scholarly journals Should the appendix always be removed during surgery for mucinous ovarian tumors?

2018 ◽  
Vol 7 (2) ◽  
pp. 677
Author(s):  
Bijal M. Patel ◽  
Ava D. Desai ◽  
Shilpa M. Patel ◽  
Meeta H. Mankad ◽  
Pariseema S. Dave ◽  
...  
Keyword(s):  
Pseudomyxoma Peritonei ◽  
Mucinous Cystadenoma ◽  
Ovarian Tumors ◽  
Mucinous Tumor ◽  
Inclusion Criteria ◽  
Single Institution ◽  
Normal Appendix ◽  
History Of ◽  
Study Population ◽  
Mucinous Ovarian Tumors

Background: Appendectomy is performed in all mucinous ovarian tumors (MOT) identified intraoperatively to ensure microscopic metastases from appendix are not missed. Several recent studies suggested that appendectomy should only be performed in cases with a grossly abnormal appendix or with evidence of pseudomyxoma peritonei. Our study aimed to determine the frequency of malignancy in a grossly normal appendix in women undergoing surgery for borderline or malignant MOT.Methods: In a single institution retrospective study, women undergoing surgery for MOT from January 1, 2008 to June 30, 2016 were included. Women with benign MOT, those with a history of either prior appendicectomy or prior gastrointestinal (GI) malignancy were excluded.Results: Of 266 women identified with MOT, 153 with borderline and malignant MOT were included in the study after application of inclusion criteria. The study population comprised of 29 (18.95%) borderline and 124 (81.05%) malignant MOT. Among the borderline MOT, 13/29 had undergone appendectomy. Five (38.46%) had grossly abnormal appendices of whom 1 had mucinous cystadenoma, 3 had borderline mucinous tumor and 1 had mucinous cystadenocarcinoma of the appendix. Histology was normal in all 8 (61.54%) grossly normal appendices. Among the malignant MOT, 80/124 (64.52%) underwent appendicectomy. Nineteen (23.46%) had grossly abnormal appendices and histology was suggestive of adenocarcinoma of appendix. Histology was normal in all 62 (76.54%) macroscopically normal appendices.Conclusions: Present results suggest that appendectomy be performed only for those appendices that are grossly abnormal or associated with pseudomyxoma peritonei at surgery for MOT

Prevalence of Appendiceal Lesions in Appendicectomies Performed During Surgery for Mucinous Ovarian Tumors: A Retrospective Study

2016 ◽  
Vol 26 (8) ◽  
pp. 1386-1389 ◽  
Author(s):  
Luiza Moore ◽  
Ketan Gajjar ◽  
Mercedes Jimenez-Linan ◽  
Robin Crawford
Keyword(s):  
Retrospective Study ◽  
Ovarian Neoplasms ◽  
Final Diagnosis ◽  
Ovarian Neoplasm ◽  
Ovarian Tumors ◽  
Surgical Removal ◽  
Mucinous Tumor ◽  
Single Institution ◽  
Metastatic Tumors ◽  
Mucinous Ovarian Tumors

ObjectivesThe aim of this study was to assess the frequency of appendiceal pathology in women undergoing surgery for mucinous ovarian neoplasm and to evaluate whether appendicectomy is necessary.MethodsThis single-institution retrospective study reviewed prevalence of appendiceal lesions in all patients operated on at our institution from 2002 to 2013 with the final diagnosis of mucinous tumor of the ovary. Clinicopathological data were analyzed.ResultsOne hundred twenty-three cases were identified. These included 45 (37%) benign mucinous ovarian neoplasms, 63 (51%) borderline, and 11 (9%) invasive mucinous ovarian tumors. In addition, 4 (3%) cases of metastatic tumors to the ovary were also identified. Appendiceal pathology was found in association with all types of mucinous ovarian tumors (benign, borderline, and malignant). In 24% of cases, appendix was macroscopically abnormal at the time of the surgery, prompting the surgical removal. Regardless of the gross findings, microscopic abnormality in the appendix was seen in 24% of all cases. The prevalence of significant occult microscopic appendiceal pathology, that is, when the appendix was grossly normal, was 6%.ConclusionsGiven the prevalence of coexisting appendiceal pathology found in this study and the reported low rates of complications associated with the procedure, an appendicectomy is recommended in the management of all mucinous ovarian neoplasms.

scholarly journals Pseudomyxoma peritonei presenting with port site hernia

2021 ◽  
pp. 89-92
Keyword(s):  
Pseudomyxoma Peritonei ◽  
Case Reports ◽  
Abdominal Distension ◽  
Right Hemicolectomy ◽  
Port Site ◽  
Mucinous Tumor ◽  
Ovarian Mass ◽  
First Case ◽  
Port Site Hernia ◽  
History Of

Pseudomyxoma peritonei (PMP) is a rare disease with an incidence of two per million. Acute appendicitis, ovarian mass, and abdominal distension are the most common presentations. A 72-year-old male patient with a history of laparoscopic cholecystectomy was admitted to the hospital with abdominal pain and increased supraumbilical port site swelling. Radiological examination revealed a mass in the terminal ileum and severe intraabdominal mucinous fluid. Intraabdominal gelatinous fluid protruding from the port site defect and a mass in the distal ap-pendix were observed during operation. He underwent a right hemicolectomy, ileocolic anasto-mosis and peritoneal debridement; cytoreductive surgery was administered two months later due to mucinous tumor of the appendix. There are only a few case reports describing PMP presen-ting with an incisional hernia after open surgical procedures. To the best of our knowledge, this report describes the first case of PMP presenting with a port site hernia after a laparoscopic in-tervention.

scholarly journals Collision tumor of ovary: a case report on bilateral dermoid cyst with co-existing unilateral mucinous cystadenoma

2020 ◽  
Vol 9 (7) ◽  
pp. 3078
Author(s):  
Sowmya Sampurna Maddipati ◽  
Sudha C. P. ◽  
Sowmya K.
Keyword(s):  
Case Report ◽  
Dermoid Cyst ◽  
Frozen Section ◽  
Mucinous Cystadenoma ◽  
Cystic Teratoma ◽  
Collision Tumor ◽  
Ovarian Tumors ◽  
Favourable Prognosis ◽  
Benign Cystic Teratoma ◽  
Mucinous Ovarian Tumors

A collision tumor is the coexistence of two adjacent, but histologically distinct tumors without histological admixture in the same tissue or organ. Such tumors have often been reported in various organs, but location in the ovary is rare. The juxtaposition with dermoid cysts has been reported as comprising approximately 5% of benign mucinous ovarian tumors and rare examples of proliferating mucinous tumors. Authors are reporting a case of collision tumor which included benign mucinous cystadenoma and benign cystic teratoma. The gynecologists and pathologists should be aware of such combination of tumors. The case was diagnosed post-operatively. It is important to correctly diagnose the component of tumor for further management and favourable prognosis. Frozen section intra-operatively plays an important role in diagnosing such tumors.

scholarly journals A case of Pseudomyxoma Peritonei of an unexpected origin

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Marie Csanyi-Bastien ◽  
France Blanchard ◽  
Aude Lamy ◽  
Jean-Christophe Sabourin
Keyword(s):  
Pseudomyxoma Peritonei ◽  
Ovarian Tumor ◽  
Histological Analysis ◽  
Mucinous Cystadenoma ◽  
Ovarian Teratoma ◽  
Mucinous Tumor ◽  
Case Presentation ◽  
Mucinous Neoplasm ◽  
Ovarian Lesion

Abstract Background Pseudomyxoma peritonei (PMP) is a complex and partially understood disease defined by mucin deposits in the peritoneal cavity, mostly of appendiceal origin caused by the rupture of a mucocele often containing Low or High grade Appendiceal Mucinous Neoplasm (LAMN/HAMN). Other origins include primitive ovarian mucinous cystadenoma or cystadenocarcinoma almost always with an associated teratoma, but to our knowledge no case of ovarian teratomatous appendiceal-like mucocele with LAMN has been reported as a cause of PMP. Case presentation A 25-year old female with infertility was diagnosed with an isolated left ovarian tumor in a context of PMP. Histological examination revealed an ovarian teratoma containing an appendiceal-like structure with mucocele and LAMN, without any associated lesion of the appendix on full histological analysis. Molecular characterization of the ovarian lesion showed co-KRAS and GNAS mutations, as described in PMP of appendiceal origin, while only KRAS mutations are reported in primitive ovarian mucinous tumor. Conclusions Detection of co-KRAS and GNAS mutations in our case of ovarian teratomatous appendiceal-like mucocele with LAMN shows that when PMP derives from a mucinous ovarian lesion (with histological proof of none-appendiceal involvement), it is probably of a digestive teratomatous origin, emphasizing the need to actively search for tetatomatous signs in a context of ovarian PMP.

scholarly journals Pseudomyxoma peritonei: unusual origin from teratoma associated mucinous cystadenoma of ovary

2021 ◽  
Vol 5 (1) ◽  
pp. 76-79
Author(s):  
Manju Pandey ◽  
Binuma Shrestha ◽  
Bijay Chandra Acharya ◽  
Suraj Upreti
Keyword(s):  
Abdominal Pain ◽  
Pseudomyxoma Peritonei ◽  
Mature Teratoma ◽  
Mucinous Cystadenoma ◽  
Clinical Syndrome ◽  
Abdominal Distention ◽  
Mucinous Tumor ◽  
Ovarian Involvement ◽  
Unusual Origin

Pseudomyxoma peritonei is an extremely rare clinical syndrome with incidence of approximately two per 10000 laparotomies. Approximately 44% of women with PMP have ovarian mucinous tumor. It is generally accepted that the ovarian involvement is secondary; PMP is nearly always gastrointestinal origin, usually from mucinous adenoma of the appendix1. Exception to this, we report a 35 years lady who presented with the complaint of abdominal pain and abdominal distention for two months, clinically and radiologically gross mucinous ascites with large abdominopelvic mass was evident. Final histopathology was reported as mucinous cystadenoma, with mature teratoma components, appendix was normal. 

scholarly journals MON-621 Prescription Analysis Shows High Metformin Use and Acceptance in a Diabetes Specialty Centre in Eastern India

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Sanat Kumar Mishra ◽  
Susant Mishra ◽  
Abhay Kumar Sahoo ◽  
Rajesh Kumar Padhi ◽  
Biswaranjan Jena ◽  
...  
Keyword(s):  
Inclusion Criteria ◽  
Type 2 Diabetics ◽  
Daily Dose ◽  
History Of ◽  
Study Population ◽  
Artery Disease ◽  
The Individual ◽  
The Right ◽  
Type 2 Diabetic

Abstract Background and aims: Achieving glycemic goals is crucial in the overall management of diabetes. Selecting the right medication for the individual patient is of paramount importance in the present day’s patient centric glucose control. Metformin is the first line and gold standard antihyperglycemic agent that can be offered to type 2 diabetics. Addition of a second or third agent or insulin should be considered in those whose HbA1c remains high despite the up-regulated metformin dose or those who do not tolerate metformin. We aimed to find the pattern of metformin use in type 2 diabetic subjects in a diabetes specialty centre in coastal Odisha. Materials and methods: This observational study was conducted in a diabetes setup in coastal Odisha in June 2018. After obtaining consent from patients, authors looked into the prescriptions of all type 2 diabetic adults. Subjects who were prescribed metformin (in any dose) were enrolled in the study. Those with established nephropathy, coronary artery disease, stroke or cancers were excluded. Results:There were 802 footfalls noted during the study period, of which 723 metformin taking participants (298 females, 41.2%) were considered for analysis (79 persons were excluded: not meeting inclusion criteria/ not willing to participate/ history of nephropathy/ CAD/ stroke). Mean age, diabetes duration, FPG, HbA1c, serum creatinine, eGFR of the study population were 51.6±10.6 years, 11.9±11.2 years, 138.7±51.7 mg/dl, 7.8±2.1%, 0.93±0.29 mg/dl and 96.5±11.1ml/min respectively. Patients were prescribed metformin in various doses, i.e., 500mg (42 patients, 5.8%), 850mg (47 patients, 6.5%), 1000mg (396 patients, 54.8%), 1500mg (13 patients, 1.8%), 1700mg (86 patients, 11.9%) and 2000mg (130 patients, 18.0%), and 2500mg (9 patients, 1.2%). Metformin was prescribed as monotherapy (n=34, 4.7%) or along with other OADs (n=589, 81.5%) or in combination with insulin (n=178, 24.6%). Retrospective analysis of the medical records and further questioning revealed that gastric intolerance was the commonest reason for withdrawal of metformin in otherwise eligible subjects. Conclusion: Metformin was the most commonly prescribed antidiabetic drug and the daily dose of more than 85% of the metformin administered individuals was 1000mg or above.

Outcome of Appendicectomies at Surgery for Mucinous Ovarian Neoplasms: Report From A UK Center and Review of Literature

2016 ◽  
Vol 26 (6) ◽  
pp. 1020-1026 ◽  
Author(s):  
Debjani Mukhopadhyay ◽  
Ramzi Rajab ◽  
Marielle Nobbenhuis ◽  
James Dilley ◽  
Owen Heath ◽  
...  
Keyword(s):  
Pseudomyxoma Peritonei ◽  
Ovarian Tumor ◽  
Electronic Patient Record ◽  
Ovarian Neoplasms ◽  
Study Data ◽  
Patient Record ◽  
Review Of Literature ◽  
Normal Appendix ◽  
Serrated Adenoma ◽  
Study Population

ObjectiveThis study aimed to determine the frequency of malignant pathology in a macroscopically normal appendix during surgery for a borderline or malignant mucinous ovarian tumor (MOT).MethodsWomen with borderline and malignant MOT were identified from the pathology database from 2000 to 2014. Women who had a benign MOT and had an appendicectomy were excluded from the study. Data were collected from the electronic patient record and case notes.ResultsOf 310 women identified with MOT, 203 patients with benign MOT were excluded. Of the remaining 107 patients, 15 patients with previous appendicectomy were also excluded. The study population consisted of 92 patients. There were 57 (62%) patients with borderline MOT and 35 (38%) patients with malignant MOT. In the borderline subgroup, 40/57 (70%) patients had appendicectomy of whom 8 (20%) had macroscopically abnormal appendices. One patient had pseudomyxoma peritonei secondarily involving the appendix and 7 patients had a histologically normal appendix. Normal histology was found in all macroscopically normal appendices. In the malignant subgroup, 29/35 (83%) patients had an appendicectomy. There were 8 (27.5%) macroscopically abnormal appendices with a malignant pathology in 7 (87.5%) patients and 1 patient had a resolving appendicitis. There were 21 macroscopically normal appendices of which, serrated adenoma was found in 1 (4.8%) patient, whereas the remaining 20 (95.2%) patients had normal histology.ConclusionsIn MOT, an abnormal appearing appendix should be excised. If the appendix is grossly normal, our data do not support performing an appendicectomy as part of a surgical staging procedure.

scholarly journals A case of Pseudomyxoma Peritonei of an unexpected origin.

2021 ◽  
Author(s):  
Marie Csanyi-Bastien ◽  
France Blanchard ◽  
Aude Lamy ◽  
Jean-Christophe Sabourin
Keyword(s):  
Pseudomyxoma Peritonei ◽  
Ovarian Tumor ◽  
Histological Analysis ◽  
Mucinous Cystadenoma ◽  
Ovarian Teratoma ◽  
Mucinous Tumor ◽  
Case Presentation ◽  
Mucinous Neoplasm ◽  
Ovarian Lesion

Abstract Background:Pseudomyxoma peritonei (PMP) is a complex and partially understood disease defined by mucin deposits in the peritoneal cavity, mostly of appendiceal origin caused by the rupture of a mucocele often containing Low or High grade Appendiceal Mucinous Neoplasm (LAMN/HAMN). Other origins include primary ovarian mucinous cystadenoma or cystadenocarcinoma almost always with an associated teratoma, but to our knowledge no case of ovarian teratomatous appendiceal-like mucocele with LAMN has been reported as a cause of PMP.Case presentation:A 25-year old female with infertility was diagnosed with an isolated left ovarian tumor in a context of PMP. Histological examination revealed an ovarian teratoma containing an appendiceal-like structure with mucocele and LAMN, without any associated lesion of the appendix on full histological analysis. Molecular characterization of the ovarian lesion showed co-KRAS and GNAS mutations, as described in PMP of appendiceal origin, while only KRAS mutations are reported in primary ovarian mucinous tumor.Conclusions:Detection of co-KRAS and GNAS mutations in our case of ovarian teratomatous appendiceal-like mucocele with LAMN shows that when PMP derives from a mucinous ovarian lesion (with histological proof of none-appendiceal involvement), it is probably of a digestive teratomatous origin, emphasizing the need to actively search for tetatomatous signs in a context of ovarian PMP.

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