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Review
. 2006 Oct 30:6:32.
doi: 10.1186/1471-230X-6-32.

Ruptured appendiceal cystadenoma presenting as right inguinal hernia in a patient with left colon cancer: a case report and review of literature

Yueh-Tsung Lee  1 , Hurng-Sheng Wu, Min-Chang Hung, Shang-Tao Lin, Yome-Shine Hwang, Min-Ho Huang
Affiliations
Review

Ruptured appendiceal cystadenoma presenting as right inguinal hernia in a patient with left colon cancer: a case report and review of literature

Yueh-Tsung Lee et al. BMC Gastroenterol. .

Abstract

Background: Mucoceles resulting from cystadenomas of the appendix are uncommon. Although rare, rupture of the mucoceles can occur with or without causing any abdominal complaint. There are several reports associating colonic malignancy with cystadenomas of the appendix. Herein, we report an unusual and interesting case of right inguinal hernia associated with left colon cancer.

Case presentation: A case of ruptured mucocele resulting from cystadenoma of the appendix was presented as right inguinal hernia in a 70-year-old male. The patient underwent colonoscopy, x-ray, ultrasound and computed tomography. Localized pseudomyxoma peritonei associated with adenocarcinoma of the descending colon was diagnosed. The patient underwent segmental resection of the colon, appendectomy, debridement of pseudomyxoma and closure of the internal ring of right inguinal canal. He is free of symptoms in one year follow-up.

Conclusion: Synchronous colon cancer may occur in patients with appendiceal mucoceles. In such patients, the colon should be investigated and colonoscopy can be performed meticulously in cases of ruptured mucoceles and localized pseudomyxoma peritonei. Surgical intervention is the current choice of management.

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Figures

Figure 1
Figure 1
The CT scan showed the irregular hypodense lesion with fat stranding nearby the cecum without obvious enlarged lymph nodes.
Figure 2
Figure 2
A heterogenous hypodense lesion with adjacent fat stranding in the right inguinal canal was noted on the CT scan.
Figure 3
Figure 3
No oral contrast media leaking from the cecum into the peritoneal cavity was noted on the CT scan.
Figure 4
Figure 4
A sessile polyp, 2 cm in diameter, in the descending colon was discovered by colonoscopy.
Figure 5
Figure 5
Microscopically, the tumor cells were large, hyperchromatic and pleomorphic with irregular glandular formation suggestive of moderately differentiated adenocarcinoma and invaded the muscle layer of colon.
Figure 6
Figure 6
At laparotomy, the appendix was excised and the pieces were removed.
Figure 7
Figure 7
The lower peritoneal cavity and the right inguinal canal were filled with yellowish gelatinous fluid.
Figure 8
Figure 8
Microscopically, the mucosal glands of the appendix demonstrated dilatation and containing mucin suggestive of mucinous cystadenoma. The periappendix tissue showed mucinous tissue mixed with granulation tissue without tumor in it and consistent with pseudomyxoma peritonei.
See this image and copyright information in PMC

References

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