Low-grade Appendiceal Mucinous Neoplasms Marco Adly RADY 401 Case - - PowerPoint PPT Presentation

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

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

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?

ACR Appropriateness Criteria

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

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

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

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

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

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

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

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

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

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

• 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

• f the

the ap appendic iceal ep epit itheliu ium

• Highly associated with

Pse seudomyxoma pe peri ritonei i

• simple or loculated low attenuation mucinous fluid throughout peritoneum,
• mentum, and mesentery
• exaggerated especially when metastasis to the ovaries (pseudomyxoma ovarii)

Omental l cak akin ing

• 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
• more septated = increased risk of being a malignancy

Take Home Poin ints: Appendiceal Mucinous Neoplasms

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