Abstract
Purpose of Review
Appendiceal mucoceles are a rare but consequential clinical entity whose discovery can alter surgical management. A variety of etiologies are responsible for the development of appendiceal mucoceles and imaging can suggest the diagnosis and associated complications preoperatively.
Recent Findings
Terminology for describing peritoneal dissemination of disease has been updated to better reflect prognosis. Primary mucinous ovarian neoplasms are rare with most representing metastatic disease from appendiceal or other primary. Bilateral ovarian masses should prompt the radiologist to look closely at the appendix.
Summary
This articles reviews the etiology, imaging findings, complications, and management of appendiceal mucoceles to allow the radiologist to alert surgeons to the possibility of an appendiceal mucocele.
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References
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Basak F, Hasbahceci M, Yucel M, Sisik A, Acar A, Kilic A, Dur MSS. Does it matter if it is appendix mucocele instead of appendicitis? Case series and brief review of literature. J Can Res Ther. 2018;14:1355–60.
Connor SJ, Hanna GB, Frizelle FA. Appendiceal tumors. Dis Colon Rectum. 1998. https://doi.org/10.1007/BF02236899.
Pitiakoudis M, Tsaroucha AK, Mimidis K, Polychronidis A, Minopoulos G, Simopoulos C. Mucocele of the appendix: a report of five cases. Tech Coloproctol. 2004;8(2):109–12.
Rangarajan M, Palanivelu C, Kavalakat AJ, Parthasarathi R. Laparoscopic appendectomy for mucocele of the appendix: report of 8 cases. Indian J Gastroenterol. 2006;25(5):256.
Smeenk RM, Van Velthuysen ML, Verwaal VJ, Zoetmulder FA. Appendiceal neoplasms and pseudomyxoma peritonei: a population based study. Eur J Surg Oncol. 2008;34(2):196–201.
∙Assarzadegan N, Montgomery E. What is new in the 2019 World Health Organization (WHO) classification of tumors of the digestive system: review of selected updates on neuroendocrine neoplasms, appendiceal tumors, and molecular testing. Arch Pathol Lab Med. 2021;145(6):664–677. This reference updates the pathologic/histologic terminology of appendiceal neoplasms including removing appendiceal adenoma from the lexicon.
Carr NJ, Cecil TD, Mohamed F, Sobin LH, Sugarbaker PH, Gonzalez-Moreno S, Taflampas P, Chapman S, Moran BJ. A consensus for classification and pathologic reporting of pseudomyxoma peritonei and associated appendiceal neoplasia. Am J Surg Pathol. 2016;40(1):14–26.
Gustafsson BI, Siddique L, Chan A, Dong M, Drozdov I, Kidd M, Modlin IM. Uncommon cancers of the small intestine, appendix and colon: an analysis of SEER 1973–2004, and current diagnosis and therapy. Int J Oncol. 2008;33(6):1121–31.
Alkhayyat M, Abou Saleh M, Coronado W, Abureesh M, Zmaili M, Qapaja T, Almomani A, Khoudari G, Mansoor E, Cooper G. Epidemiology of neuroendocrine tumors of the appendix in the USA: a population-based national study (2014–2019). Ann Gastroenterol. 2021;34(5):713.
Anwar K, Desai M, Al-Bloushi N, Alam F, Cyprian FS. Prevalence and clinicopathological characteristics of appendiceal carcinoids in Sharjah (United Arab Emirates). World J Gastrointest Oncol. 2014;6(7):253.
Akbulut S, Tas M, Sogutcu N, Arikanoglu Z, Basbug M, Ulku A, Semur H, Yagmur Y. Unusual histopathological findings in appendectomy specimens: a retrospective analysis and literature review. World J Gastroenterol. 2011;17(15):1961.
Lien WC, Huang SP, Chi CL, Liu KL, Lin MT, Lai TI, Liu YP, Wang HP. Appendiceal outer diameter as an indicator for differentiating appendiceal mucocele from appendicitis. Am J Emerg Med. 2006. https://doi.org/10.1016/j.ajem.2006.04.003.
Bennett GL, Tanpitukpongse TP, Macari M, Cho KC, Babb JS. CT diagnosis of mucocele of the appendix in patients with acute appendicitis. AJR Am J Roentgenol. 2009. https://doi.org/10.2214/AJR.08.1572.
Caspi B, Cassif E, Auslender R, Herman A, Hagay Z, Appelman Z. The onion skin sign: a specific sonographic marker of appendiceal mucocele. J Ultrasound Med. 2004;23(1):117–21.
Crane EK, Brown J. Early stage mucinous ovarian cancer: a review. Gynecol Oncol. 2018;149(3):598–604. https://doi.org/10.1016/j.ygyno.2018.01.035.
Garg PK, Prasad D, Aggarwal S, Mohanty D, Jain BK. Acute intestinal obstruction: an unusual complication of mucocele of appendix. Eur Rev Med Pharmacol Sci. 2011;15(1):99–102.
Costa V, DeMuro JP. Low-grade appendiceal neoplasm presenting as a volvulus of the cecum. Gastroenterol Rep. 2013;1(3):207–10.
Stark C, Jousi M, Enholm B. Preoperative assessment and treatment of appendiceal mucocele complicated by acute torsion: a case report. BMC Res Notes. 2014;7(1):1–5.
Laalim SA, Toughai I, Majdoub KH, Mazaz K. Appendiceal intussusception to the cecum caused by mucocele of the appendix: laparoscopic approach. Int J Surg Case Rep. 2012;3(9):445–7.
∙Govaerts K, Lurvink RJ, De Hingh IH, Van der Speeten K, Villeneuve L, Kusamura S, Kepenekian V, Deraco M, Glehen O, Moran BJ, Barrios-Sanchez P. Appendiceal tumours and pseudomyxoma peritonei: literature review with PSOGI/EURACAN clinical practice guidelines for diagnosis and treatment. Eur J Surg Oncol. 2021;47(1):11–35. Up to date overview of the current terminology and pathologic classification for pseudomyxoma peritonei.
Ronnett BM, Yan H, Kurman RJ, Shmookler BM, Wu L, Sugarbaker PH. Patients with pseudomyxoma peritonei associated with disseminated peritoneal adenomucinosis have a significantly more favorable prognosis than patients with peritoneal mucinous carcinomatosis. Cancer. 2001;92(1):85–91.
∙∙Glasgow SC, Gaertner W, Stewart D, Davids J, Alavi K, Paquette IM, Steele SR, Feingold DL. The American society of colon and rectal surgeons, clinical practice guidelines for the management of appendiceal neoplasms. Dis Colon Rectum. 2019;62(12):1425–38. Current surgical guidelines for management of appendiceal neoplasms depending on grade and metastasis.
Dhage-Ivatury S, Sugarbaker PH. Update on the surgical approach to mucocele of the appendix. J Am Coll Surg. 2006. https://doi.org/10.1016/j.jamcollsurg.2005.12.003.
Sugarbaker PH. Successful management of microscopic residual disease in large bowel cancer. Cancer Chemother Pharmacol. 1999;43:S15-25.
Cotte E, Passot G, Gilly FN, Glehen O. Selection of patients and staging of peritoneal surface malignancies. World J Gastrointest Oncol. 2010;2(1):31.
Acknowledgements
Thank you to Dr. Shaaban, Dr. Rezvani, and Dr. Rogers for providing the cross-sectional imaging cases included in figures above.
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Literature search and draft manuscript by RB. Multiple of the figures and revisions courtesy of MR.
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Brown, R., Rezvani, M. Imaging Features of Appendiceal Mucoceles and It’s Complications. Curr Radiol Rep 11, 135–141 (2023). https://doi.org/10.1007/s40134-023-00417-0
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DOI: https://doi.org/10.1007/s40134-023-00417-0