APPENDICEAL MUCOCELE - A RADIOLOGICAL CONUNDRUM
Marta Fedor, University Hospitals Plymouth NHS Trust
This study demonstrates an unexpected presentation of an appendiceal mucocele. We observe the patient’s pathway via multiple imaging modalities, MDT discussions and diagnostic tests before arriving at the correct diagnosis and treatment option.
A 54-year-old female was referred from her GP on a 2WW pathway with a suspected pelvic mass. The CA125 was normal. On reviewing symptoms, the patient reported pain and swelling in her upper right thigh.
A 180x90x80mm, hypoechoic, solid, abdominal mass was identified which caused medial displacement of the right iliac vessels and extended into the right groin. Transvaginal scan indicated an avascular mass of smooth outline and heterogenous echo pattern. The suspicion of a ilio-psoas muscle sarcoma was raised, and a CT scan for staging and MR for further evaluation was recommended.
CT showed a lobulated, retroperitoneal mass containing a couple of calcific foci, which followed the right ilio-psoas muscle to the level of insertion. MR had similar findings.
The sarcoma MDT discussed the possibility that the mass is cystic and could represent a myxoid tumour or bursa.
A gynae MDT flagged elevated CEA.
A CT-guided biopsy of the mass at the level of the groin came back as a gelatinous material and was confirmed by histopathology as benign.
At an HPB MDT, MRI review noted a subtly, thickened appendix inseparable from the mass, with a fleck of calcification and peripheral enhancement of the lesion.
Based on all the above findings an appendiceal mucocele was finally diagnosed.
The presence of the mucocele is likely to cause ongoing groin symptoms and the patient is also at risk of developing pseudomyxoma peritoni. The patient was therefore treated with Hyperthermic Intraperitoneal Chemotherapy at Basingstoke, a highly specialised procedure involving removal of the mass and peritoneum, followed by topical application of chemotherapy agents.