F.Zah a Cheikhna. (2025). Appendicula Mucocele Complica ed by Pseudomyxoma Pe i onei. MAR Oncology
and Hema ology. (2025) 5:09
Appendicula Mucocele Complica ed by Pseudomyxoma Pe i onei
Sidi Ely Mokh a 1, F.Zah a Cheikhna2*, Md Dede Alioune3, Mkhai a Yahya4
Radiology Depa men , Gas oen e ology Depa men , Su ge y Depa men
Nouakcho Mili a y Hospi al, Mau i ania.
*Co espondence o: F.Zah a Cheikhna, Nouakcho Mili a y Hospi al, Mau i ania.
Copy igh .
© 2025 F.Zah a Cheikhna This is an open access a icle dis ibu ed unde he C ea i e Commons A ibu ion
License, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal
wo k is p ope ly ci ed.
Recei ed: 06 Oc 2025
Published: 15 Oc 2025
MAR Oncology and Hema ology (2025) 5:09
Case Repo
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F.Zah a Cheikhna. (2025). Appendicula Mucocele Complica ed by Pseudomyxoma Pe i onei. MAR Oncology
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Obse a ion
A 47-yea -old pa ien wi h no pa icula medical his o y p esen ed wi h hypogas ic abdominal pain and e e
o 40 deg ees Celsius (104.4 Fah enhei ) o he pas 48 hou s. Physical examina ion no ed gua ding in he
igh iliac ossa and hypogas ic egion. Blood coun : Whi e blood cell coun a 17,000 cells/mm3,
p edominan ly polymo phonuclea neu ophils. Abdominal CT: Tubula o ma ion a he le el o he IDF
measu ing 34 mm in maximum hickness, wi h luid con en and a calci ied wall enhanced a e injec ion o
con as agen wi h a luid collec ion a ound i .
She unde wen su ge y by midline lapa o omy objec i ying a up u ed swollen appendix wi h gela inous luid
eme ging om he up u e loca ed pe iappendicula . The su gical p ocedu e consis ed o an appendec omy
since he base was mac oscopically heal hy wi h abdominal cleansing and d ainage o he culs o he Douglas
sac.
The pa ien was placed on dual an ibio ic he apy + analgesic and an icoagulan . The pos ope a i e cou se was
un ema kable wi h esump ion o bowel mo emen s on pos ope a i e day 2. The pa ien was decla ed
discha ged on he ou h day o hospi aliza ion. Ana omopa hological s udy: Mo phological appea ance in
a o o acu e suppu a i e appendici is on a low-g ade appendicula mucinous neoplasm; issu ed wi h
pe i oneal eac ion and p esence o mucin on he appendicula se osa; heal hy appendicula ma gin.
ABSTRACT
Appendiceal mucocele is a a e condi ion, de ined as a cys ic dila ion o he lumen o he appendix
due o an accumula ion o in aluminal mucinous sec e ions, which a e anslucen and gela inous,
and may a ec ei he he en i e o gan o a segmen , mos o en dis al. Appendiceal pseudomyxoma,
o gela inous pe i oneal disease, is he mos d eaded complica ion o appendiceal mucocele; i is a
a e disease cha ac e ized by he p esence o abundan gela inous ma e ial in he abdomen
seconda y o he up u e o a mucinous appendix lesion.
Ou case in ol es a 47-yea -old woman who p esen s wi h pe i oneal pseudomyxoma, de ec ed ea ly
in ela ion o a up u ed appendiceal pseudomyxoma localized in he pe i-appendiceal egion.
Keywo d: Appendiceal mucocele, pe i oneal pseudomyxoma, su ge y, appendiceal mucinous
neoplasm.
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F.Zah a Cheikhna. (2025). Appendicula Mucocele Complica ed by Pseudomyxoma Pe i onei. MAR Oncology
and Hema ology. (2025) 5:09
Figu e 1
Figu e 2
Discussion
Appendiceal mucocele (AM) was i s desc ibed by Roki ansky in 1842. [1]
Appendiceal mucocele is a a e condi ion, de ined as a cys ic dila ion o he appendiceal lumen ollowing an
in aluminal accumula ion o anslucen , gela inous mucinous sec e ions, which can a ec ei he he en i e
o gan o a segmen , mos o en dis al. I is a pa hology disco e ed pos ope a i ely his ologically in nea ly 70%
o cases; Two con e ging heo ies ha e been pu o wa d o explain his disease: he obs uc i e heo y: AMs
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F.Zah a Cheikhna. (2025). Appendicula Mucocele Complica ed by Pseudomyxoma Pe i onei. MAR Oncology
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a e due o an accumula ion o mucus ups eam o a s enosis o he appendiceal lumen (cecal adenoca cinoma,
appendiceal umo , ube culosis). The neoplas ic heo y: he umo is esponsible o hype sec e ion o mucus
in o he appendiceal lumen. [2,3,4, 5]
Appendiceal mucoceles ha e a highly a ied and nonspeci ic clinical p esen a ion. They may be asymp oma ic
and disco e ed inciden ally du ing imaging (CT, ul asound, e c.), colonoscopy, o e en in aope a i ely o
pos ope a i ely h ough pa hological examina ion o esec ion specimens. [4, 6]
The mos equen ly encoun e ed symp oms a e igh iliac ossa pain (p esen in 27 o 64% o cases o
appendec omy and in 40 o 77% o cases o cys adenoca cinoma), an abdominal mass (9 o 46% o cases), an
AOI, and an enla ged umbilical o inguinal he nia. Mos o en, he symp oma ology is domina ed by igh iliac
ossa pain; mucoceles a e ound in 0.2 o 0.3% o appendec omies. [5, 6]
The mos se ious complica ion is pe i oneal up u e in 5-15% o cases: pseudomyxoma pe i onei [5, 6]
Pa aclinical in es iga ions can be o g ea alue o diagnosis [3, 4, 6]. Indeed, annula o a cua e calci ica ions
wi h a po celain appendix can some imes be p esen on a plain abdominal X- ay.
Imaging based on a combina ion o ul asound and CT is a c ucial examina ion o p eope a i e diagnosis. On
ul asound, MA p esen s as an ellip ical cys ic mass, well-limi ed by he wall which may be pa ially calci ied,
wi h echogenic and s a i ied con en , p oducing an “onion bulb” appea ance. The di e en ial diagnosis is
gene ally wi h acu e appendici is. A ans e se diame e g ea e han o equal o 15 mm is associa ed wi h a
sensi i i y o 83% and a speci ici y o 92% o he diagnosis o MA. In he case o simple acu e appendici is,
he ans e se diame e is g ea e han 6 mm [4].
On compu ed omog aphy (CT), uncomplica ed AD appea s as a cys ic mass o he IDF, well-dema ca ed by
luid densi y. A cua e pa ie al calci ica ions a e inconsis en , bu hei p esence suppo s he diagnosis o AD,
di e en ia ing i om an abscessed collec ion o he IDF [5]. The benign o malignan na u e o AD is
con i med by pa hological examina ion. On MRI, he con en s o he AD appea as T1-weigh ed hypoin ense
and T2-weigh ed hype in ense. Calcifica ions a e less well isualized han on CT.
Complica ions include acu e in es inal in ussuscep ion, o sion, o ex insic comp ession on a neighbo ing
o gan. Bu he mos ea ed complica ion is in ape i oneal up u e, spon aneous o du ing a su gical p ocedu e,
esponsible o pseudomyxoma pe i onei (PMP). PMP is de ined by dissemina ion in he abdominal ca i y o
he mucous con en s o he MA; i is he e o e a hick asci es like jelly. I was long hough ha o a ian o igin
was a cause o PMP due o he clea emale p edominance and he equen in ol emen o he o a ies, bu
mo e ecen s udies ha e con adic ed his hypo hesis based on immunohis ochemical and molecula biology
analyses demons a ing he appendicula o igin o almos all PMPs. O a ian in ol emen is he e o e
seconda y [6]. Abdominal CT is he examina ion o choice o diagnose PMP and speci y i s cha ac e is ics;
he ypical appea ance o PMP is "scalloping" on he su ace o solid o gans, pa icula ly he li e and spleen.
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F.Zah a Cheikhna. (2025). Appendicula Mucocele Complica ed by Pseudomyxoma Pe i onei. MAR Oncology
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This sign is explained by he ex insic comp ession o gela inous masses on solid o gans. On CT, his asci es
appea s hypodense (dense han se ous asci es), and some imes i can con ain ine sep a and cu ilinea
calci ica ions. [7,8,9].
T ea men consis s o appendec omy in he absence o his ological signs o malignancy and in he p esence o
e en ional MA. In he p esence o a cys adenoma, cecal esec ion is some imes necessa y o comple e
excision o he lesion. In he case o a malignan lesion, hemicolec omy is conside ed he ea men o choice
and is equi ed immedia ely in he case o ozen sec ion examina ion o seconda ily a e a de ini i e
his ological diagnosis, hence he impo ance o sys ema ically pe o ming an ana omopa hological
examina ion o any appendec omy specimen. The lapa oscopic app oach should be a oided gi en he isks o
ecu ence and in aope a i e dissemina ion. [10,11].
Conclusion
Mucus-sec e ing umo s o he appendix a e a e. They should be conside ed in cases o a ypical appendiceal
synd ome o a igh iliac ossa mass. Ea ly diagnosis o un up u ed AM by a adiologis imp o es he p ognosis
o he disease and hus a oids any o m o epea in e en ions.
Con lic s o In e es
The au ho s decla e no con lic s o in e es .
Au ho Con ibu ions
All au ho s con ibu ed o his wo k.
Re e ences
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