Endoscopy 2009; 41: E17-E18
DOI: 10.1055/s-0028-1103461
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Giant appendiceal mucocele mimicking gastrointestinal stromal tumor of the cecum

T.  Akaraviputh1 , A.  Trakarnsanga1 , S.  Pongprasobchai2 , W.  Boonnuch1
  • 1Siriraj GI Endoscopy Center, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • 2Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Further Information

T. AkaraviputhMD 

Faculty of Medicine Siriraj Hospital – Surgery

Bangkoknoi Road
Bangkoknoi
Bangkok 10700
Thailand

Fax: +66-2-4121370

Email: sitak@mahidol.ac.th

Publication History

Publication Date:
13 February 2009 (online)

Table of Contents

A 54-year-old man presented with chronic abdominal pain and chronic diarrhea. He underwent a routine endoscopic examination. Colonoscopy demonstrated a huge submucosal tumor measuring 4.2 × 4.0 × 5.0 cm at the cecum ([Fig. 1]). Endoscopic ultrasonography (EUS) using a miniprobe revealed a 4-cm well-circumscribed, hypoechoic, homogeneous lesion arising from the fourth sonographic layer ([Fig. 2]), and the lesion was diagnosed as a large gastrointestinal stromal tumor (GIST) of the cecum. CT scan of the lower abdomen showed a cystic lesion compressing the cecum ([Fig. 3]). The patient underwent an exploratory laparotomy and the intraoperative finding was of a giant appendiceal mass ([Fig. 4]). Right hemicolectomy was performed and the pathological analysis confirmed a mucinous tumor of borderline malignancy with free surgical margins. The patient recovered well without any postoperative complications.

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Fig. 1 Colonoscopy revealed large submucosal mass covered with normal colonic mucosa.

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Fig. 2 Endoscopic ultrasonography demonstrated a 4-cm well-circumscribed, hypoechoic, homogeneous lesion compressing the cecal wall.

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Fig. 3 CT scan of the lower abdomen demonstrated a round, low-density, thin-walled, encapsulated mass at the cecum (arrow), about 5 cm in diameter.

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Fig. 4 Intraoperative photograph showing a large appendiceal mass.

Patients with appendiceal mucocele usually manifest a variety of symptoms, but they can also be asymptomatic. Right lower quadrant pain is the most common symptom, occurring in 64 % of patients [1]. Accurate preoperative diagnosis is rare, but it is possible using appropriate investigations. Endoscopically, this lesion appears as a submucosal mound with normal mucosa in the cecum. The classical appearance is of a “volcano sign” with the appendiceal orifice visible at the center of the mound [2] [3]. The EUS finding was first described by using an ultrasonic probe to rule out colonic submucosal tumors such as carcinoids or lipoma prior to surgery [4] [5]. Right hemicolectomy is a standard treatment and gives an excellent prognosis for these lesions. This case exemplifies the challenge of detection and the management of an appendiceal mucocele presenting as a large GIST of the cecum.

Endoscopy_UCTN_Code_CCL_1AD_2AC

Endoscopy_UCTN_Code_CCL_1AD_2AJ

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References

  • 1 Aho A, Heinonen R, Lauren P. Benign and malignant mucocele of the appendix: histologic types and prognosis.  Acta Chir Scand. 1993;  139 392-400
  • 2 Hamilton D L, Stormont J M. The volcano sign of appendiceal mucocele.  Gastrointest Endosc. 1989;  35 453-456
  • 3 Raijman I, Leong S, Hassaram S, Marcon N E. Appendiceal mucocele: endoscopic appearance.  Endoscopy. 1994;  26 326-328
  • 4 Mizuma N, Kabemura T, Akahoshi K. et al . Endosonographic features of mucocele of the appendix: report of a case.  Gastrointest Endosc. 1997;  46 549-552
  • 5 Akahoshi K, Mizukami Y, Yoshinaga S, Oya M, Nagaie T. Ultrasound catheter probe detection of appendiceal mucocele.  Endoscopy. 2002;  34 937

T. AkaraviputhMD 

Faculty of Medicine Siriraj Hospital – Surgery

Bangkoknoi Road
Bangkoknoi
Bangkok 10700
Thailand

Fax: +66-2-4121370

Email: sitak@mahidol.ac.th

#

References

  • 1 Aho A, Heinonen R, Lauren P. Benign and malignant mucocele of the appendix: histologic types and prognosis.  Acta Chir Scand. 1993;  139 392-400
  • 2 Hamilton D L, Stormont J M. The volcano sign of appendiceal mucocele.  Gastrointest Endosc. 1989;  35 453-456
  • 3 Raijman I, Leong S, Hassaram S, Marcon N E. Appendiceal mucocele: endoscopic appearance.  Endoscopy. 1994;  26 326-328
  • 4 Mizuma N, Kabemura T, Akahoshi K. et al . Endosonographic features of mucocele of the appendix: report of a case.  Gastrointest Endosc. 1997;  46 549-552
  • 5 Akahoshi K, Mizukami Y, Yoshinaga S, Oya M, Nagaie T. Ultrasound catheter probe detection of appendiceal mucocele.  Endoscopy. 2002;  34 937

T. AkaraviputhMD 

Faculty of Medicine Siriraj Hospital – Surgery

Bangkoknoi Road
Bangkoknoi
Bangkok 10700
Thailand

Fax: +66-2-4121370

Email: sitak@mahidol.ac.th

Zoom Image

Fig. 1 Colonoscopy revealed large submucosal mass covered with normal colonic mucosa.

Zoom Image

Fig. 2 Endoscopic ultrasonography demonstrated a 4-cm well-circumscribed, hypoechoic, homogeneous lesion compressing the cecal wall.

Zoom Image

Fig. 3 CT scan of the lower abdomen demonstrated a round, low-density, thin-walled, encapsulated mass at the cecum (arrow), about 5 cm in diameter.

Zoom Image

Fig. 4 Intraoperative photograph showing a large appendiceal mass.