CT manifestations and pathological features of low-grade appendiceal mucinous neoplasms_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Yiming ^1,2 ,  YIN Longlin ^1,2 , YIN Peiyuan ³ , WU Ying ² , CAO Xinyue ² , SUN Ju ²

1. Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. Department of Radiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, P. R. China;
3. Clinical Medical College, Chengdu Medical College, Chengdu 610500, P. R. China;

Corresponding author：

YIN Longlin, Email: yinlonglin@163.com

Keywords：

low-grade appendiceal mucinous neoplasm; CT examination; pathological feature; diagnosis; differential diagnosis

DOI：

10.7507/1007-9424.202106112

Video：

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Objective To conclude the CT manifestations and pathological features of low-grade appendiceal mucinous neoplasms. Methods We reviewed the clinical and CT findings of 24 patients with low-grade appendiceal mucinous neoplasms, who were confirmed by pathology within 1 month after CT examination in SichuanProvincial People’s Hospital from January 2018 to December 2020. The distribution, morphological characteristics, cyst wall and internal characteristics, CT value and enhancement characteristics of tumors were be detected in detail. Results ① Distribution: of the 24 patients, 22 patients located in the appendix area of the right lower quadrant, 2 patients located in the right middle abdomen, and 2 patients located in the pelvic cavity. ② Morphological characteristics: of the 24 patients, 15 patients manifested as tubular, 3 patients manifested as ellipsoidal, 5 patients manifested as saccular, and 1 patient manifested as irregular shape. The average length of tumors was about 6.4 cm (4.2–12.0 cm), and the average short diameter of tumors was about 2.2 cm (0.8–5.0 cm). The short diameter of 17 patients were more than 1.5 cm. ③ The cyst wall and internal characteristics: all the 24 patients demonstrated as cystic mass, 6 patients had evenly thin and smooth cyst wall, and other 18 patients had uneven cyst wall. Of all the patients,8 patients had arc-shaped, punctate or eggshell-like calcification. ④ The CT value and enhancement characteristics: 24 patients examined by plain CT scan, 22 patients showed uniform low density (the CT value were 7–25 HU), 2 patients contained some slightly high density, 16 patients examined by enhanced CT, the cyst wall, separation, or mural nodules of 8 patients were slightly or moderately enhanced. ⑤ Pathological results: of all the gross specimens, 15 patients showed tubular dilation, 9 patients showed partial or complete dilation as cystic mass. All the 24 patients had gelatinous or mucinous contents. Microscopically, all the patients showed low-grade mucinous epithelial hyperplasia, submucosa, and mucosal muscle atrophy, accompanied by fibrosis or calcification. Conclusion Low-grade appendiceal mucinous neoplasms show some specific CT manifestations, recognize these features can improve the accuracy of preoperative CT.

Citation： LIU Yiming, YIN Longlin, YIN Peiyuan, WU Ying, CAO Xinyue, SUN Ju. CT manifestations and pathological features of low-grade appendiceal mucinous neoplasms. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(11): 1499-1503. doi: 10.7507/1007-9424.202106112 Copy

1.	Carr NJ, Cecil TD, Mohamed F, et al. A consensus for classification and pathologic reporting of pseudomyxoma peritonei and associated appendiceal neoplasia: The results of the peritoneal surface oncology group international (PSOGI) modified delphi process. Am J Surg Pathol, 2016, 40(1): 14-26.
2.	Amin MB, Edge SB, Greene FL, et al. AJCC cancer staging manual, eighth edition. New York: Springer International Publishing, 2017.
3.	Smeenk RM, van Velthuysen ML, Verwaal VJ, et al. Appendiceal neoplasms and pseudomyxoma peritonei: a population based study. Eur J Surg Oncol, 2008, 34(2): 196-201.
4.	Charfi S, Sellami A, Affes A, et al. Histopathological findings in appendectomy specimens: a study of 24,697 cases. Int J Colorectal Dis, 2014, 29(8): 1009-1012.
5.	韩松, 李雪伟, 赵鹏翔, 等. 阑尾低级别黏液性肿瘤临床诊治的研究进展. 中华解剖与临床杂志, 2019, 24(5): 512-515.
6.	Brunner M, Lapins P, Langheinrich M, et al. Risk factors for appendiceal neoplasm and malignancy among patients with acute appendicitis. Int J Colorectal Dis, 2020, 35(1): 157-163.
7.	Son J, Park YJ, Lee SR, et al. Increased risk of neoplasms in adult patients undergoing interval appendectomy. Ann Coloproctol, 2020, 36(5): 311-315.
8.	Karande GY, Chua WM, Yiin RSZ, et al. Spectrum of computed tomography manifestations of appendiceal neoplasms: acute appendicitis and beyond. Singapore Med J, 2019, 60(4): 173-182.
9.	马晓龙, 王锡山. 阑尾黏液性肿瘤的诊断和治疗进展. 中国肿瘤外科杂志, 2020, 12(6): 600-604.
10.	温琪, 刘序友, 何雅军, 等. 阑尾黏液性囊腺瘤引起的成人肠套叠1例报道. 胃肠病学和肝病学杂志, 2021, 30(3): 345-346.
11.	曹雪源, 何亮, 金美善, 等. 阑尾黏液性囊腺瘤并发肠套叠一例. 中华普外科手术学杂志 (电子版), 2012, 6(1): 104-105.
12.	马原, 王刚, 李泮泉, 等. 阑尾黏液性囊腺瘤并发成人回盲肠套叠一例. 中华消化外科杂志, 2014, 13(10): 817-818.
13.	Ashrafi M, Joshi V, Zammit M, et al. Intussusception of the appendix secondary to mucinous cystadenoma: A rare cause of abdominal pain. Int J Surg Case Rep, 2011, 2(2): 26-27.
14.	Teke Z, Eray IC, Aydin E, et al. Appendiceal intussusception caused by mucinous cystadenoma presenting as acute appendicitis. Ann R Coll Surg Engl, 2020, 102(4): e1-e4.
15.	Musa DH, Mohammed AA. Intussusception of the vermiform appendix caused by mucinous tumor of the appendix: Case report. Int J Surg Case Rep, 2020, 67: 51-53.
16.	Laalim SA, Toughai I, Benjelloun el B, et al. Appendiceal intussusception to the cecum caused by mucocele of the appendix: Laparoscopic approach. Int J Surg Case Rep, 2012, 3(9): 445-447.
17.	Zhang W, Tan C, Xu M, et al. Appendiceal mucinous neoplasm mimics ovarian tumors: Challenges for preoperative and intraoperative diagnosis and clinical implication. Eur J Surg Oncol, 2019, 45(11): 2120-2125.
18.	中国医师协会结直肠肿瘤专业委员会. 中国阑尾肿瘤多学科综合治疗专家共识 (2021版). 中华结直肠疾病电子杂志, 2021, 10(3): 225-231.
19.	Marotta B, Chaudhry S, McNaught A, et al. Predicting underlying neoplasms in appendiceal mucoceles at CT: Focal versus diffuse luminal dilatation. AJR Am J Roentgenol, 2019, 213(2): 343-348.
20.	王林茹, 叶菊香, 石雪迎. 阑尾黏液性肿瘤的病理诊断及发生机制研究进展. 临床与实验病理学杂志, 2020, 36(2): 178-181.
21.	Shaib WL, Assi R, Shamseddine A, et al. Appendiceal mucinous neoplasms: diagnosis and management. Oncologist, 2017, 22(9): 1107-1116.
22.	欧阳林, 刘士远, 肖湘生. 肠周脂肪CT征象在诊断肠疾病中的临床价值. 中国医学影像技术, 2009, 25(3): 462-464.
23.	Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res, 1996, 82: 359-374.
24.	Legué LM, Creemers GJ, de Hingh IHJT, et al. Review: Pathology and its clinical relevance of mucinous appendiceal neoplasms and pseudomyxoma peritonei. Clin Colorectal Cancer, 2019, 18(1): 1-7.
25.	Bartlett DJ, Thacker PG Jr, Grotz TE, et al. Mucinous appendiceal neoplasms: classification, imaging, and HIPEC. Abdom Radiol (NY), 2019, 44(5): 1686-1702.
26.	Van Hooser A, Williams TR, Myers DT. Mucinous appendiceal neoplasms: pathologic classification, clinical implications, imaging spectrum and mimics. Abdom Radiol (NY), 2018, 43(11): 2913-2922.
27.	韩太林, 赵慧萍, 曾蒙苏, 等. 阑尾黏液性肿瘤的CT和MRI诊断及良恶性鉴别. 放射学实践, 2014, 29(7): 808-813.

1. Carr NJ, Cecil TD, Mohamed F, et al. A consensus for classification and pathologic reporting of pseudomyxoma peritonei and associated appendiceal neoplasia: The results of the peritoneal surface oncology group international (PSOGI) modified delphi process. Am J Surg Pathol, 2016, 40(1): 14-26.
2. Amin MB, Edge SB, Greene FL, et al. AJCC cancer staging manual, eighth edition. New York: Springer International Publishing, 2017.
3. Smeenk RM, van Velthuysen ML, Verwaal VJ, et al. Appendiceal neoplasms and pseudomyxoma peritonei: a population based study. Eur J Surg Oncol, 2008, 34(2): 196-201.
4. Charfi S, Sellami A, Affes A, et al. Histopathological findings in appendectomy specimens: a study of 24,697 cases. Int J Colorectal Dis, 2014, 29(8): 1009-1012.
5. 韩松, 李雪伟, 赵鹏翔, 等. 阑尾低级别黏液性肿瘤临床诊治的研究进展. 中华解剖与临床杂志, 2019, 24(5): 512-515.
6. Brunner M, Lapins P, Langheinrich M, et al. Risk factors for appendiceal neoplasm and malignancy among patients with acute appendicitis. Int J Colorectal Dis, 2020, 35(1): 157-163.
7. Son J, Park YJ, Lee SR, et al. Increased risk of neoplasms in adult patients undergoing interval appendectomy. Ann Coloproctol, 2020, 36(5): 311-315.
8. Karande GY, Chua WM, Yiin RSZ, et al. Spectrum of computed tomography manifestations of appendiceal neoplasms: acute appendicitis and beyond. Singapore Med J, 2019, 60(4): 173-182.
9. 马晓龙, 王锡山. 阑尾黏液性肿瘤的诊断和治疗进展. 中国肿瘤外科杂志, 2020, 12(6): 600-604.
10. 温琪, 刘序友, 何雅军, 等. 阑尾黏液性囊腺瘤引起的成人肠套叠1例报道. 胃肠病学和肝病学杂志, 2021, 30(3): 345-346.
11. 曹雪源, 何亮, 金美善, 等. 阑尾黏液性囊腺瘤并发肠套叠一例. 中华普外科手术学杂志 (电子版), 2012, 6(1): 104-105.
12. 马原, 王刚, 李泮泉, 等. 阑尾黏液性囊腺瘤并发成人回盲肠套叠一例. 中华消化外科杂志, 2014, 13(10): 817-818.
13. Ashrafi M, Joshi V, Zammit M, et al. Intussusception of the appendix secondary to mucinous cystadenoma: A rare cause of abdominal pain. Int J Surg Case Rep, 2011, 2(2): 26-27.
14. Teke Z, Eray IC, Aydin E, et al. Appendiceal intussusception caused by mucinous cystadenoma presenting as acute appendicitis. Ann R Coll Surg Engl, 2020, 102(4): e1-e4.
15. Musa DH, Mohammed AA. Intussusception of the vermiform appendix caused by mucinous tumor of the appendix: Case report. Int J Surg Case Rep, 2020, 67: 51-53.
16. Laalim SA, Toughai I, Benjelloun el B, et al. Appendiceal intussusception to the cecum caused by mucocele of the appendix: Laparoscopic approach. Int J Surg Case Rep, 2012, 3(9): 445-447.
17. Zhang W, Tan C, Xu M, et al. Appendiceal mucinous neoplasm mimics ovarian tumors: Challenges for preoperative and intraoperative diagnosis and clinical implication. Eur J Surg Oncol, 2019, 45(11): 2120-2125.
18. 中国医师协会结直肠肿瘤专业委员会. 中国阑尾肿瘤多学科综合治疗专家共识 (2021版). 中华结直肠疾病电子杂志, 2021, 10(3): 225-231.
19. Marotta B, Chaudhry S, McNaught A, et al. Predicting underlying neoplasms in appendiceal mucoceles at CT: Focal versus diffuse luminal dilatation. AJR Am J Roentgenol, 2019, 213(2): 343-348.
20. 王林茹, 叶菊香, 石雪迎. 阑尾黏液性肿瘤的病理诊断及发生机制研究进展. 临床与实验病理学杂志, 2020, 36(2): 178-181.
21. Shaib WL, Assi R, Shamseddine A, et al. Appendiceal mucinous neoplasms: diagnosis and management. Oncologist, 2017, 22(9): 1107-1116.
22. 欧阳林, 刘士远, 肖湘生. 肠周脂肪CT征象在诊断肠疾病中的临床价值. 中国医学影像技术, 2009, 25(3): 462-464.
23. Jacquet P, Sugarbaker PH. Clinical research methodologies in diagnosis and staging of patients with peritoneal carcinomatosis. Cancer Treat Res, 1996, 82: 359-374.
24. Legué LM, Creemers GJ, de Hingh IHJT, et al. Review: Pathology and its clinical relevance of mucinous appendiceal neoplasms and pseudomyxoma peritonei. Clin Colorectal Cancer, 2019, 18(1): 1-7.
25. Bartlett DJ, Thacker PG Jr, Grotz TE, et al. Mucinous appendiceal neoplasms: classification, imaging, and HIPEC. Abdom Radiol (NY), 2019, 44(5): 1686-1702.
26. Van Hooser A, Williams TR, Myers DT. Mucinous appendiceal neoplasms: pathologic classification, clinical implications, imaging spectrum and mimics. Abdom Radiol (NY), 2018, 43(11): 2913-2922.
27. 韩太林, 赵慧萍, 曾蒙苏, 等. 阑尾黏液性肿瘤的CT和MRI诊断及良恶性鉴别. 放射学实践, 2014, 29(7): 808-813.

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CT manifestations and pathological features of low-grade appendiceal mucinous neoplasms

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