Mucinous Neoplasm of Appendix Treatment

Volume 8, Issue 3, March – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Mucinous Neoplasm of Appendix: Treatment

Dr. Ratikant Narayan Raikar1, Dr. C.N Manoj Raj2 , Dr. Manjunath A P3 , Dr. Rahul Raikar*
1
Associate Professor, Department of General Surgery, AIMS, B G Nagara, India
2
Post Graduate, Department of General Surgery, AIMS, B G Nagara, India
3
Post Graduate, Department of General Surgery, AIMS, B G Nagara, India
*Assistant Professor, Department of General Surgery, AIMS, B G Nagara, India
Abstract:- II. CASE SERIES

AIM:This study aims to treatment for mucinous neoplasm
of appendix A. Case 1
MATERIAL AND METHODS: A prospective descriptive A elderly obese female (BMI – 30.6 kg/m2) presented to
study was done in patient with history of pain abdomen the out-patient of surgery department in tertiary care center in
and distension presented to our hospital July 2021, with a pain abdomen since 6 months with no history
RESULTS: We provide an overview of the most recent of chronic cough/ tuberculosis as well as in close contacts. On
information and conflicts about the classification of AMNs, examination patient compliants of right ilac fossa pain with
clinical manifestations, and the effectiveness of rest of the physical examination being normal.
cytoreductive surgery and hyperthermic intraperitoneal Ultrasonography of abdomen and pelvis was performed which
chemotherapy (HIPEC) suggested sealed off appendicular perforation. The patient was
CONCLUSION: Appendiceal mucinous tumors are planned for an explorative laprotomy. Intra-operatively a
frequently an incidental finding. The treatment of this appendix was enlarged and peroration was seen at the tip of
disease depands on the Histologic tumor grade and the the appendix and appendecetomy was performed and
presence of peritoneal dissemination will determine specimen was sent for HPE and the wound was closed with
surgery which includes, from appendectomy to primary interrupted sutures. HPE report suggested of low
cytoreductive surgery.The tretment for Low-grade grade mucinous carcinoma of appendix. The scar healed by
tumors includes resection of the primary site in early stage primary intension and the patient was followed up for a
disease, or peritoneal debulking and for advance stage duration of 3 months having no recurrence.
includes HIPEC .While treatment for high-grade tumors
include debulking surgery and HIPEC with or without B. Case 2
preoperative chemotherapy . A elderly male (BMI – 28.9 kg/m2) presented to the out-
patient of surgery department in tertiary care center in
Keywords:- Mucinous Neoplams of Appendix, Appendix, December 2021, with abdominal distension and pain abdomen
Treatment. since 3months. Patient has no history of chronic cough/
tuberculosis as well as in close contacts. On examination
I. INTRODUCTION patient Local guarding was seen in right ilac fossa with
minimal ascitis fluid with bowel sound present.
These are the rare tumors accounting for less than 1% of Ultrasonography of abdomen was performed which suggested
all cancers. The way the symptoms manifest themselves can Appendicular perforation with minimal ascitis and CECT
vary, but the most common symptoms is right iliac fossa Abdomen was done which showed appendicular perforation
abdominal pain, which can be misdiagnosed as acute with periappoendicular collection with ascitis with no
appendicitis. Lowgrade tumors that are limited to the appendix lymphnode enlargement. The patient was planned for an
are typically benign. On the other hand, tumors that have explorative laprotomy. Intra-operatively appendicular
invaded the appendiceal wall or have a high degree of atypia perforation was seen at the tip with mucin deposition in the
may grow rapidly and are classified as adenocarcinomas. abdomen and appendecetomy was done and specimen was
sent for HPE and the wound was closed with primary
Types of Mucinous appendiceal tumors are 1) mucinous interrupted sutures. HPE report suggested of low grade
cystadenoma (MC), 2)mucinous tumors of uncertain mucinous carcinoma of appendix. The scar healed by primary
malignant potential (M-UMP), 3)mucinous tumors with low intension with no recurrence during the follow up period of 2
malignant potential (M-LMP) and 4)mucinous months.
adenocarcinoma(MA).The treatment of AMN is largely based
on stage and histology.
IJISRT23MAR1015 www.ijisrt.com 1228

ISSN No:-2456-2165
C. Case 3  Localized AMNs
An elderly male presented to the out-patient of surgery The majority of surgical research implies that a
department in tertiary care centre in May 2022 with a pain straightforward appendectomy is sufficient for tumors
abdomen since 6 months and abdominal distension and pain demonstrating only local malignancy since the incidence of
abdomen since 3months. Physical examination patient Local nodal spread of well-differentiated localized appendiceal
guarding was seen in right ilac fossa with minimal ascitis fluid malignancies is less than 2%.In case of positive margins after
with bowel sound present. The rest of the physical appendecetomy, Right hemicolectomy should be considered
examination was under normal limits with no other swelling/ as the next step of mangement .The same is to be considered
lump noted in the axilla, groin or the neck. Ultrasonography of for peri-appendiceal tumors . Tumor size of 2 cm or larger,
abdomen abdomen was performed which suggested high grade histology, or tumor that invades through the
Appendicular perforation with minimal ascitis and CECT muscularis propria, criteria for right hemicolectomy include
Abdomen was done which showed appendicular perforation the following: (1) degree of cellular undifferentiation,(2)
with periappoendicular collection with ascitis with no increased mitotic activity, (3)Appendicular base involvement
lymphnode enlargement . Patient was planned for surgery – (4) metastasis to lymph nodes, or (e) tumor size more than 2
Explorative Laparotomy. Intra-operatively appendicular cm. As mentioned above features are risk factor for local
perforation was seen at the tip with mucin deposition in the recurrences, thus supporting right hemicolectomy.
abdomen and appendecetomy was done excised specimen was
sent for HPE and the wound was closed with primary  Treatment of AMN with Peritoneal Metastasis
interrupted sutures. HPE report suggested low grade mucinous In these patient main stay of tretment includes repeated
carcinoma of appendix. The scar healed by primary intension drainage of the mucinous ascites and serial debulking
with no recurrence during the follow up period of 6 months. surgeries.they were also study which showed intraperitoneal
chemotherapy with debulking surgery improved the condition
III. DISCUSSION of the patient.
Appendiceal mucinous neoplasms account for 0.4%–1% IV. CONCLUSION

of all gastrointestinal malignancies, According to estimates,
there are 0.12 cases of AMN per 1 million people each year. Staging and histology type are needed for treatment . The
The majority of appendiceal tumor patients (70–74%) are tretment for Low-grade tumors includes resection of the
white, and 50%–55% of them are women. Over time, no primary site in early stage disease, or peritoneal debulking and
discernable demographic change has been seen. for advance stage includes HIPEC . Treatment of high-grade
tumors options include debulking surgery and HIPEC, with or
The most frequent clinical manifestation in early stage without preoperative chemotherapy.
disease is right lower abdomen pain, which the patient may
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Volume 8, Issue 3, March – 2023 International Journal of Innovative Science and Research Technology

Mucinous Neoplasm of Appendix: Treatment

Abstract:- II. CASE SERIES

IJISRT23MAR1015 www.ijisrt.com 1228

Appendiceal mucinous neoplasms account for 0.4%–1% IV. CONCLUSION

IJISRT23MAR1015 www.ijisrt.com 1229

IJISRT23MAR1015 www.ijisrt.com 1230

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