Acellular Appendix Vermiform Mucinous Neoplasm

Abstract

Appendiceal neoplasms are usually asymptomatic or associated with mild, nonspecific symptoms. Due to the rarity of the disease and the lack of specific symptoms, this clinical entity escapes the diagnostic consideration of the gynecologist, when women come in with right iliac fossa pain. A case is presented of a 56-year-old woman with a mass in the right small pelvis, which was preoperatively diagnosed as originating from the ovary. An exploratory laparotomy followed in which the uterus and appendages were found to be macroscopically normal, while the mass described above came from the appendix, extended into the anatomical area of the right accessory, and was in contact with the atrophic right ovary. The appendix vermiformis was removed intact. The final pathologic examination confirmed an acellular mucinous tumor of the appendix. Accurate preoperative diagnosis of mucoceles is extremely difficult to make. The formation is discovered in a random imaging test, and the diagnosis is confirmed only intraoperatively.

Keywords: acellular appendix vermiform; diagnosis; management.

Figure 1

The appendix distended in saccular form.

Figure 2

The appendix specimen shown as a gelatinous polycystic mass.

Figure 3

Epithelial mucinous cells with apical mucin and elongated nuclei with low-grade atypia (hematoxylin–eosin stain, ×10 HPF magnification).

Figure 4

Villous proliferation mucinous epithelial cells that originate from the lumen of the appendix (hematoxylin–eosin stain, ×4 HPF magnification).