevent epithelial cells from escaping into the peritoneal cavity (arrow).
Mentions: The patient was a 64-year-old man who was born in Yueyang City, Hunan Province, in Southern China, one of the most heavily endemic areas with schistosomiasis over the past five decades. The patient was admitted to our department with a one-year history of intermittent pain in the lower right quadrant of the abdomen. When the lower right quadrant of the abdomen was palpated, the patient felt pain, but his muscles were not rigid and there was no rebound tenderness. On physical examination, there was no palpable mass in the right lower abdomen. No liver or spleen enlargement was noted. Abdominal ultrasonography revealed a well-encapsulated hypoechoic process measuring 103 × 43 mm (Figure 1B). Computed tomography of the abdomen showed a large, hypodense, tubular, cystic structure measuring 96 × 49 × 48 mm. Moreover, the mass extended below the inferior wall of the cecum (Figure 1A). Colonoscopy revealed a submucosal elevation on the appendiceal orifice (Figure 1C). The patient was diagnosed with mucocele of the appendix, and open surgery was performed. During surgery, a plastic bag was placed on the tumor to prevent epithelial cells from escaping into the peritoneal cavity (Figure 2). At the time of surgery, intraoperative frozen section analysis could not exclude the possibility of malignancy, and the appendiceal base was large. Therefore, right hemicolectomy was performed. The resected right hemicolectomy specimen revealed a dilated appendix, 11 cm in length and 6 cm in diameter, and showed thin fibrous tissue that was distended with intraluminal thick, mucinous material (Figure 3). The final pathological diagnosis was mucinous cystadenoma of the appendix. Moreover, histologic examination revealed numerous calcified, nonoperculated Schistosome eggs within the mucosa, submucosa of the appendix, small intestine, colon, and lymph nodes, associated with surrounding fibrosis (Figure 4). Given the absence of dysplasia in the appendiceal mucosa, we deduced that the mucocele had developed because of fibrosis formed as a result of the obstruction by the Schistosome eggs to the appendiceal outflow of mucin. The patient did not undergo chemotherapy following surgery, recovered uneventfully, and has remained well.Figure 1

Bottom Line: A 64-year-old man from China presented with a one-year history of pain in the right lower quadrant of the abdomen.We deduced that the pathogenesis of appendiceal mucinous cystadenoma in our case was Schistosome eggs causing luminal obstruction, finally resulting in intraluminal accumulation of mucoid material.Postoperatively, the patient recovered well.

View Article: PubMed Central - PubMed

Affiliation: Department of General surgery, The Third XiangYa Hospital of Central South University, Tongzipo Road, Changsha 410013 Hunan, PR China. lixiaorong@medmail.com.cn.

ABSTRACT
Both mucinous cystadenoma of the appendix and intestinal schistosomiasis are rare lesions. We report a rare case of simultaneous giant mucinous cystadenoma of the appendix and intestinal schistosomiasis. A 64-year-old man from China presented with a one-year history of pain in the right lower quadrant of the abdomen. There were no other pertinent historical findings, other than schistosomiasis. Imaging showed a large, tubular, mesenteric cystic structure extending downwards from the inferior wall of the cecum. Right hemicolectomy was performed for the appendiceal tumor. The final pathological diagnosis was mucinous cystadenoma with calcified Schistosome eggs within the mucosa and submucosa of the appendix, small intestine, colon, and lymph nodes. We deduced that the pathogenesis of appendiceal mucinous cystadenoma in our case was Schistosome eggs causing luminal obstruction, finally resulting in intraluminal accumulation of mucoid material. Postoperatively, the patient recovered well.

Show MeSH
Related in: MedlinePlus