Acellular Appendix Vermiform Mucinous Neoplasm: A Rare Clinical Entity

Abstract

Neoplasms of the appendix are infrequent and either asymptomatic or present with nonspecific symptoms, rendering their diagnosis extremely difficult. In female patients, these tumors are frequently misdiagnosed as gynecologic disorders, particularly when patients complain of right iliac fossa pain. Because of their rarity and absence of distinctive clinical characteristics, appendiceal tumors are not considered in the differential diagnosis by gynecologists during the evaluation of patients with pelvic masses.  This case report describes a 56-year-old female patient with a mass in the right lower pelvis that was initially presumed to be of ovarian nature according to preoperative imaging. Upon exploratory laparotomy, however, the uterus and adnexa were found to be macroscopically normal. The mass was subsequently discovered to be of appendiceal origin growing into the right adnexa's anatomical territory and closely associated with the atrophic right ovary. Appendix was resected intact and histopathology confirmed a tumor made up of acellular mucin. This case emphasizes the difficulty in preoperative diagnosis of appendiceal mucoceles, which are typically incidental radiologic findings and are typically diagnosed only at the time of surgery. The dilemma in diagnosis mandates that gynecologists and surgeons must be more vigilant to consider appendiceal pathology in the context of unexplained right lower quadrant or pelvic masses.