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. 2015:15:66-9.
doi: 10.1016/j.ijscr.2015.08.030. Epub 2015 Aug 20.

Low-grade mucinous neoplasia in a cecal diverticulum: A case report

Kazuyoshi Nakatani  1 , Katsuji Tokuhara  2 , Tatsuma Sakaguchi  3 , Hironori Ryota  4 , Kazuhiko Yoshioka  5 , Masanori Kon  6
Affiliations

Low-grade mucinous neoplasia in a cecal diverticulum: A case report

Kazuyoshi Nakatani et al. Int J Surg Case Rep. 2015.

Abstract

Introduction: Low-grade mucinous neoplasia is an uncommon benign tumor that develops in the appendix. The development of mucocele disease has never been reported in a colonic diverticulum. We present a case developing low-grade mucinous neoplasia in a cecal diverticulum.

Presentation of case: A tumor in the ileocecal region was found during a medical examination of a 66-year-old woman. Three months later, the tumor was still present and the patient developed abdominal pain. Laparoscopic ileocecal resection with D2 lymph node dissection was performed. Histopathological examination revealed a low-grade mucinous neoplasm in a cecal diverticulum.

Discussion: Colonic mucoceles reportedly originate from the appendix. There are no previous reports of mucocele disease in a colonic diverticulum worldwide. This report reviews and discusses the management of the appendiceal mucoceles.

Conclusion: The incidence of colonic diverticula has recently begun to increase in Japan. The possibility of a mucocele within a colonic diverticulum should be considered in patients with submucosal colonic tumors.

Keywords: Diverticulum; Mucinous cystadenocarcinoma; Mucinous cystadenoma; Mucinous neoplasia.

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Figures

Fig. 1
Fig. 1
Abdominal CT revealed an 18- × 36-mm tumor,in the ileocecal region (white arrow).
Fig. 2
Fig. 2
Colonoscopy revealed a submucosal tumor in the ileocecal region. It was difficult to insert the endoscope to the mouth side of the tumor. The orifice of the diverticulum was not found.
Fig. 3
Fig. 3
The submucosal tumor was located in the ileocecal region. There was no continuity between the proximal edge of the appendix and the tumor.
Fig. 4
Fig. 4
Macroscopic view of the resected specimen shows the submucosal tumor, which measured 35 × 30 mm, in the ileocecal region (arrow). The tumor was not continuous with the appendix.
Fig. 5
Fig. 5
(A) Loupe image. The cystic mass was present with mucinous collection in the muscularis propria. (B) The colonic lamia propria curved within the muscularis propria; therefore, this fistula was considered to be a cecal diverticulum. There was continuity in the colonic lamia propria of the surface and the muscularis propria. The orifice of the diverticulum was present on the surface of the colonic lamia propria (arrow), therefore it was considered to be cecal diverticulum. (C) Although epithelial neoplastic transformation was evident in the wall of the cystic mass as shown by cells exhibiting increased nuclear size and chromatin, these malignant cells were not present in the cystic tumor.
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