Low-Grade Appendiceal Mucinous Neoplasm Diagnosed during Exploratory Laparoscopy for a Presumed Pelvic Mass

Study objective: To demonstrate a surgical video of laparoscopic management of an appendiceal mass preoperatively misdiagnosed as a pelvic mass. This study was deemed to be exempt from the Yale New Haven Hospital Institutional Review Board.

Design: A step-by-step explanation of the diagnosis and laparoscopic management of an appendiceal mass using an instructive video (Canadian Task Force classification III).

Setting: A teaching hospital in New Haven, Connecticut.

Patient: A 53-year-old multiparous perimenopausal woman.

Intervention: Laparoscopic management of an appendiceal mass.

Measurements and main results: A 53-year-old multiparous perimenopausal patient underwent workup for pelvic pain. Pelvic imaging revealed a 72 × 35 × 28 mm cystic structure abutting the uterine fundus with thin partial septum but no mural nodules or concomitant pelvic lymphadenopathy. Exploratory laparoscopy showed unremarkable pelvic anatomy. After the entire small bowel was run, the cystic structure abutting the uterine fundus was deemed to be an appendiceal mass. The observed convergence of the 3 taeniae coli at the junction of the cecum with the cystic mass confirmed the diagnosis. For laparoscopic resection the umbilical fold port site was extended to 12 mm to introduce the Endo GIA stapler (Medtronic, Minneapolis, MN). The appendiceal mass was stabilized in view with a laparoscopic grasper, and the stapler was articulated to fit the base of the appendix without narrowing the lumen of the cecum. The specimens were removed through the umbilical port site in a laparoscopic bag without spillage. Pathology returned low-grade appendiceal mucinous neoplasm with no evidence of invasion. The patient was managed appropriately with laparoscopic appendectomy and discharged home on the day of surgery.

Conclusion: Appendiceal masses should be considered in the differential diagnosis of a presumed pelvic mass. For low-grade appendiceal mucinous neoplasms that are diagnosed intraoperatively, laparoscopic resection without spillage or rupture is a feasible and appropriate approach for treatment [1-3].