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Low-grade Appendiceal Mucinous Neoplasms Marco Adly RADY 401 Case Presentation August 2019 Focused pati tient his istory 54 y.o. female, began feeling right sided pain in March, thereafter began feeling more fatigued, experienced


  1. Low-grade Appendiceal Mucinous Neoplasms Marco Adly RADY 401 Case Presentation August 2019

  2. Focused pati tient his istory • 54 y.o. female, began feeling right sided pain in March, thereafter began feeling more fatigued, experienced decreased appetite, n/v and constipation. Over the same time period, she noted weight gain and abdominal distension

  3. Clinical Workup • LABS • MARKERS : CA19-9, CEA, CA 125 – ALL NEGATIVE • METABOLIC PANEL – MILD HYPONATREMIA – ALL OTHERS WNL • LIVER MARKERS: AST /ALT / ALP , PT/PTT/INR – ALL WNL • IMAGING • CT- ABD / PELVIS w/ IV + ORAL CONTRAST • Did they order the correct initial study?

  4. ACR Appropriateness Criteria

  5. In Initial CT CT Scan: Coronal Im Images +IV IV and Oral Contrast

  6. In Initial CT CT Scan: Sagittal and Coronal Im Images +IV IV and Oral C

  7. In Initial CT CT Scan: Axial Im Image +IV IV and Oral Contrast

  8. In Initial CT CT Scan: Sagittal and Axial Im Images +IV IV and Oral C

  9. In Initial CT CT Scan: Coronal Im Image +IV IV and Oral Contrast

  10. Exploratory ry la laparotomy and ti tissue bio iopsy • SURGERY: Resection of masses and bilateral salpingo-oophorectomy • 40 lb post-op weight loss • normalized (return of) appetite • however, she continues to experience weakness and abdominal pain • FINAL PATHOLOGY • low grade mucinous ap appendiceal (NOT ovarian) neoplasm • ABD / PELVIS w/ IV + ORAL CONTRAST • Initial CT was reviewed: likely appendiceal mucocele, a descriptive term which refers to the appearance of a dilated mucin-filled appendix. • Postop CTs: see next slides. Chest CT negative

  11. Follow-up CT CT Scan: Axial Im Image +IV IV and Oral Contrast

  12. Follow-up CT CT Scan: Axial Im Images +IV IV and Oral Contrast

  13. Follow-up CT CT Scan: Axial Im Images +IV IV and Oral Contrast

  14. Follow-up CT CT Scan: Axial and Coronal Im Images +IV IV and Oral C

  15. Take Home Poin ints: Appendiceal Mucinous Neoplasms • The spectrum of symptoms varies from vague abdominal pain, nausea, vomiting, and weight loss, to a palpable mass, abdominal distension, and acute appendicitis. • Vill Villous ad adenomatous ne neopla lastic ic ch changes of of the the ap appendic iceal ep epit itheliu ium • Highly associated with Pse seudomyxoma pe peri ritonei i o simple or loculated low attenuation mucinous fluid throughout peritoneum, omentum, and mesentery o exaggerated especially when metastasis to the ovaries (pseudomyxoma ovarii) Omental l cak akin ing o refers to infiltration of the omental fat by malignant soft-tissue density Appendiceal l muc ucocele descriptive term which refers to the appearance of a dilated mucin-filled appendix o more septated = increased risk of being a malignancy o

  16. References https://radiopaedia.org/articles/omental-cake?lang=us https://radiopaedia.org/articles/low-grade-appendiceal-mucinous-neoplasm?lang=us https://radiopaedia.org/articles/pseudomyxoma-peritonei?lang=us Misdraji J. Appendiceal mucinous neoplasms: controversial issues. Arch. Pathol. Lab. Med. 2010;134 (6): 864-70. Arch. Pathol. Lab. Med. (link) Leonards LM, Pahwa A, Patel MK, Petersen J, Nguyen MJ, Jude CM. Neoplasms of the Appendix: Pictorial Review with Clinical and Pathologic Correlation. Radiographics : a review publication of the Radiological Society of North America, Inc. 37 (4): 1059-1083. doi:10.1148/rg.2017160150 Carr NJ, Cecil TD, Mohamed F, Sobin LH, Sugarbaker PH, González-Moreno S, Taflampas P, Chapman S, Moran BJ. A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: The Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process. The American journal of surgical pathology. 40 (1): 14- 26. doi:10.1097/PAS.0000000000000535

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