Optimal Surgical Approaches for Incidentally Discovered Ruptured Mucinous Appendiceal Neoplasms.

Mucinous neoplasms of the appendix, including low-grade appendiceal mucinous neoplasms (LAMNs), are rare but significant due to their potential for peritoneal dissemination. These tumors are often discovered incidentally during imaging or surgery for unrelated conditions. The presence of mucinous material in the peritoneum raises concern for pseudomyxoma peritonei, necessitating careful intraoperative and postoperative management. A 52-year-old male presented with testicular pain, leading to a diagnosis of seminoma. Staging computerized tomography (CT) revealed a dilated appendix with a surrounding fluid collection, suggestive of a ruptured mucocele. Exploratory laparotomy uncovered a large mucinous mass encasing the appendix, with mucinous deposits in the peritoneum. Final pathology confirmed an invasive mucinous adenocarcinoma, well-differentiated, arising in the background of a low-grade mucinous appendiceal neoplasm. The invasive component extended into the subserosa (pT3), while the LAMN component involved the serosa (pT4a). When mucin is found intraoperatively, surgeons should consider appendectomy with possible conversion to an open approach for thorough exploration. Emergency HIPEC is unnecessary; instead, it should be planned electively after complete cytoreduction. The prognosis depends on the extent of the disease and the success of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC).

Sudden Blindness as the Only Symptom Caused by a Small Sphenoid Sinus Mucocele in a Young Child.

Background: Sphenoid sinus mucocele (SSM) represents a relatively rare disease among pediatric population as compared to adults, with a 1% to 3% incidence of all paranasal sinus mucoceles. Since the initial symptoms varied often, SSM caused blindness was scarcely seen. Case Presentation: Here we described an unusual case of small, isolated SSM causing acute visual loss in a 9-year-old girl. The patient first consulted an ophthalmologist for her right blindness. A diagnosis of SSM was suspected indicated by an orbital MRI scan. Thereafter the patient was referred to our department and an endoscopic sphenoidotomy and optic nerve decompression was performed. Surprisingly, her vision was relieved immediately after surgery, followed by dramatic improvement during the postoperative 20-month follow-up period. Conclusion: To our knowledge, a better understanding of SSM in pediatrics is essential for clinicians, including neurologists, ophthalmologists, and otolaryngologists to make early diagnoses and correct treatment by MRI and CT scan. Prompt surgical intervention of endoscopic transnasal sphenoidectomy is a quite safe, effective, and minimally invasive method for patients.

Appendiceal Mucocele Presenting as a Cecal Bulge on Surveillance Colonoscopy.

Appendiceal mucoceles are rare tumors with diverse presentations and clinical implications. Generally, mucoceles are discovered on imaging or intraoperatively, but, rarely, can be found on colonoscopy. Appendectomy is the recommended next step in management, followed by subsequent treatment according to guidelines dictated by pathology findings. We present the case of a 52-year-old female undergoing routine colonoscopy screening who had incidental findings of a cecal bulge at the appendiceal orifice. The patient was entirely asymptomatic with an unremarkable medical history. Further workup suggested appendiceal mucocele and she was referred to surgery. After an appendectomy, pathology confirmed simple appendiceal mucocele. The patient made a full recovery and continued routine colonoscopy screening. This case demonstrates the variance in the clinical presentation of appendiceal mucocele and the possibility of discovery on routine screening colonoscopy.

Diffusion-Weighted MRI Over Standard MRI for Differential Diagnosis between Mucopyocele and Mucoceles.

OBJECTIVE(S): To determine the accuracy of conventional and diffusion-weighted (DWI) MRI for the differential diagnosis between mucopyocele and mucocele using surgical diagnosis as a reference. METHODS: This retrospective study included patients referred to our institution between March 2017 and February 2024 for paranasal sinus MRI to characterize an expansile non-enhanced sinus filling on CT. The T1 and T2 signal intensities were recorded, as well as the presence of restriction diffusion, of the penumbra sign, the double rim sign, and the presence of parietal micro-abscesses. Quantitative apparent diffusion coefficient values were also recorded. RESULTS: The study included 74 patients aged 18 to 88 years (mean age: 60.4 ± 17.7 years). Of these, 43 had a mucopyocele and 31 had a mucocele. The T1 high signal intensity was different amongst groups as an hypersignal was present in 35.5% of mucoceles and only 4.7% of mucopyoceles (p = 0.02). The T2 signal did not differ between the two groups (p = 0.59). The double rim sign and the presence of parietal micro-abscesses demonstrated 96.8% and 100% specificities, respectively, but were predominantly located in the maxillary sinus. The penumbra sign exhibited a sensitivity of 60.5% and a specificity of 67.7%. All mucopyoceles exhibited a diffusion restriction with an apparent diffusion coefficient of less than 0.78 × 10-3 mm2/s. CONCLUSION: DWI is the most useful MRI tool for the accurate differential diagnosis between mucopyocele and mucocele in non-enhanced sinus fillings. LEVEL OF EVIDENCE: III (case-control study) Laryngoscope, 2024.

Ultrasonographic diagnosis of a cecal mucocele in a cat.

A 3-year-old neutered male domestic medium-hair cat presented for sudden onset of vomiting and anorexia. Ultrasonographically, severe distension of the cecum by hyperechoic material associated with variable posterior attenuation was identified. The cecum was surgically excised. A retention cyst cecal mucocele complicated by mucosal ulceration and inflammation was diagnosed. A literature review of this well-described lesion in humans, once described in dogs but as yet undescribed in cats, is briefly presented.

Silent but Significant: A Case Report of Appendiceal Mucocele.

Appendiceal mucocele is a rare disease that can sometimes mimic acute appendicitis or be discovered accidentally during surgeries. The clinical presentation of appendiceal mucocele is observed as lumen distension due to mucin accumulation. This condition has both benign and malignant underlying etiologies, which can be confirmed by histopathological examination. Acute presentation of appendiceal mucocele is rare and mostly resembles the symptoms of acute appendicitis. The treatment of appendiceal mucocele is crucial due to the risk of pseudomyxoma peritonei caused by the spread of mucus, mucocele perforation, or the presence of malignancy such as mucinous carcinoma. Surgical resection, either appendicectomy, typhlectomy, or sometimes right hemicolectomy, is the recommended management approach. This is a case of a 74-year-old male with pain in the abdomen as the major presenting complaint. He had a palpable right iliac fossa mass. The diagnosis of appendiceal mucocele was made by contrast-enhanced computed tomography, which was later confirmed by histopathology. The patient underwent surgical resection and was doing well at the three-month follow-up.

Low-Grade Appendiceal Mucinous Neoplasm Adhered to the Posterior Cecum: A Case Report.

Low-grade appendiceal mucinous neoplasms (LAMN) constitute a rare subset of epithelial tumors and represent the second most common form of appendiceal cancer. LAMN typically presents as acute appendicitis, with definitive diagnosis often occurring incidentally during appendectomy surgery. While contrast-enhanced computed tomography (CECT) is the imaging of choice, misdiagnoses are common, highlighting the need for additional diagnostic modalities that are often underutilized. There is ongoing debate about treatment recommendations which typically involve a simple appendectomy, but controversy persists regarding the intraoperative necessity of a cecectomy, ileocecectomy, or formal right hemicolectomy. Here, we present a case featuring a 72-year-old African American female referred to our surgery clinic presenting solely with bloating and constipation rather than classical acute appendicitis, discrepancies between CT and MR imaging, and an unusual intraoperative finding of a posteriorly positioned mucocele adhered to the cecum, necessitating right hemicolectomy.

Sinonasal Pathologies Masquerading as Ophthalmic Disease.

This report presents 2 illustrative cases of sinonasal pathologies masquerading as ocular diseases: one of a 43-year-old male with a frontoethmoidal mucocele resulting from multiple prior surgeries for juvenile nasopharyngeal angiofibroma, and the other of a 72-year-old male with sinonasal diffuse large B-cell lymphoma, both presenting primarily with ocular symptoms including diplopia and visual disturbance. Through these cases, we highlight the importance of considering sinonasal pathologies in the differential diagnosis of patients presenting with ocular symptoms and discuss the diagnostic and therapeutic approaches that enabled effective disease management. Multidisciplinary collaboration involving otolaryngologists, ophthalmologists, radiologists, and oncologists was critical in achieving accurate diagnoses and successful management of these sinonasal diseases with ocular involvement.

Delayed Post-traumatic Frontal Mucocele Occurrence: A Case Report.

Mucoceles, benign cystic lesions with pseudo-stratified epithelial lining, typically arise due to chronic sinus ostia obstruction. Mucoceles can cause expansive erosion and, in severe cases, intracranial or intraorbital extension. Here, we present a case of delayed frontal mucocele formation following head trauma, emphasizing the importance of timely diagnosis and surgical intervention. Treatment involves careful mucocele removal and cranialization or obliteration of sinuses. Meticulous reconstruction using various materials ensures optimal cosmetic outcomes.

Nonsurgical Treatment of Oral Mucocele With Intralesional Corticosteroid Injections: A Case Report.

Oral mucoceles are common lesions resulting from alterations in minor salivary glands due to mucus accumulation. Deleterious habits such as lip biting, sucking, or trauma from oral appliances can result in the occurrence of mucoceles. Although conventional surgical removal has been the preferred treatment option, it is associated with drawbacks, including the risk of damaging nearby ducts and the formation of satellite lesions. A 13-year-old male patient visited the department with a sessile, nodular, and exophytic lesion on the lower lip and a persistent history of traumatic lip biting. The treatment involved the administration of intralesional injections of triamcinolone acetonide at the base of the lesion. A significant reduction was noted after the first injection, with the lesion showing complete resolution within two weeks. No recurrence was observed during the six-month follow-up period. This case highlights the effectiveness of intralesional corticosteroid injections as a non-surgical treatment option for mucoceles. This treatment modality, due to its non-invasive nature, can be particularly considered as the primary treatment choice in the pediatric population, facilitating effective behavior management.

Mucocele: A Case Report.

Mucoceles are the most common minor salivary gland disorder and represent the second most frequent benign soft tissue tumors of the oral cavity, following irritative fibroma. Various treatment modalities have been suggested for mucocele among which different types of lasers being the most recent and advanced. In the present case reports, diode laser was used for the excision of mucocele on the lower lip, and the advantages of it over the conventional scalpel method were minimal discomfort, bleeding, recurrence, and better compliance among patients.

Ileocolic Intussusception Due to Low-Grade Appendiceal Mucinous Neoplasm.

We report a rare case of low-grade appendiceal mucinous neoplasm (LAMN) causing ileocolic intussusception. The case underscores the importance of considering ileocolic intussusception in differential diagnoses for nonspecific gastrointestinal symptoms. Early diagnosis via contrast-enhanced CT and scrupulous surgical intervention are crucial for favorable outcomes.

Mucous extravasation phenomenon: A clinicopathologic evaluation of 68 cases.

Background: A mucocele is a benign, mucus-containing cystic lesion of the minor salivary gland also called a sialocele and ptyalocele. Two types are recognized as mucus extravasation cyst and the other is retention type. Objective: To evaluate the clinicopathologic features of oral mucocele cases. Materials and Methods: The archival blocks which were signed out as mucocele were taken for the study. The following parameters such as age, gender, history of trauma, site, histological features, and clinical presentations were taken into consideration. Results: 68 cases of mucous extravasation cysts were analysed, among which 58% were males and 42% were females. Age of the patients ranged from 4 to 70 years with an average of 20 years. The most common locations were the lower lip (87%), tongue (5%) and buccal mucosa (8%). Almost 53% of cases are seen on the left side of the oral cavity. Most of the cases presented a history of trauma. Histopathologically 23% of cases presented with muciphages in the lumen and connective tissue. Conclusion: The commonly encountered benign salivary lesion of the oral cavity is the mucus extravasation phenomenon of the mucocele. Various histopathological features were discussed in this study to avoid misdiagnosis of this common lesion in dental practice.

Pediatric isolated intraorbital mucocele: Case report and review of literature.

A 9-year-old child presented with a palpable swelling under the right lower lid for 3 years. On examination, the swelling was nontender, well circumscribed, and cystic on palpation. A computed tomography scan showed a well circumscribed, hyperdense lesion in the inferior orbit with no anatomic connection with the paranasal sinuses. Transcutaneous orbitotomy was performed, and the lesion was excised in toto. Histopathological examination was suggestive of a mucocele.

Risk stratification of surveillance for low-grade appendiceal mucinous neoplasms.

BACKGROUND: Low-grade appendiceal mucinous neoplasms (LAMNs) can progress to pseudomyxoma peritonei (PMP). The incidence and risk factors for recurrence are unclear, and there is a lack of consensus on the need and duration of surveillance imaging. METHODS: Patients at the Mayo Clinic in Rochester, Minnesota, with a histologic diagnosis of LAMNs confined to the appendix and limited involvement of the right lower quadrant from 1992 to 2023 were included. Associations between recurrence and risk factors were assessed using Kaplan-Meier curves and Cox proportional hazards regression. RESULTS: A total of 125 patients with LAMNs underwent abdominal imaging surveillance for a median of 51.2 months (IQR, 26-92). Of note, 5 patients (4%) recurred, all of which were PMP. Overall, the 5- and 10-year cumulative recurrence incidence rates were 3% and 6%, respectively. The median time to recurrence was 24 months (IQR, 23-87). Only LAMNs limited to the right lower quadrant and LAMN tumor size of <2 cm were associated with recurrence (P < .05). The 5- and 10-year cumulative recurrence risks were 12% and 30%, respectively, for the 21 patients with either risk factor. Only 1% of patients without these 2 risk factors developed a recurrence at 10 years. CONCLUSION: The overall recurrence risk of LAMN after resection is low. Appendectomy is sufficient for LAMN. Select patients with acellular mucin confined to the right lower quadrant and a tumor size of <2 cm are at higher risk of recurrence. Thus, long-term surveillance is recommended for high-risk individuals. Conversely, LAMNs without risk factors can be safely observed expectantly.

Suspected large gall bladder mucocele extending from right hypochondrium up to right iliac region turned out to be gall bladder perforation in a patient with schizophrenia: A rare case report and literature review.

Key Clinical Message: This is a challenging case where the surgeon has initially thought it is a gallbladder (GB) mucocele. The surprise finding of a mucocele during an emergency laparotomy highlights the deceptive nature of certain clinical manifestations within the hepatobiliary domain. The intraoperative discovery of a 1×1 cm GB hole on the right lateral wall of the GB fundus revealed an unexpected and significant deviation from the hypothesized pathogenesis. Abstract: This case report provides a complicated diagnosis scenario for a hepatobiliary illness aggravated by schizophrenia. Arriving with frequent nausea and vomiting, a 70-year-old female patient with schizophrenia missed typical symptoms of gallbladder (GB) disease, including fever and stomach discomfort. This odd look and corroborative imaging showing a cystic lesion in the right belly led to a diagnostic suspicion of a sizable GB mucocele. But a surprising result from an emergency laparotomy revealed a significant GB perforation, different from the previous diagnosis. This case highlights the difficulties in identifying atypical GB diseases, particularly in individuals with mental comorbidities that could conceal or alter the expression of physical symptoms. To confirm or rule out differential diagnosis and allow early and tailored treatments, it emphasizes the need for thorough diagnostic tests, including a complete clinical history, physical examinations, laboratory analysis, imaging modalities, and surgical procedures. This case emphasizes the importance of careful examination in complex medical contexts by stressing the requirement of thorough assessments and comprehensive diagnostic frameworks in navigating challenging clinical situations.

Multicompartmental Paranasal Sinus Osteoma Complicated by Frontal Bone Hyperostosis, Intracranial Mucocele, and Inflammatory Pseudotumor.

Parasinusal osteoma complicated by intracranial and orbit extension, cranial vault hyperostosis, intracranial mucocele, and inflammatory pseudotumor is exceptional. A 68-year-old man presented with a long history of progressive proptosis and recurrent episodes of keratoconjunctivitis in the left eye, with restriction in upward gaze. Contrast-enhanced magnetic resonance imaging revealed a frontal sinus lesion extending to the left anterior fossa and orbit, featuring an intracranial cystic component and heterogeneous contrast enhancement. Head computed tomography confirmed the double calcific-cystic nature of the lesion. A left supraorbital-pterional approach allowed complete resection of mucocele and drilling of intracranial and orbital osteoma, including the intrasinusal component. The frontal sinus was cranialized, and a flap of pericranium, reinforced by Gelfoam sponge, was reflected on the anterior cranial base/orbital roof. The postoperative course was uneventful; magnetic resonance imaging depicted resolution of proptosis. Histological examination favored parasinusal osteoma associated with intracranial mucocele, frontal bone hyperostosis, and inflammatory pseudotumor.

Macrocystic secretory carcinoma arising from the buccal minor salivary gland clinically mimicking a mucocele: A case report.

Secretory carcinoma (SC) is an uncommon salivary gland tumor that has been recently conceptualized. The present report describes a case of SC that was diagnosed as a mucocele on preoperative examination. A 46-year-old man presented to the Department of Oral and Maxillofacial Surgery at Saiseikai Senri Hospital (Suita-shi, Japan) with a main complaint of swelling of the right buccal mucosa. A mobile, elastic, hard mass was found beneath the right normal-appearing buccal mucosa. T2-weighted magnetic resonance imaging revealed a well-defined, internally homogeneous high-signal area with a maximum diameter of 18 mm. Based on the clinical diagnosis of mucocele, the buccal lesion was excised. Histopathological, immunohistochemical and fluorescence in situ hybridization analyses revealed the cystic lesion to be a macrocystic SC of a minor salivary gland. SC may have a mucocele-like appearance on magnetic resonance imaging. Even if a non-neoplastic lesion is suspected, the possibility of a malignant lesion such as SC must be considered for salivary gland disease.

Frontal Sinus Mucopyocele Presenting as a Painful Subcutaneous Forehead Mass in a Patient with Chronic Sinusitis.

Mucoceles of the paranasal sinuses are benign, expansile lesions that develop secondary to sinus ostia obstruction. Presenting signs and symptoms vary widely but frequently include frontal headache and swelling, as well as visual changes and globe displacement depending on orbital involvement in the case of frontal sinus mucoceles. Given the potential for orbital or intracranial involvement, urgent imaging with computed tomography (CT) is important for patients with symptoms concerning for a frontal sinus mucocele. Definitive treatment is surgical. In this article, we report a case of a 50-year-old male who presented to a primary care clinic with a painful forehead mass, found to have a frontal sinus mucocele with erosion through the frontal bone that was eventually treated surgically. We also summarize presenting signs and symptoms of frontal mucoceles reported in the literature as these are important for clinicians to be familiar with, considering the potential emergent complications.