scholarly journals Low-Grade Appendiceal Mucinous Neoplasm (LAMN) Primarily Diagnosed as an Ovarian Mucinous Tumor

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Konstantinos Perivoliotis ◽  
Gregory Christodoulidis ◽  
Athina A. Samara ◽  
Ioanna-Konstantina Sgantzou ◽  
Theodoros Floros ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Transvaginal Ultrasound ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Tertiary Hospital ◽  
Right Hemicolectomy ◽  
Cystic Tumor ◽  
Low Grade ◽  
Mucinous Neoplasms ◽  
The Right

Background. Low-grade appendiceal mucinous neoplasms (LAMN) are detected in 0.7 to 1.7% of all appendicectomies. The diagnosis can be challenging, particularly in female patients where the differential diagnosis of primary appendiceal and ovarian mucinous neoplasms is unclear. Case Presentation. A 71-year-old female was referred to our tertiary hospital with the working diagnosis of a right ovarian cystic tumor. The lesion was identified through a transvaginal ultrasound performed for vague lower abdominal pain symptoms. CT scan confirmed these findings. Intraoperatively, an appendiceal mucocele was identified and a right hemicolectomy was performed. The histopathology examination revealed a LAMN. Six months later, the patient remains disease-free. A close biannual oncological follow-up has been suggested. Conclusion. This case underlines the difficulty in determining the origin of mucinous neoplasms of the right pelvic area. Mucocele of the appendix should be considered in the differential diagnosis of a mass in the right iliac fossa.

scholarly journals LAMN as a differential diagnosis for abdominal pain: a case report from Syria

2022 ◽  
Vol 2022 (1) ◽  
Author(s):  
Joudi Tarabishi ◽  
Alma Douedari ◽  
Tahreer Almasalmeh ◽  
Mario Tarzi
Keyword(s):  
Computed Tomography ◽  
Differential Diagnosis ◽  
Abdominal Pain ◽  
Adnexal Mass ◽  
Right Hemicolectomy ◽  
Low Grade ◽  
Computed Tomography Scan ◽  
Mucinous Neoplasms ◽  
Retroperitoneal Tumors ◽  
Tomography Scan

Abstract Low-grade appendiceal mucinous neoplasms (LAMNs) are papillary or flat mucinous tumors with low-grade cytologic atypia found in <0.3% of appendectomy specimens among older population. They are the most frequent source of pseudomyxoma peritonei. They can be easily misdiagnosed, due to unspecific symptoms, with acute appendicitis, retroperitoneal tumors or adnexal mass. Macroscopically, the appendix may appear normal or be variably dilated. Microscopic study determines whether the studied specimen is LAMN or mucinous adenocarcinomas. We report a 77-year-old patient presented with 15-day abdominal pain accompanied with chills and hyperthermia. Decision was made for right hemicolectomy as a result of the findings on ultrasound and computed tomography scan. Diagnosis was made after the pathologic study, which revealedLAMN.

scholarly journals Late presentation of extrauterine adenomyomas after laparoscopic morcellation at hysterectomy: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammed Nagdi Zaki ◽  
Aafia Mohammed Farooq Gheewale ◽  
Nada Ibrahim ◽  
Ibrahim Abd Elrahman
Keyword(s):  
Case Report ◽  
Transvaginal Ultrasound ◽  
Iliac Fossa ◽  
Abdominal Cavity ◽  
Laparoscopic Hysterectomy ◽  
Pathology Report ◽  
Presacral Space ◽  
Gnrh Analogue ◽  
Power Morcellation ◽  
The Right

Abstract Background An adenomyoma is a well circumscribed form of adenomyosis and can be located within the myometrium, in the endometrium as a polyp, or extrauterine with the last being the rarest presentation amongst the three. With the ongoing advancement in gynecological surgery, the use of electromechanical morcellators have made the removal of large and dense specimens possible with minimally invasive techniques. However, it has also caused an increase in complications which were previously rare. Whilst the tissue is being grinded within the abdominal cavity, residual tissue can spread and remain inside, allowing for implantation to occur and thereby giving rise to recurrence of uterine tissue as a new late postoperative complication. Case presentation A 45-year-old woman presented with worsening constipation and right iliac fossa pain. Her past surgical history consists of laparoscopic supra-cervical hysterectomy that was indicated due to uterine fibroids. Computerized tomography and magnetic resonance imaging were done, which showed an irregular lobulated heterogeneous mass seen in the presacral space to the right, located on the right lateral aspect of the recto-sigmoid, measuring 4.5 × 4.3 × 4.3 cm in size. A transvaginal ultrasound revealed a cyst in the left ovary. The patient had a treatment course over several months that included Dienogest (progestin) and Goserelin (GnRH analogue) with add-back therapy. In line with the declining response to medications, the patient was advised for a laparoscopic ovarian cystectomy. During the surgery, an additional lesion was found as a suspected fibroid and the left ovarian cyst was identified as pockets of peritoneal fluid which was sent for cytology. The surgical pathology report confirmed adenomyosis in both specimens, namely the right mass and the initially suspected fibroid. Conclusion In this case report, we showcase a rare occurrence of an extrauterine adenomyoma presenting two years post laparoscopic morcellation at hysterectomy. This poses questions regarding the benefits versus risks of power morcellation in laparoscopic hysterectomy.

EP.FRI.999 Case report of a Low Grade appendiceal mucinous neoplasm (LAMN) and review of literature

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Kimberly Da Costa ◽  
Sivakumaran Sabanathan
Keyword(s):  
Intraperitoneal Chemotherapy ◽  
Pseudomyxoma Peritonei ◽  
Right Hemicolectomy ◽  
Low Grade ◽  
Mucinous Neoplasm ◽  
Mucinous Neoplasms ◽  
Mucocele Of The Appendix ◽  
Preoperative Ct ◽  
Inflammatory Processes ◽  
Progressive Accumulation

Abstract A mucocele refers to an appendix that has dilated due to progressive accumulation of mucus within its lumen. Appendiceal mucocele is a rare cause of an acute abdomen. They represent 0.2-0.7% of all appendix specimens. LAMN account for less than 0.3% of appendicectomy specimens.  We present a 38 year old man with an acute RIF’s pain who went on to have CT scan which revealed a mucocele of appendix but did not show any features of perforation or pseudomyxoma peritonei. He had a laparoscopic converted to open appendicectomy. The proximal 2 cm of appendix was oedematous but normal calibre. Histology revealed a low grade appendiceal mucinous neoplasm (LAMN) that was completely excised.  The mucocele of the appendix was first described by Rokitansky in 1842. Appendix mucocele may come as a consequence of obstructive or inflammatory processes, cystadenomas or cystadenocarcinomas. Appendiceal mucinous neoplasms commonly presents in the sixth decade of life and our patient was much younger in comparison. Several literatures suggest the value of preoperative CT imaging in obtaining diagnosis and also in planning further treatment. Appendicectomy or a right hemicolectomy is treatment of choice based on presence or absence of following factors 1. Perforated mucocele 2. Involvement of the base of the appendix. 3. Positive lymph nodes of mesoappendix and ileocolic. Patients with malignancy or pseudomyxoma peritonei are likely to require cytoreductive surgery, heated intraoperative intraperitoneal chemotherapy, early postoperative intraperitoneal chemotherapy.

Torsion of a parasitic leiomyoma: a rare but important differential in women presenting with lower abdominal pain

2021 ◽  
Vol 14 (1) ◽  
pp. e232797
Author(s):  
Clemmie Stebbings ◽  
Ahmed Latif ◽  
Janakan Gnananandan
Keyword(s):  
Abdominal Pain ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Sudden Onset ◽  
Greater Omentum ◽  
Caribbean Woman ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Fat Stranding

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.

scholarly journals Sertoliform Endometrioid Carcinomas of the Right Ovary

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A785-A785
Author(s):  
Humoud Alhubail ◽  
Khaled Aljenaee ◽  
Sulaiman Hajji
Keyword(s):  
Rare Variant ◽  
Stromal Tumor ◽  
Cystic Tumor ◽  
Histopathological Diagnosis ◽  
Low Grade ◽  
Endometrioid Adenocarcinoma ◽  
Endometrioid Carcinoma ◽  
Palpable Mass ◽  
The Right ◽  
Sex Cord Stromal Tumor

Abstract Background: Endometrioid carcinomas of the ovary are a sub-type of epithelial ovarian tumors. The vast majority are malignant and invasive. On imaging, they are usually characterized as complex nonspecific solid-cystic masses and found associated with endometriosis. However, endometrioid carcinoma of ovary resembling sex cord-stromal tumor is a rare variant of endometrioid adenocarcinoma that focally looks like a sex cord-stromal tumor with sertoli, leydig, or granulosa cells. Sertoliform endometrioid carcinoma of the ovary (SEC) is one variant that bears histologic similarity to Sertoli and Sertoli-Leydig cell tumors (SLTs). Clinical Case: A 47 year old, premenopausal female, presented with rapid growing hirsutism, frontal hair loss, abdominal distension and constipation for less than one year. On clinical examination modified Ferriman-Gallwey (mFG) score was 17/36. Abdominal examination showed a palpable mass in lower abdomen, 25cm in size, rounded, and hard in nature. CT abdomen and pelvis revealed large pelvic abdominal mass (21x20.5x17 cm) with cystic and basal soft tissue components related to right ovary. Preoperatively laboratory investigations showed FSH 9.96 mIU/mL, LH 15.4, Estradiol (E2) 94.7 pg/ml, raised total testosterone 4.38 nmol/l, normal SHBG 34 nmol/l and normal DHEA-S 161 microg/dl. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was done, in which the right ovary was seen to be replaced by a solid cystic tumor with ruptured capsule. Grossly, the right ovary was enlarged measuring 9.5 cm × 8 cm × 4.8 cm. Microscopy showed round to solid tubules lined by pseudostratified columnar epithelium with elongated nuclei resembling sertoli tumor-like pattern along with conventional endometrioid tumor. A histopathological diagnosis of SEC of right ovary was made. Immunohistochemistry showed tumor cells strongly immunoreactive for epithelial membrane antigen (EMA), cytokeratin (CK) but negative for inhibin, thus confirming the diagnosis of SEC of right ovary. Conclusion: SEC is extremely rare variant of endometrioid carcinomas and tend to present at an earlier stage as compared with most endometrioid carcinomas of the ovary. Recognition of SEC in virilizing patients is important as it is a well-differentiated, low-grade malignancy that displays a good prognosis when confined to the ovary.

scholarly journals A study on right iliac fossa mass

2017 ◽  
Vol 4 (10) ◽  
pp. 3292
Author(s):  
Anita Samraj ◽  
Sanjay Prakash J. ◽  
Muthukumaran G.
Keyword(s):  
Psoas Abscess ◽  
Iliac Fossa ◽  
Right Hemicolectomy ◽  
Contrast Enema ◽  
The Other ◽  
Histopathological Diagnosis ◽  
Hodgkins Lymphoma ◽  
Non Hodgkins Lymphoma ◽  
The Right ◽  
Appendicular Mass

Background: Patients with mass in the right iliac fossa may confront the surgeon, pediatrician or gynecologist. Thus, thorough understandings of the anatomy and pathological process that may occur within the abdomen are essential for an accurate diagnosis and plan of treatment. The objective of this study was to interpret aetiopathology, clinical presentation, differential diagnosis and management of mass in the right iliac fossa.Methods: A total of 60 cases with mass in the right iliac fossa (RIF) were included in the study. Investigations like colonoscopy and CT scan were done. All the cases underwent right hemicolectomy followed by chemotheraphy. Other cases like psoas abscess, non-hodgkins lymphoma, Meckels diverticulum and intussusception were diagnosed and treated.Results: During this study period, a total number of 36 cases of appendicular mass and 10 cases of appendicular abscess were encountered. In this study 10 cases of appendicular abscess were encountered and treated by extraperitoneal drainage, 4 cases of ileocaecal kochs were encountered. Patients presented with constitutional symptoms like pain, fever, weight loss etc. Right hemicolectomy was done, specimens after operative procedures were examined microscopically and histopathological diagnosis. 3 cases of carcinoma caecum and 3 cases of carcinoma ascending colon were seen. Contrast enema was done which showed filling defect and mucosal irregularities.Conclusions: This study showed that appendicular mass is the commonest pathology in right iliac fossa amongst all and conservative treatment followed by interval appendicectomy is the best mode of treatment. Carcinoma of the colon and ileocaecal tuberculosis is the other two common causes for mass in the right iliac fossa. These cases also carry a good prognosis, if properly diagnosed and treated. The other rare causes of mass in the right iliac fossa are intussusception, psoas abscess and Non Hodgkins lymphoma.

scholarly journals A Pink Herring in the Colon: A Case Report of Eosinophilic Colitis Masking Invasive Adenocarcinoma of the Colon

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
David Malcolm Milne ◽  
Jason Rattan ◽  
Alyssa Muddeen ◽  
Amrit A. Rambhajan
Keyword(s):  
Colon Cancer ◽  
Weight Loss ◽  
Iliac Fossa ◽  
Fluid Collection ◽  
Right Hemicolectomy ◽  
Subsequent Treatment ◽  
Invasive Adenocarcinoma ◽  
Lower Quadrant ◽  
Eosinophilic Colitis ◽  
The Right

Eosinophilic colitis is an inflammatory condition in which the wall of the colon becomes infiltrated by eosinophils which stain densely pink on microscopy. It is an uncommon clinical entity which has a long list of differential diagnoses. We present a case of a patient whose biopsy at colonoscopy revealed eosinophilic colitis which led to a delay in the diagnosis and subsequent treatment of colon cancer. A 35-year-old male presented with a six-week history of right lower quadrant abdominal pain associated with diarrhoea and weight loss. Colonoscopy showed an inflamed cecum; computed tomography revealed a small ascitic fluid collection in the right iliac fossa. Biopsy showed eosinophilic colitis, and he was treated conservatively with albendazole and mesalamine. The patient failed to improve over the following month with continued weight loss. A repeat CT scan showed a right iliac fossa mass. A right hemicolectomy was performed with histopathology from the specimen showing mucinous adenocarcinoma. Eosinophilic colitis can mask colon cancer and should be considered a diagnosis of exclusion.

Appendiceal Mucocele of Mucinous Cystadenocarcinoma with a Cutaneous Fistula

2002 ◽  
Vol 30 (4) ◽  
pp. 452-456 ◽  
Author(s):  
A Nakao ◽  
S Sato ◽  
A Nakashima ◽  
A Nabeyama ◽  
N Tanaka
Keyword(s):  
Iliac Fossa ◽  
Right Hemicolectomy ◽  
Cystic Mass ◽  
Japanese Woman ◽  
Mucinous Cystadenocarcinoma ◽  
Appendiceal Mucocele ◽  
Old Japanese ◽  
Well Differentiated ◽  
The Right ◽  
Skin Fistula

We report a novel case of cystadenocarcinoma forming an appendiceal mucocele with development of a skin fistula. The patient was a 75-year-old Japanese woman who originally presented with a skin ulcer on the right flank (inferior to the ribs and superior to the iliac bone) with mucus discharge. The serum concentration of carcinoembryonal antigen was elevated (57.4 ng/ml). Ultrasonography and computed tomography demonstrated a cystic mass with septations in the right iliac fossa. Fistulography from the skin ulceration showed a communication via the fistula to the caecum. A right hemicolectomy and enbloc resection of the skin fistula was performed. The histological findings revealed a well-differentiated mucinous cystadenocarcinoma of the appendix. The patient has been alive for 7 years following surgery without any sign of recurrence. This report is of interest as it demonstrates that tumour rupture to the extraperitoneal space could result in a good outcome by preventing the development of pseudomyxoma peritonei.

scholarly journals Laparoscopic Management of an Abdominal Pregnancy

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Aarthi Srinivasan ◽  
Suzanne Millican
Keyword(s):  
Ectopic Pregnancy ◽  
Transvaginal Ultrasound ◽  
Lower Abdominal Pain ◽  
Pain Patient ◽  
Prior History ◽  
Intrauterine Pregnancy ◽  
Beta Hcg ◽  
Maternal Morbidity And Mortality ◽  
History Of ◽  
The Right

Background. Ectopic pregnancy is one of the leading causes of significant maternal morbidity and mortality. Abdominal surgeries increase the risk of postoperative adhesions. We here present a case of omental ectopic pregnancy in a patient with a prior history of cesarean section.Case. A 20-year-old female presented with a two-day history of crampy lower abdominal pain. Patient was hemodynamically stable with a beta HCG of 1057 mI/mL. Transvaginal ultrasound did not show an intrauterine pregnancy but revealed an ill-defined mass in the midline pelvis extending to the right of the midline. Diagnostic laparoscopy revealed large clots in the pelvis with normal uterus and adnexa. Intra-abdominal survey revealed an omental adhesion close to the right adnexa with a hematoma. Partial omentectomy was completed and the portion of the omentum with the hematoma was sent to pathology for confirmation. Final pathology confirmed the presence of chorionic villi consistent with products of conception.Conclusion. Omental ectopic pregnancy is a rare diagnosis and often missed. We recommend careful intra-abdominal survey for an ectopic pregnancy in the presence of hemoperitoneum with normal uterus and adnexa. This can be safely achieved using laparoscopy in early gestational ages when the patient is hemodynamically stable.

scholarly journals Torsion of caecal appendices epiploicae: mimicking acute appendicitis

2020 ◽  
Vol 7 (7) ◽  
pp. 2407
Author(s):  
A. P. Roshini ◽  
Dattaprasad Samant ◽  
F. P. Noronha
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Free Fluid ◽  
Normal Appendix ◽  
Menstrual Cycles ◽  
Rebound Tenderness ◽  
Appendices Epiploicae ◽  
The Right

Acute appendicitis is a common cause for pain in the right iliac fossa, which requires urgent surgical intervention. However, at the time of surgery, if the appendix is normal, the surgeon has to search for other causes of acute abdominal pain including rare etiologies, such as torsion of appendices epiploicae and subsequently its gangrene. We report the case of a 45 years old female who presented with right lower abdominal pain, rebound tenderness and guarding in right iliac fosse, with regular menstrual cycles and no urinary complaints. Investigation revealed leucocytosis and ultra-sonography abdomen was suggestive of an inflamed appendix in the right iliac fossa with free fluid. Intra-operatively, we found a normal appendix with gangrene of the appendices epiploicae which had undergone torsion. She underwent excision off appendices epiploicae with appendicectomy with uneventful post-operative period. Histopathology of the appendices was suggestive of congestion.  Preoperative diagnosis of this condition is rarely made.

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