Low-grade Appendiceal Mucinous Neoplasm and Peritoneal Pseudomyxoma: a case of appendiceal mucocele perforation and autoamputation
Autores
Luís Henrique Ribeiro; Rita Araújo; Catarina Longras; Mariana Martins; Inês Peixoto; Ricardo Fernandes; Anita Santos; André Graça Magalhães; Carlos Alpoim;
Resumo Introdução
LAMNs are neoplastic lesions producing mucin without infiltrative growth. These present as acute appendicitis due to the obstruction appendiceal lumen or on imaging exams when studding an abdominal pain. It presents intraoperative or on images with a mucocele, which perforation can lead to a Pseudomyxoma Peritonei (PP).
Resumo Métodos
Reviewing the case of a 31yo women referred to Colorectal Surgery evaluation.
Resumo Resultados
A patient with lower abdominal pain was submitted to a CT and MRI imaging revealing an appendiceal mucocele, with a small volume of free intraperitoneal fluid. The patient underwent a laparoscopic exploration, an appendiceal mucocele completely amputated from the cecum was identified along with mucin deposits on the appendiceal serosa, and free mucin within the peritoneal cavity. By AJCC, the lesion was staged as LAMN T4a M1a. Cytological analysis of the mucine was negative for malignant cells. The patient is currently scheduled to undergo CRS/HIPEC.
Resumo Discussão
Appendiceal perforation lead to dissemination of mucin or neoplastic cells into the peritoneal cavity. Lymphatic and hematogenous is rare and typically restricted to high-grade disease. It was also observed the autoamputation of the appendix, a rare finding, the amputated appendix was tethered to the mesoappendix with preserved blood supply. PP risk of recurrence: 3?7% when mucin is acellular, and 33?77% when cellular mucin. PSOGI recommend that patients with LAMNs with mucocele perforation are almost invariably candidates CRS/HIPEC.