Hernández-Ramírez DA, Portela-Rubio G, Suárez-Moreno RM, Salazar-Lozano CR, Madrazo-Navarro M

Language: Spanish
References: 17
Page: 357-360
PDF size: 302.43 Kb.

ABSTRACT

Background: Patients with ulcerative colitis (UC) or Crohn´s disease (CD) have an increased risk for the development of colorectal dysplasia and carcinoma. Although appendiceal inflammation occurs histologically in 40-86% of colectomy specimens from patients with inflammatory bowel disease (IBD), appendiceal neoplasms have been reported only infrequently, and the notion of a direct association between IBD and appendiceal neoplasia is speculative.
Clinical case: A 54-year-old male patient developed abdominal pain and bloody diarrhea 3 years prior. Colonoscopy and biopsy established the diagnosis of UC (proctosigmoiditis). Disease activity was moderate at the beginning and the patient initially received medical treatment with mesalazine and prednisone. He was admitted to our clinic for right lower abdominal pain. Physical examination revealed tenderness on palpation at this site. Laboratory tests were normal (including serum carcinoembryonic antigen and CA 19-9). Colonoscopy showed intrinsic compression of the cecum. The patient underwent partial cecum resection and extirpation of the mucocele. He presented postsurgical ileus resolved with medical treatment. Final histological report revealed cystadenoma of the appendix. At the 20-month follow-up, the patient was in satisfactory condition.
Conclusions: We present the eighth patient, to our knowledge, with a primary cystadenoma of the appendix and UC. Special attention should be paid to patients with extraordinary symptoms during follow-up, even in UC patients.

REFERENCES

1. Ruiz-Tovar J, Teruel DG, Castineiras VM, Dehesa AS, Quindos PL, Molina EM. Mucocele of the appendix. World J Surg 2007;31:542- 548.

2. Misdraji J, Yantiss RK, Graeme-Cook FM, Balis UJ, Young RH. Appendiceal mucinous neoplasms: a clinicopathological analysis of 107 cases. Am J Surg Pathol 2003;27:1089-1103.

3. Stocchi L, Wolff BG, Larson DR, Harrington JR. Surgical treatment of appendiceal mucocele. Arch Surg 2003;138:585-590.

4. Orta L, Trindade A, Luo J, Harpaz N. Appendiceal mucinous cystadenoma is a neoplastic complication of IBD: case-control study of primary appendiceal neoplasms. Inflamm Bowel Dis 2009;15:415-421.

5. Deraco M, Baratti D, Inglese MG, Allaria B, Andreola S, Gavazzi C. Peritonectomy and intraperitoneal hyperthermic perfusion: a strategy that has confirmed its efficacy in patients with pseudomyxoma peritonei. Ann Surg Oncol 2004;11:393-398.

6. Soweid AM, Clarkston WK, Andrus CH, Janney CG. Diagnosis and management of appendiceal mucoceles. Dig Dis 1998;16:183-186.

7. Dhage-Ivatury S, Sugarbaker PH. Update on the surgical approach to mucocele of the appendix. J Am Coll Surg 2006;202:680-684.

8. Nelson SF, Sarr MG. Mucinous cystadenocarcinoma of the appendix the controversy persists: a review. Hepatogastroenterology 2003;50:432- 437.

9. Nitecki SS, Wolff BG, Schlinkert R, Sarr MG. The natural history of surgically treated primary adenocarcinoma of the appendix. Ann Surg 1994;219:51-57.

10. Matsumoto T, Nakamura S, Shimizu M, Iida M. Significance of appendiceal involvement in patients with ulcerative colitis. Gastrointest Endosc 2002;55:180-185.

11. Jo Y, Matsumoto T, Yada S, Nakamura S, Yao T, Hotokezaka M, et al. Histological and immunological features of appendix in patients with ulcerative colitis. Dig Dis Sci 2003;48:99-108.

12. Kashani M, Levy M. Primary adenocarcinoma of the appendix with bilateral Krukenberg ovarian tumors. J Surg Oncol 1983;22:101-105.

13. Odze RD, Medline P, Cohen Z. Adenocarcinoma arising in an appendix involved with chronic ulcerative colitis. Am J Gastroenterol 1994;89:1905-1907.

14. Zannoni U, Masci C, Bazzocchi R, Gandolfo F, Pezzi A, Alampi G, et al. Cancer of the appendix in long-standing ulcerative colitis: a case report. Tumori 1997;83:958-959.

15. Villanueva-Sáenz E, Pérez-Aguirre J, Belmonte MC, Martínez PH, Márquez RM, Carranza RJ. Appendix adenocarcinoma associated with ulcerative colitis: a case report and literature review. Tech Coloproctol 2006;10:54-56.

16. Lyda MH, Noffsinger A, Belli J, Fischer J, Fenoglio-Preiser CM. Multifocal neoplasia involving the colon and appendix in ulcerative colitis: pathological and molecular features. Gastroenterology 1998;115:1566- 1573.

17. Lakatos PL, Gyori G, Halasz J, Fuszek P, Papp J, Jaray B, et al. Mucocele of the appendix: an unusual cause of lower abdominal pain in a patient with ulcerative colitis. A case report and review of literature. World J Gastroenterol 2005;11:457-459.