Cistoadenocarcinoma mucinoso de apéndice cecal / Mucinous cystoadenocarcinoma of the appendix

Objetivo Exposición de 3 casos tratados quirúrgicamente en nuestra clínica. Casos clínicos Caso 1: paciente mujer de 78 años con diagnóstico de quiste complejo de ovario derecho, se realizó la cirugía y se evidencia tumoración de apéndice cecal. Caso 2: paciente varón de 38 años con dolor abdominal crónico. Presenta marcador tumoral antígeno carcinoembrionario elevado, laparoscopia exploratoria evidencia líquido mucinoso peritoneal y tumoración apendicular. Caso 3: paciente mujer de 42 años con dolor crónico en fosa iliaca derecha con marcadores tumorales normales. Laparoscopia exploratoria evidencia tumoración dependiente del apéndice cecal con localización retrocecal ascendente. Discusión Se debe considerar a los mucoceles apendiculares dentro del diagnóstico diferencial de dolor en cuadrante inferior derecho del abdomen. Es preferible realizar una hemicolectomia radical para lesiones grandes y/o perforadas por el riesgo de existir cistoadenocarcinoma. El abordaje laparoscópico es una buena alternativa de manejo.

Objective We present three surgically treated cases in our hospital Case Reports Case 1: A 78 years old woman with a diagnosis of complex ovarian cyst. During surgery, an appendicular tumor was found. Case 2: A 38 years old male with chronic abdominal pain with high levels of carcinoembryonic antigen. During exploratory laparoscopy an appendicular tumor and mucinous peritoneal fluid were found. Case 3: A 42 years old woman with chronic pain in the right lower abdomen, negative tumor markers. During exploratory laparoscopy a retrocecal appendicular tumor was found. Discussion Appendiceal mucoceles should be considered in the differential diagnosis of right lower abdominal pain. If the lesions are big or perforated, a radical hemicolectomy should be performed due to the risk of a cystadenocarcinoma. Laparoscopic approach is a good alternative for management.

Appendiceal pseudomyxoma peritonei in a pregnant woman

One in 1000 cancers occur during pregnancy. Epithelial tumors of the appendix occur in approximately 1% of all colorectal tumors, and the occurrence of this neoplasm during pregnancy is extremely rare. We report an unusual case of pseudomyxoma peritonei [PMP] in a 41-year-old full-term pregnant women. Cesarean section was carried out, and the abdomen was found to contain an appendiceal mucinous tumor with large volume PMP. This case illustrates the incidental nature of the disease and its occurrence in a pregnant women with no clinical features during the antenatal period. A review of recent literature is also documented. Pseudomyxoma peritonei is commonly discovered during surgery for other conditions and a high index of suspicion is required to make a diagnosis. Diagnostic modalities such as ultrasound, CT, and MRI can provide some evidence for PMP, but the definitive diagnosis is only made laparoscopically or by exploratory laparotomy

Clinical Approach to Incidental Pancreatic Cystic Lesions / 대한소화기학회지

Cystic lesions of the pancreas are being incidentally recognized with increasing frequency and become a common finding in clinical practice. Despite of recent remarkable advances of radiological and endoscopic assessment and a better understanding of natural history of certain subgroups of cystic lesions, differentiating among lesions and making an optimal management plan is still challenging. A multimodal approach should be performed to evaluate incidentally detected cystic lesions. Emerging evidence supports selective nonoperative management for the majority of patients with cystic lesions, but, for those in whom a suspicion of malignancy remains, surgery is indicated. Concerning long-term follow-up, there is limited data to support the ideal modality, intensity, and duration. Therefore, evidence-based guidelines for the diagnosis, management, and follow-up of cystic lesions of the pancreas should be established.

Clinicopathologic Review of 41 Cases of Pancreatic Mucinous Cystic Neoplasms / 대한소화기학회지

BACKGROUND/AIMS: Intraductal papillary mucinous neoplasms (IPMN) and mucinous cystic neoplasms are included in mucin-producing pancreatic tumors. The reports about IPMN are not uncommon but those about the mucinous cystic neoplasms are relatively few. The aims of this study were to define the natural history of resected mucinous cystic neoplasms of the pancreas and to identify the findings which suggest malignancy. METHODS: The authors retrospectively evaluated the clinical outcomes of 41 patients with mucinous cystic neoplasms who were surgically resected at Asan Medical Center between 1995 and 2004. RESULTS: Women (n=33) were more frequently affected than men (n=8). Thirty three patients (80.6%) had adenoma, 1 (2.4%) borderline malignancy, 1 (2.4%) carcinoma in situ, and 6 (14.6%) invasive mucinous cystadenocarcinoma. The most frequent symptom was abdominal pain (39%). About half of the enrolled patients were asymptomatic. Unilocular type (79%) was more frequent than the multilocular type (21%) on gross morphology. The tumor size of invasive mucinous cystic neopolasms was larger than that of non-invasive mucinous cystic neoplalsms (p=0.01). Abdominal pain was more frequent in invasive mucinous cystic neoplasms (p=0.026). On gross morphology, mural nodules were detected in 4 of 6 patients with invasive mucinous cystic neoplasms. However, they were not detected in any patients with non-invasive mucinous cystic neoplasms. Recurrence developed in none of the 35 patients with non-invasive mucinous cystic neoplasms, however 2 of the 6 patients with invasive mucinous cystic neoplasms died within 5 years. CONCLUSIONS: Clinical predictors of invasive mucinous cystic neoplasms are suggested to be tumor size and abdominal pain. The prognosis of the non-invasive mucinous cystic neoplasms is excellent when curative resection is performed.

Primary Retroperitoneal Mucinous Cystadenocarcinoma: A Case Report and Review of the Literature

Primary retroperitoneal mucinous cystadenocarcinoma is a rare tumor. Only about 30 such cases have been reported in the worldwide literature, and a few Korean cases have been reported. The pathogenesis is not clear, and coelomic metaplasia of the retroperitoneal mesothelium has gained wide support. There is no consensus on the appropriate treatment, but surgical exploration is needed for the diagnosis and treatment, and adjuvant chemotherapy may be recommended following complete surgical excision. The long-term prognosis has not been established. We report here on a 32-year-old woman who was diagnosed as having a retroperitoneal mucinous cystadenocarcinoma with mural nodules of sarcomatoid change. Tumor excision and adjuvant chemotherapy were done and the patient is doing well without any evidence of recurrence at 42 months postoperatively.

Marcador tumoral ca 19.9 aumentado sin evidencia de malignidad / Elevated Ca 19.9 tumor marker without evidence of malignancy

Los marcadores tumorales son de gran utilidad clínica en el seguimiento de los pacientes oncológicos. Su papel en el diagnóstico de tumoraciones malignas es controvertido. Presentamos un caso de una mujer con un quiste ovárico benigno en la cual los marcadores aumentan de forma inexplicable después de la extirpación del mismo.

Tumor markers are a useful tool for surveillance of oncologic patients, whereas their role in the diagnosis of a malignancy is controversial. We present the case of a woman with a benign ovarian cyst with an unexpected elevation of Ca 19.9 after laparoscopic bilateral anexectomy.

Ovarian mucinous cystadenocarcinoma of low malignant potential associated with a mature cystic teratoma

The development of mucinous cystadenocarcinoma of low malignant potential in a mature cystic teratoma is rare. We report a 36-year-old single female presented with abdominal distension and was found to have a huge pelvic/abdominal mass. Ultrasound revealed a huge cystic ovarian mass with no ascites. Laparotomy and left oophorectomy was performed to the mass. Histology revealed mucinous cystadenocarcinoma of low malignant potential in a mature cystic teratoma

Mucocele apendicular: reporte de un caso clínico / Appendicular mucocele: report of a clinical case

La patología tumoral de apéndice presenta baja incidencia. Dentro de este grupo el mucocele alcanza al 0,2 a 0,4 por ciento de todas las apendicectomías. El término mucocele describe una dilatación quística del lumen apendicular por mucus, que incluye diferentes entidades anatomopatológicas. El caso clínico es una paciente de sexo femenino de 73 años, con una cuadro de 2 meses de dolor abdominal localizado en hemiabdomen inferior, de intensidad moderada, asociado a dificultad para la micción, baja de peso de 8 kilos y compromiso del estado general. Al examen físico se constata una masa en fosa ilíaca derecha de aproximadamente 10 cm de diámetro mayor. Se realizó un TAC de abdomen y pelvis que mostró masa tubular de 10 x 5 cm de diámetros con material hipodenso en su interior, compatible con mucocele apendicular. Se realizó en el Hospital Clínico de la Universidad de Chile una laparotomía exploradora confirmando los hallazgos del TAC, se realizó apendicectomía y el estudio de la pieza informó cistoadenoma mucinoso del apéndice con displasia leve. Los posibles hallazgos histopatológicos de los mucoceles incluyen hiperplasia mucosa, cistoadenoma como en este caso y cistoadenocarcinoma, que es la variante neoplásica maligna. En correspondencia a la histopatología de este caso se recomienda la apendicectomía como tratamiento.

Krukenberg tumor of ovary with features of mucinous cystadenocarcinoma.

An unusual case of bilateral Krukenberg tumors having a predominant multicystic mucinous component which on gross and microscopic examination resembled a mucinous cystadenocarcinoma is presented. It is important to distinguish between these two tumors as Krukenberg tumours have a significantly worse prognosis.

Cistadenocarcinoma mucinoso de páncreas. Informe de un caso / Pancreatic mucinous cystadenocarcinoma: Case report

El cistadenocarcinoma de páncreas es una neoplasia quística proliferativa que se incluye dentro de las neoplasias quísticas mucinosas y que afecta con más frecuencia a la mujeres. Estas neoplasias quísticas contiene epitelio columnar que secretan mucina. Informamos de una paciente en estado de puerperio mediato con presentación de abdomen agudo secundario a perforación de tumoración quística del páncreas. Las neoplasias quísticas mucinosas se presentan como cistadenocarcinomas malignos con franca invasión local o a distancia, o cistadenomas mucinosos benignos considerados por tener un potencial latente de degeneración maligna. El diagnóstico preoperatorio es esencial para establecer el tratamiento definitivo