Cefalea rinogénica causada por mucopiocele en concha bullosa, un origen infrecuente. Reporte de caso / Rhinogenic headache caused by concha bullosa mucopyocele, an unusual origin. Case Report

Introducción: la cefalea rinogénica es secundaria al contacto permanente de la mucosa nasal y puede ser secundario a concha bullosa, si se infecta puede ser mucocele o mucopiocele. Caso clínico: paciente de 34 años con cefalea hemicraneal izquierda, dolor periocular ipsilateral, congestión y rinorrea hialina con cambios en consistencia y coloración del moco. En la tomografía computarizada (TAC) de senos paranasales (SPN) desviación septal derecha por concha bullosa izquierda, ocupación de líquido. Se sospecho mucocele y cefalea rinogénica secundaria, prueba de lidocaína positiva. Se detecto por cultivo, Eikenella corrodens. Manejo con antibiótico y posterior resolución de patología. Conclusiones: debe incluirse en el diagnóstico diferencial de cefalea y concha bullosa, realizarse endoscopia nasal y TAC de SPN. El manejo quirúrgico ha demostrado reducir la intensidad y la frecuencia de la cefalea a corto y largo plazo, y es exitoso si hay test de lidocaína positivo.

Introduction: rhinogenic headache is secondary to permanent contact with the nasal mucosa and may be secondary to concha bullosa, if infected it may be mucocele or mucopiocele. Clinical case: 34-year-old patient with left hemicranial headache, ipsilateral periocular pain, congestion, and hyaline rhinorrhea with changes in consistency and coloration of the mucus. In the computed tomography (CT) of the paranasal sinuses (SPN) right septal deviation due to left concha bullosa, fluid occupation. Mucocele and secondary rhinogenic headache were suspected, lidocaine test positive. Eikenella corrodens was detected by culture. Management with antibiotics and subsequent resolution of pathology. Conclusions: nasal endoscopy and SPN CT should be included in the differential diagnosis of headache and concha bullosa. Surgical management has been shown to reduce headache intensity and frequency in the short and long term, and is successful if there is a positive lidocaine test.

Mucocele apendicular benigno / Benign Appendiceal Mucocele

Introducción: El mucocele apendicular se considera una lesión rara del apéndice que se caracteriza por la dilatación de la luz del órgano con acumulación de moco. Este puede ser benigno o maligno. Objetivo: Caracterizar un caso de mucocele apendicular de comportamiento benigno en un paciente adulto masculino. Presentación del caso: Se asiste a un paciente, en estudio de tumor de vías digestivas, que se interviene quirúrgicamente con cuadro peritoneal agudo hallando masa de localización apendicular. Se realiza apendicectomía convencional y se estudia la pieza por anatomía patológica como mucocele apendicular benigno. La evolución del paciente fue satisfactoria. Conclusiones: Se presenta clínicamente de forma inespecífica, lo que posibilita que su diagnóstico sea intraoperatorio con mayor frecuencia. La estrategia quirúrgica depende de los hallazgos intraoperatorios donde la apendicectomía y la hemicolectomía derecha son las técnicas más utilizadas. El pseudomixoma peritoneal es una complicación temida(AU)

Introduction: Appendiceal mucocele is considered a rare lesion of the appendix characterized by dilatation of the organ lumen with mucus accumulation. It can be benign or malignant. Objective: To characterize a case of appendiceal mucocele with benign behavior in an adult male patient. Case presentation: A patient under study of digestive tract tumor is attended. The patient underwent surgery for having acute peritoneal symptoms; a mass of appendicular location was found. Conventional appendicectomy was performed and the piece was studied by pathological anatomy, being a benign appendicular mucocele. The patient's evolution was satisfactory. Conclusions: This condition is presented clinically in a nonspecific manner, which makes for its diagnosis to be more frequently intraoperative. The surgical strategy depends on the intraoperative findings, in which appendectomy and right hemicolectomy are the most used techniques. Pseudomyxoma peritonei is a feared complication(AU)

Ultrasonographic aspects of the gallbladder mucocele in 30 dogs: retrospective study / Aspectos ultrassonográficos da mucocele biliar em 30 cães: estudo retrospectivo

Gallbladder mucocele is characterized by hyperplasia of the gallbladder epithelium, increased mucus production, accumulation, and densification of the bile content, which can lead to biliary obstruction, necrosis, and rupture of the gallbladder wall. Its finding may be accidental or related to symptoms. A retrospective study (2016-2019) was carried out based on abdominal ultrasound examinations in dogs, correlating aspects of the gallbladder and biliary system in the mucocele with existing comorbidities. Thirty dogs diagnosed with biliary mucocele were evaluated, of which 46.66% had the disease at an early stage, and 53.33% showed a more advanced stage. Of these, 66.66% were related to endocrinopathies and hyperadrenocorticism. Signs of extrahepatic bile duct obstruction and biliary peritonitis were observed in two animals. Due to their potential risk of complications, follow-up ultrasound assessments are indicated in cases that opt for clinical treatment, not excluding the need for surgical intervention.(AU)

A mucocele biliar caracteriza-se pela hiperplasia do epitélio da vesícula biliar, aumento da produção de muco, acúmulo e densificação do conteúdo biliar, podendo levar à obstrução, necrose e ruptura da parede da vesícula biliar. Seu achado pode ser acidental ou estar relacionado à sintomatologia. Foi realizado um estudo retrospectivo (2016-2019) a partir de exames ultrassonográficos abdominais em cães, correlacionando os aspectos da vesícula biliar na mucocele, com comorbidades existentes. Foram avaliados 30 cães com diagnóstico de mucocele biliar, dos quais 46,66% apresentaram a doença em estágio inicial e 53,33% demonstraram estágio mais avançado. Destes, 66,66% tinham endocrinopatias, principalmente hiperadrenocorticismo. Sinais de obstrução de vias biliares extra-hepáticas e peritonite biliar foram observados em dois animais. Por seu potencial risco de complicação, avaliações ultrassonográficas de seguimento são indicadas nos casos de tratamento clínico, não se descartando a necessidade de intervenção cirúrgica.(AU)

Mucocele fronto-etmoidal gigante / Giant frontoethmoidal mucocele

Se presenta el caso de un paciente varón de 18 años, con un gran mucocele frontoetmoidal derecho, postoperado en dos oportunidades anteriores, que acudió a nuestro servicio por un empeoramiento de la diplopía. Al examen físico se visualizaba un desplazamiento del globo ocular hacia abajo y afuera. Se le realizó estudios de imágenes, una tomografía computarizada y una resonancia magnética nuclear que sugerían un mucocele frontoetmoidal derecho. Se le realizó una sinusotomía tipo Draf III para drenaje de la lesión, con mejoría de los síntomas.

We present the case of an 18-year-old male patient with a large right frontoethmoidal mucocele, postoperatively on two previous occasions, who came to our department due to worsening diplopia. Physical examination revealed a downward and outward displacement of the eyeball. Imaging studies, computed tomography, and magnetic resonance imaging were performed that suggested a right frontoethmoidal mucocele. A type Draf III sinusotomy was performed to drain the lesion, with improvement of the symptoms.

Fenômeno de extravasamento de muco: relato de dois casos clínicos / The mucous retention phenomenom: tho clinical cases report

O fenômeno de extravasamento de muco, também referido como mucocele, é uma lesão comum da mucosa oral resultante da ruptura de um ducto da glândula salivar com extravasamento da mucina. O principal fator etiológico é o trauma local. A localização mais comum é o lábio inferior, mas outros locais podem ser afetados. Existe a necessidade de diagnóstico diferencial uma vez que, pelo aspecto clínico e localização, as mucoceles assemelham-se a outras lesões que afetam a boca. Diante desse cenário, o objetivo deste trabalho foi relatar dois casos clínicos de fenômeno de extravasamento de muco (mucocele), evidenciando suas características clínicas, histopatológicas, tratamento e prognóstico. Acredita-se que o conhecimento das principais características dessa condição patológica possa auxiliar o clínico na adoção dos principais procedimentos na avaliação, conduta e tratamento desses pacientes.

The mucous retention phenomenon, also called as oral mucocele, is a common lesion of the oral mucosa resulting from the rupture of a salivary gland duct. The main etiological factor is local trauma. The most common location is the lower lip, but other locations can be affected. Differential diagnosis is important because mucoceles resemble other oral lesions. Thus, the aim of the present study was to report two cases of mucocele, demonstrating its clinical and histopathological characteristics, treatment and prognosis.. It is believed that knowledge of the main characteristics of this lesions can help the clinician in carrying out the main procedures in the evaluation, conduct and treatment of these patients.

Abordaje laparoscópico de la neoplasia mucinosa apendicular de bajo grado / Laparoscopic approach of low-grade appendiceal mucinous neoplasm

RESUMEN Las neoplasias mucinosas apendiculares son infrecuentes y se clasifican en neoplasias mucinosas de bajo grado, de alto grado y adenocarcinoma mucinoso. Se consideran precursoras del pseudomixoma peritoneal, caracterizado por la acumulación de mucina dentro de la cavidad abdominal. Informamos tres casos de neoplasia mucinosa apendicular de bajo grado, dos varones y una mujer, que presentaron dolor abdominal agudo, diagnosticados preoperatoriamente mediante tomografía y que fueron manejados con un abordaje laparoscópico (apendicectomía, resección parcial de ciego y colectomía derecha, respectivamente). Los tres casos tuvieron una buena evolución posoperatoria y no hubo complicaciones. Se concluye que las neoplasias mucinosas apendiculares son raras y no tienen una presentación clínica específica. El abordaje laparoscópico es una opción segura y factible. La frecuencia y la duración del seguimiento de estos pacientes es motivo de controversia.

ABSTRACT Appendiceal mucinous neoplasms are rare and are classified in low-grade mucinous neoplasm, high-grade mucinous neoplasm and mucinous adenocarcinoma. They are considered precursors of pseudomyxoma peritonei, characterized by the accumulation of mucin within the abdominal cavity. We report three cases of low-grade appendiceal mucinous neoplasm, two men and one woman, who presented with acute abdominal pain. The diagnoses were made preoperatively by computed tomography scan and the tumors were managed through laparoscopic approach (appendectomy, partial resection of the cecum and right colectomy, respectively). The three patients evolved with favorable postoperative outcome without complications. Appendiceal mucinous neoplasms are rare without specific clinical presentation. The laparoscopic approach is a safe and feasible option. The frequency and duration of surveillance in these patients are still controversial.

Tratamiento simple y de bajo costo de mucocele oral en un paciente pediátrico: reporte de caso / Tratamento simples e de baixo custo de mucocele em paciente pediátrico: relato de caso / Simple and low-cost treatment of mucocele in a pediatric patient: case report

Objetivo: El objetivo de este reporte de caso es presentar una técnica simple de escisión quirúrgica de un mucocele oral en un paciente pediátrico mediante manejo conductual no farmacológico. Discusión: Este relato debe destacarse por la simpleza de la técnica, su bajo costo, menor tiempo y mayor aceptación por el paciente pediátrico. Además, se debe prestar atención a la técnica de escisión quirúrgica, enfatizando en la importancia de la selección del hilo de sutura y del análisis histológico. El mucocele es generalmente asintomático, sin embargo, en este caso la lesión afecta el habla, la masticación y autoestima del niño. Conclusión: Es competencia del odontopediatra tratar oportunamente y evitar secuelas como las encontradas en este reporte.

Objetivo: El objetivo de este reporte de caso es presentar una técnica simple de escisión quirúrgica de un mucocele oral en un paciente pediátrico mediante manejo conductual no farmacológico. Discusión: Este relato debe destacarse por la simpleza de la técnica, su bajo costo, menor tiempo y mayor aceptación por el paciente pediátrico. Además, se debe prestar atención a la técnica de escisión quirúrgica, enfatizando en la importancia de la selección del hilo de sutura y del análisis histológico. El mucocele es generalmente asintomático, sin embargo, en este caso la lesión afecta el habla, la masticación y autoestima del niño. Conclusión: Es competencia del odontopediatra tratar oportunamente y evitar secuelas como las encontradas en este reporte.

Mucocèle de la lèvre inférieure: rapport de cas et revue de la littérature / Lower lip mucocele: case report and review of literature

A mucocele is a mucus-filled, variable-sized, cavity that can appear as a nodule in the oral mucosa. It's a very common exophytic lesion resulting from a salivary accumulation, due to an alteration of the minor salivary gland.They can be categorized according to their etiology: they may occur from extravasation or retention of the secretion.The main one is the extravasation mucocele caused by traumatic rupture of the gland's epithelium spilling out the mucus in the extra-glandular space. The mechanical trauma can be caused by lip biting habits or by a cutting tooth in constant contact with the lip. [1] The collection then triggers an immune reaction in the mucosa with swelling, leading to the formation of granulation tissue with inflammatory cells. At this point, there is a pseudo capsule with no epithelialized lining defining a pseudocyst. [2] However, the retention cyst is a true cyst due to an epithelial proliferation of the exit ducts that generates an obstruction of the salivary flow. [2] Treatment options for mucoceles involve surgical resection, marsupialization, cryosurgery, steroid injection. The surgical excision remains the gold standard therapy for this lesion, but relapse might happen (8.8% on the labial/buccal mucosa). [3]

Atresia bronquial / Bronchial atresia

Introducción: La atresia bronquial es una patología poco frecuente, generalmente asintomática e incidental en las imágenes del tórax. La aproximación diagnóstica de esta entidad se puede hacer por radiografía y broncoscopia, donde se identifican algunos aspectos claves en el diagnóstico diferencial. De acuerdo las manifestaciones clínicas y posibles complicaciones el tratamiento puede ser desde conservador hasta quirúrgico con resección lobar o segmentaria. Objetivo: Presentar las características de un caso con atresia bronquial. Presentación de caso: Se presenta un caso de atresia bronquial en una paciente de 19 años de edad cuyo tratamiento definitivo fue bilobectomía media-inferior derecha. Conclusiones: La atresia bronquial es una entidad infrecuente que puede cursar de manera asintomática y ser detectada por un hallazgo radiológico en pacientes adultos de manera incidental. El diagnóstico se puede confirmar por broncoscopia y el tratamiento casi siempre es quirúrgico(AU)

Introduction: Bronchial atresia is a rare disease, generally asymptomatic and incidental in chest images. The diagnostic approach of this entity can be done by radiography and bronchoscopy, some key aspects are identified in the differential diagnosis. According to the clinical manifestations and possible complications, the treatment can range from conservative to surgical with lobar or segmental resection. Objective: To describe a case of bronchial atresia. Case report: A case of bronchial atresia is reported in a 19-year-old patient whose definitive treatment was a right-lower-middle bilobectomy. Conclusions: Bronchial atresia is a rare entity that can occur asymptomatically and be detected incidentally by a radiological finding in adult patients. The diagnosis can be confirmed by bronchoscopy, and treatment is almost always surgical(AU)

Oral Mucocele and its surgical approach as treatment: Case series

@#A common benign lesion in children’s oral cavity is mucocele on the lower lips that originates from the accumulation of mucous due to local trauma and a lip-biting habit. Lip-biting is often motivated by a psychological condition of anxiety. Mucoceles are painless but can be bothersome for patients when eating and speaking. Mucoceles can affect the general population but are more common among the young. The etiology of oral mucoceles may vary, and surgical treatment is best chosen for its convenience, child-friendliness, and high treatment success rate. Awareness education for children and parents is necessary to eliminate a lip-biting habit. If the pattern persists due to anxiety, it is essential to inquire more about the etiology and consult a professional psychologist.

Neoplasia Mucinosa de apéndice. Abordaje laparoscópico. Reporte de caso / Neoplastic appendiceal mucinous lesion. Laparoscopic approach. Case report

El mucocele apendicular es la dilatación quística del apéndice con acumulación de material mucinoso. Su forma de presentación más frecuente es dolor en fosa ilíaca derecha, sin embargo, la mitad de los casos son asintomáticos. En el presente trabajo se presenta caso de un paciente con diagnóstico incidental de mucocele apendicular, al cual se le realizó apendicectomía laparoscópica como tratamiento definitivo. Caso clínico: Paciente masculino de 44 años sin antecedentes patológicos conocidos, quien se realiza ultrasonido abdominal que informa tumor quístico en fosa ilíaca derecha. Se decide resolución quirúrgica laparoscópica. Informe histológico: mucocele apendicular sin evidencia de malignidad y recuperación satisfactoria del paciente. Conclusión: La neoplasia mucinosa del apéndice es una patología poco frecuente, puede presentarse con una variedad de manifestaciones clínicas hasta un hallazgo incidental. El tratamiento es fundamentalmente quirúrgico y el abordaje laparoscópico es de elección en pacientes sin evidencia de ruptura y diseminación de la enfermedad(AU)

The appendicular mucocele is a cystic dilation of the appendix with accumulation of mucinous material. The most frequent form of presentation is pain in the right iliac fossa; however, half of the cases are asymptomatic patients. In the present work we present a case of a patient with an incidentally diagnosis of appendicular mucocele who underwent laparoscopic appendectomy as definitive treatment. Clinical case: A 44-year-old male patient with no known pathological history, who underwent an abdominal ultrasound that reported a cystic tumor in the right iliac fossa. Laparoscopic surgical resolution was decided, the histological examination revealed appendicular mucocele without evidence of malignancy and satisfactory recovery of the patient. Conclusion: Mucinous neoplasia of the appendix is an uncommon pathology, patients are often asymptomatic or have nonspecific symptoms, and the diagnosis is made incidentally in the course of other examination. Treatment is primarily surgical and the laparoscopic approach is the choice in patients without evidence of rupture and dissemination of the disease(AU)

Parotid salivary mucocele in a companion rabbit (Oryctolagus cuniculus): a report on the clinical and laboratory characteristics and surgical treatment - case report / [Mucocele salivar parotídea em coelho doméstico (Oryctolagus cuniculus): relato de características clínico-laboratoriais e tratamento cirúrgico - relato de caso]

The present report aimed to describe the main characteristics of the parotid salivary mucocele in an adult male rabbit, which presented with a painless fluctuating mass with fluid content. Owing to the need for repeated fluid drainage, surgical excision was the chosen mode of treatment. Preoperative evaluation included radiography and blood analysis. The patient underwent surgical excision of the affected gland. Inhalation anesthesia was maintained by means of isoflurane and the cardio-respiratory parameters were monitored throughout the surgery. A bipolar electrocautery was used to assist in the incision and polyglactin 910 and nylon were the suture materials used in the wound closure technique. Post-operative medications included analgesics, anti-inflammatory agents and antibiotics. Histopathology of the excised glandular tissue revealed a mixed inflammatory infiltrate, fibroblasts, hemorrhage and hyperemia. The observations in this case suggest that surgical excision of the affected gland is the treatment of choice for the management of mucocele in companion rabbits, which has already been identified for other animals. Periodic acid-reactive Schiff staining confirmed the diagnosis of salivary mucocele. The complementary investigations helped to rule out the differential diagnosis and indicated a favorable prognosis, in view of the fact that the case was successfully resolved without complications or recurrence.(AU)

O presente relato teve como objetivo descrever as principais características da mucocele salivar parotídea em um coelho macho adulto, que apresentou uma massa flutuante indolor e com um conteúdo líquido em seu interior. Devido à necessidade de repetidas punções deste fluido, optou-se pela excisão cirúrgica como forma de tratamento. A avaliação pré-operatória incluiu radiografias e análises sanguíneas. O paciente foi submetido ao tratamento cirúrgico com excisão da glândula afetada. A anestesia inalatória foi mantida com isoflurano e os parâmetros cardio-respiratórios foram monitorados durante a cirurgia. Um eletrocautério bipolar foi utilizado para auxiliar na incisão e os fios poliglactina 910 e nylon foram utilizados na técnica de sutura. As medicações pós-operatórias incluíram agentes analgésicos, anti-inflamatórios e antibióticos. A histopatologia do tecido glandular removido revelou infiltrado inflamatório misto, fibroblastos, hemorragia e hiperemia. As observações neste caso sugerem que a remoção cirúrgica da glândula afetada seja o tratamento de escolha no manejo da mucocele em coelhos de companhia, o que já vem sendo identificado para outros animais. A coloração do ácido periódico reativo de Schiff confirmou o diagnóstico da mucocele salivar. Os exames complementares ajudaram a excluir as doenças que fazem parte do diagnóstico diferencial e indicaram um prognóstico favorável, tendo em vista o fato que este caso foi resolvido com sucesso, sem complicações ou recorrência.(AU)

Mucocele de glándulas de Blandin Nuhn. Caso inusual y revisión de la literatura / Mucocele da glândula Blandin Nuhn. Caso incomum e revisão da literatura / Mucocele of Blandin Nuhn glands. Unusual case and review of the literature

El mucocele asociado a las glándulas de Blandin Nuhn es un fenómeno de extravasación mucosa que ocurre en las glándulas salivales localizadas en la superficie ventral anterior de la lengua, son de tipo mixto, no encapsuladas, que forman parte del complejo de glándulas salivales menores de cavidad bucal. Objetivo: Se presenta el caso clínico de un paciente masculino que cursa la segunda década de vida con características clínicas peculiares de un mucocele de Blandin Nuhn. Caso clínico: Adolescente masculino de 14 años de edad presenta aumento de volumen localizado en superficie ventral de lengua, forma cilíndrica, de 3 meses de evolución y asintomático. Se realiza biopsia excisional para estudio histopatológico, el cual reporta fenómeno de extravasación mucosa y se establece la correlación clínico histopatológica. Conclusiones: Se debe fundamentar un diagnóstico correcto para proporcionar un tratamiento oportuno y evitar complicaciones en el paciente que afecten su calidad de vida.

Mucoceles of the glands of BlandinNuhn consist in a mucus extravasation phenomenon that occurs in the salivary glands located in the anterior ventral surface of the tongue. They are mixed, not encapsulated, and part of the complex of minor salivary glands of the oral cavity. Objective: This paper presents the clinical case of a male patient in his second decade of life with peculiar clinical characteristics of a mucocele of the glands of Blandin-Nuhn. Clinical case: A 14-year-old male adolescent has an increase in volume located on the ventral surface of the tongue, of cylindrical shape, with three months of evolution and is asymptomatic. An excisional biopsy is performed for histopathological study, which reports mucosal extravasation phenomenon and a histopathological clinical correlation is established. Conclusions: A correct diagnosis should have a solid foundation in order to provide timely treatment and avoid complications for the patient that may affect quality of life

A mucocele associada às glândulas de Blandin Nuhn é um fenômeno de extravasamento de mucosa que ocorre nas glândulas salivares localizadas na superfície ventral anterior da língua, do tipo misto, não encapsuladas, que fazem parte do complexo de glândulas salivares menores da cavidade oral. Objetivo: É apresentado o caso clínico de um paciente do sexo masculino na segunda década de vida com características clínicas peculiares de uma mucocele de Blandin Nuhn. Caso clínico: Adolescente de 14 anos apresenta aumento de volume localizado na superfície ventral da língua, formato cilíndrico, evolução de 3 meses e assintomático. A biópsia excisional é realizada para estudo histopatológico, que relata o fenômeno do extravasamento da mucosa e a correlação clínica histopatológica é estabelecida. Conclusões: Um diagnóstico correto deve ser baseado para fornecer tratamento oportuno e evitar complicações no paciente que afetem sua qualidade de vida

Mucocele de cavidades paranasales / Sinus mucocele

Los mucoceles son quistes expansivos e indolentes de las cavidades paranasales. A pesar de ser lesiones benignas, tienen potencial destructivo local por su expansión crónica y cambios óseos. Su ubicación más frecuente es frontoetmoidal. Se postula que su origen es por alteración de la vía de drenaje de los senos. La clínica es dependiente de su ubicación: los mucoceles frontoetmoidales presentan aumento de volumen, cefalea o proptosis. Las imágenes juegan un rol importante en el diagnóstico, siendo la tomografía computarizada y la resonancia magnética los exámenes que detectan patrones sugerentes de mucoceles. El tratamiento es quirúrgico, donde el abordaje endoscópico ha desplazado al abierto por ser mínimamente invasivo, presentar menos comorbilidades y tener menor tasa de recurrencia.

Mucoceles are expansive and indolent cyst of the paranasal cavities. Despite being benign lesions, they have local destructive potential because of its chronic expansion and bony changes. Its most common location is frontoethmoidal. Alterations in the drainage pathway of sinus is thought to be the origin of mucoceles. The clinical features depend on the location. Frontoethmoidal often presents frontal swelling, headache or proptosis. Imaging plays an important part of diagnosis. Tomography and magnetic resonance have patterns that can suggest the presence of a mucocele. Paranasal sinus mucoceles are primarily treated surgically. The endoscopic surgical management has replaced the open resection because of its minimally invasive treatment, less morbidity and low recurrence rates.

A prospective study of discrepancy between clinical and pathological diagnosis of appendiceal mucinous neoplasm

PURPOSE: Appendiceal tumoral lesions can occur as benign, malignant, or borderline disease. Determination of the extent of surgery through accurate diagnosis is important in these tumoral lesions. In this study, we assessed the accuracy of preoperative CT and identified the factors affecting diagnosis.METHODS: Patients diagnosed or strongly suspected from July 2016 to June 2019 with appendiceal mucocele or mucinous neoplasm using abdominal CT were included in the study. All the patients underwent single-incision laparoscopic cecectomy with the margin of cecum secured at least 2 cm from the appendiceal base. To compare blood test results and CT findings, the patients were divided into a mucinous and a nonmucinous group according to pathology.RESULTS: The total number of patients included in this study was 54 and biopsy confirmed appendiceal mucinous neoplasms in 39 of them. With CT, the accuracy of diagnosis was 89.7%. The mean age of the mucinous group was greater than that of the nonmucinous group (P = 0.035). CT showed that the maximum diameter of appendiceal tumor in the mucinous group was greater than that in the nonmucinous group (P < 0.001). Calcification was found only in the appendix of patients in the mucinous group (P = 0.012). Multivariate analysis revealed that lager tumor diameter was a factor of diagnosis for appendiceal mucinous neoplasm.CONCLUSION: The accuracy of preoperative diagnosis of appendiceal mucinous neoplasms in this study was 89.7%. Blood test results did not provide differential diagnosis, and the larger the diameter of appendiceal tumor on CT, the more accurate the diagnosis.

Complete enucleation surgical treatment and histological analysis of a mucocele in lower lip in a child: case report / Tratamiento quirúrgico de enucleación completa y análisis histológico de un mucocele en el labio inferior en un niño: reporte de caso

Objective: The aim of this case report is to describe the surgical removal of a mucocele and its histological analysis, in a child. Case Report: An 11-year-old female patient attended the Pediatric Dentistry clinic complaining of a lower lip lesion. During the anamnesis, the mother reported that the child had a habit of biting and sucking the spot frequently. Clinical examination showed the lesion was compatible with a mucocele. The proposed treatment was a complete enucleation of the lesion under local anesthesia. The incision and tissue divulsion were performed for maximum preservation of the mucosa, avoiding a possible recurrence. Total adjacent glands removal was also performed. The lesion was placed in 10% formaldehyde for histopathological analysis (H&E Staining), which showed dense connective tissue presenting chronic inflammatory infiltrate and extravasated mucin, presence of granulation tissue delimiting the area of extravasated mucin and presence of minor salivary glands. The patient was advised to quit the habit, and after seven days the sutures were removed. At the one-year follow-up there was no recurrence of the lesion. Conclusion: The proposed treatment proved to be effective without recurrence of the lesion.

Objetivo: El objetivo de este reporte de caso es describir la extirpación quirúrgica de un mucocele y su análisis histológico en un niño. Informe del caso: una paciente de 11 años de edad asistió a la clínica de Odontopediatria quejándose de una lesión en el labio inferior. Durante la anamnesis, la madre informó que el niño tenía la costumbre de morder y chupar el lugar con frecuencia. En el examen clínico, la lesión fue compatible con un mucocele. El tratamiento propuesto fue una enucleación completa de la lesión bajo anestesia local. La incisión y la divulgación del tejido se realizaron para la máxima preservación de la mucosa, evitando una posible recurrencia. También se realizó la extracción total de las glándulas adyacentes. La lesión se colocó en formaldehído al 10% para el análisis histopatológico (tinción H&E), que mostró tejido conectivo denso que presenta infiltrado inflamatorio crónico y mucina extravasada, presencia de tejido de granulación que delimita el área de mucina extravasada y presencia de glándulas salivales menores. Se aconsejó al paciente que abandonara el hábito, y después de siete días se retiraron las suturas. En el seguimiento de un año no hubo recurrencia de la lesión. Conclusión: El tratamiento propuesto demostró ser efectivo sin recurrencia de la lesión.

Mucocele of the vermiform appendix: diagnostic challenges and therapeutic approach / Mucocele de apêndice vermiforme: desafios no diagnóstico e sua abordagem terapêutica

ABSTRACT Introduction: Mucocele of the appendix is defined as the obstructive dilatation of the vermiform appendix by the abnormal accumulation of mucinous substance in its lumen. Imaging tests may be useful, but they commonly fail to evidence the etiology in question. Regarding the therapeutic approach, there are different options for treatment. Appendectomy was routinely used in simple cystadenomas, with good results. However, in cases of neoplasias, more aggressive resection is necessary, and the therapeutic course of choice is the right hemicolectomy. Case report: Patient presented to the surgery outpatient clinic with magnetic resonance imaging presenting an adnexal cyst of about 11.0 × 4.5 cm on the right. The patient had pain in the right iliac fossa for 6 months. Due to the radiological finding and persistence of the clinical picture, videolaparoscopy was performed, and an appendicular mass suggestive of mucocele was identified. A laparoscopic appendectomy was performed, with no signs of mucus extravasation. Histopathological analysis confirmed the diagnosis. Discussion: Mucocele is rarely diagnosed effectively in the preoperatively. In this context, imaging tests do rarely evidence such etiology. Given the importance of preoperative diagnosis for the definition of conduct, it is essential that this condition be always taken into account as a diagnostic hypothesis.

RESUMO Introdução: A mucocele do apêndice é definida como a dilatação obstrutiva do apêndice vermiforme pelo acúmulo anormal de substância mucinosa em seu lúmen. Os exames de imagem podem ser úteis, porém não raramente falham em evidenciar a etiologia em questão. Em relação à abordagem terapêutica, existem diferentes opções de conduta. A apendicectomia foi o tratamento rotineiramente utilizado em cistoadenomas simples, com bons resultados. Todavia, em casos de neoplasias, é necessária ressecção mais agressiva, sendo a conduta terapêutica a hemicolectomia direita. Relato de caso: Paciente compareceu ao ambulatório de cirurgia com ressonância magnética apresentando cisto anexial de cerca de 11,0 × 4,5 cm à direita. Apresentava quadro de dor em fossa ilíaca direita há 6 meses. Devido ao achado radiológico e persistência do quadro clínico foi realizado videolaparoscopia, sendo identificada massa apendicular sugestiva de mucocele. Foi realizada apendicectomia videolaparoscópica, sem extravasamento do conteúdo mucinoso. A análise histopatológica confirmou o diagnóstico. Discussão: A mucocele raramente é diagnosticada de maneira eficaz no pré-operatório. Neste contexto, os exames de imagem não raramente falham em evidenciar tal etiologia. Diante da importância do diagnóstico pré-operatório para a definição da conduta, é essencial que sempre se leve em conta tal afecção como uma hipótese diagnóstica.