Low grade appendiceal mucinous neoplasm metastatic to the ovary: A case report and intraoperative assessment guide.

Autor:	Nguyen CGT; Oregon Health and Sciences University, Department of Obstetrics and Gynecology, 3182 SW Sam Jackson Park Road, Portland, OR 97239, United States of America. Electronic address: nguyendc@ohsu.edu., Hamid A; Oregon Health and Sciences University, Department of Pathology, 3182 SW Sam Jackson Park Road, Portland, OR 97239, United States of America., Chen A; Oregon Health and Sciences University, Department of Pathology, 3182 SW Sam Jackson Park Road, Portland, OR 97239, United States of America., Sood D; Oregon Health and Sciences University, Department of Surgery, Division of Surgical Oncology, 3182 SW Sam Jackson Park Road, Portland, OR 97239, United States of America., Jou J; Oregon Health and Sciences University, Department of Obstetrics and Gynecology, 3182 SW Sam Jackson Park Road, Portland, OR 97239, United States of America.
Jazyk:	angličtina
Zdroj:	International journal of surgery case reports [Int J Surg Case Rep] 2023 Aug; Vol. 109, pp. 108563. Date of Electronic Publication: 2023 Jul 26.
DOI:	10.1016/j.ijscr.2023.108563
Abstrakt:	Introduction: Incidence of low grade appendiceal mucinous neoplasm is increasing. Preoperatively, it may present similarly to primary ovarian malignancy. This case report describes a case of presumed ovarian malignancy with final pathologic diagnosis of low grade appendiceal mucinous neoplasm. We also propose several surgical strategies to approach this conundrum. Presentation of Case: A postmenopausal woman with abdominal pain was found to have a 30 cm abdominopelvic mass with elevated CA-125 and CEA presumably a primary ovarian malignancy. During surgical staging, intraoperative findings were notable for an appendiceal mass. Intraoperative surgical oncology consultation recommended appendectomy for diagnostic purposes. Following primary surgery and final pathologic diagnosis, she underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Discussion: Low grade appendiceal mucinous neoplasm should be within the differential diagnosis of gynecologic surgeons when presented with a patient with large volume ascites and biopsy of acellular mucin. Intraoperatively, an abnormal appearing appendix with normal appearing gynecologic structures should trigger suspicion for appendiceal rather than ovarian origin. Preoperative symptoms, imaging studies, tumor markers, and frozen section pathology may not be able to differentiate between appendiceal and epithelial ovarian malignancies. Conclusion: A recognition of mucinous material and abnormal appearing appendix should prompt the surgeon to consider performing an appendectomy to obtain primary pathologic diagnosis. A high level of suspicion could better optimize the patient for a joint case with the appropriate surgeons. Given the documented disguise of low grade appendiceal mucinous neoplasm as primary ovarian cancer and its increasing incidence, diagnosis and general understanding of treatment should be understood. Competing Interests: Declaration of competing interest The authors do not have any conflicts of interest. (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze:	MEDLINE
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