[Incidental finding of appendiceal mucinous neoplasms]. / Zufallsbefund muzinöse Neoplasie der Appendix.

Low-grade appendiceal mucinous neoplasms (LAMN) are rare and are diagnosed in at least 0.13% of appendectomies in Germany, although significant underreporting is likely. Perforation of the tumors can result in abdominal mucinous collections, so-called pseudomyxoma peritonei (PMP). The challenge in the treatment of LAMN is the adequate approach to the incidental finding of these tumors. If a mucinous neoplasm is preoperatively suspected in cases of an acute condition, usually appendicitis, it must be weighed up whether a conservative approach is justifiable or whether immediate appendectomy is necessary. If this is the case, an intraoperative perforation of the appendix must be avoided and the complete abdominal cavity must be inspected for mucin deposits. If conservative treatment is possible, further treatment should take place at a specialized center. If the neoplasm is first found incidentally during surgery, perforation of the appendix should also be avoided and the entire abdominal cavity should be inspected for a PMP. If a PMP is present cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) should be performed in a specialized center. If LAMN are found during the postoperative histological work-up, it should be evaluated whether a perforation was present and mucin collections are noted in the surgical report. In the case of LAMN without evidence of a PMP, appendectomy is the adequate treatment. In cases of intra-abdominal mucinous collections, samples should be taken and further treatment should be performed at a center with sufficient expertise. An ileocecal resection or oncological hemicolectomy is not indicated. After adequate treatment, all patients should receive a follow-up using cross-sectional imaging (preferably magnetic resonance imaging, MRI) and determination of the tumor markers CEA, CA 19-9 and CA 125.

Tumor sincrónico de colon y apéndice. Reporte de caso / Synchronous colon and appendix tumor. A case report

RESUMEN Introducción: Los tumores sincrónicos son sumamente raros, la coexistencia de cáncer de colon y apéndice es un fenómeno relativamente inusual, que plantea problemas diagnósticos a la hora de discriminar la naturaleza primaria o metastásica de cada uno de ellos. Este hecho se suscita en la mayor parte de los casos ante adenocarcinomas mucosecretores sincrónicos. Reporte de caso: Presentamos el caso de una paciente femenina de 72 años de edad que ingresó al servicio de emergencia del Hospital Regional Docente Las Mercedes de Chiclayo por sintomatología de dolor abdominal agudo, donde se le realizan estudios imagenológicos con diagnóstico presuntivo de neoplasia maligna de recto, ingresando a sala de operaciones. El resultado anatomopatológico evidenció un diagnóstico de Adenocarcinoma tubular con componente mucinoso en recto- sigmoides de bajo grado de malignidad (moderadamente diferenciado), con invasión hasta tejido adiposo peri rectal adyacente, bordes de invasión infiltrativo e invasión perineural, con margen de resección libre y ganglios linfáticos libres de neoplasia maligna; además de, Adenocarcinoma mucinoso de apéndice moderadamente diferenciado (G2), de localización difusa, la neoplasia invade hasta la muscular propia, margen de resección libres de neoplasia maligna. Conclusión: La importancia de esta categoría es que la frecuencia de neoplasias malignas a nivel apendicular no es alta, y su asociación simultánea con Adenocarcinoma colorrectal las hace aún más insólitas.

ABSTRACT Introduction: Synchronous tumors are extremely rare, the coexistence of colon and appendix cancer is a relatively unusual phenomenon, which poses diagnostic problems when it comes to discriminating the primary or metastatic nature of each of them. This fact occurs in most cases with synchronous mucosecretory adenocarcinomas. Case report: We present the case of a 72- year-old female patient who was admitted to the emergency service of the Las Mercedes Regional Teaching Hospital in Chiclayo due to symptoms of acute abdominal pain, where imaging studies were performed with a presumptive diagnosis of malignant neoplasia of the rectum. operations room. The pathological result shows a diagnosis of tubular adenocarcinoma with a mucinous component in the rectus-sigmoid of a low grade of malignancy (moderately differentiated), with invasion to the adjacent peri-rectal adipose tissue, infiltrative invasion borders and perineural invasion, with a free resection margin and lymph nodes. lymphatics free of malignant neoplasm; In addition to moderately differentiated mucinous adenocarcinoma of the appendix (G2), of diffuse location, the neoplasm invades even the muscularis propria, resection margin free of malignant neoplasia. Conclusion: The importance of this category is that the frequency of malignant neoplasms at the appendicular level is not high, and their simultaneous association with colorectal adenocarcinoma makes them even more unusual

A case report of a giant appendiceal mucocele and literature review.

A 43-year-old female presented at the accident and emergency department of Princess Marina Hospital, Gaborone, Botswana. She reported a deep dull aching pain of two years duration in the right iliac fossa that has been progressively becoming worse. Ultrasound revealed a large sausage like cystic mass extending from the pelvis up to the medial aspect of the ascending colon. CT scan showed a large sausage like cystic mass extending from the pelvis up to the hepatic flexure of the colon with the cecum displaced. No metastatic features were seen. We made an impression of appendiceal mucocele. A semi-elective laparotomy was scheduled. Intraoperative findings: a giant intact cystic distended appendix with involved base, displacing the cecum cranially. A right hemicolectomy was performed. The histopathological results revealed a low-grade appendicular mucinous neoplasm with no lymph node involvement. The surgical margins were free. The patient recovered uneventfully.