Appendiceal
mucocele is a
rare disease (0.3% of all
appendectomy) and is characterized by the accumulation of mucoid material in the appendiceal lumen. Etiopathogenesis can be inflammatory or neoplastic. Four entities can be distinguished on the basis of histopathologic epithelial characteristics: simple appendiceal
mucocele (AM),
mucocele with epithelial
hyperplasia,
cystadenoma and
cystadenocarcinoma; the last two subgroups represent neoplastic forms. Dissemination of neoplastic cells and mucoid material in abdominal cavity, caused by appendiceal perforation, clinically results in
pseudomyxoma peritonei which is the dramatic evolution in 10-15% of cases. Clinically it can remain either asymptomatic for long time or it can manifest with
abdominal pain that can be associated with the presence of a palpable mass. The most common clinical manifestation is
pain in the right iliac fossa. Preoperative diagnosis is rare, while it is more frequently intraoperative.
Therapy is fundamentally surgical:
appendectomy is curative for simple AM, for AM with epithelial
hyperplasia and for
cystadenoma with intact appendiceal base; cecum resection is indicated for
cystadenoma with larger base of implantation; right
hemicolectomy has been the elective treatment in case of
cystadenocarcinoma for several years although Gonzalez-Moreno and Sugarbaker have recently demonstrated its validity as definitive treatment only if it is performed in order to obtain complete cytoreduction, if there is lymph node involvement, or if histopathological examination indicates non-mucinous type. We report the case of a 60-year-old woman that presented with cystic neoformation in the right iliac fossa, that was preoperatively considered deriving from the ovary. We intraoperatively found the presence of appendiceal
mucocele that histological examination defined as
mucinous cystadenoma.