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![Postoperative findings. a. The appendiceal mucosa was completely everted, and the appendix measured 11 × 1.5 × 1.5 cm. The entire appendix mucosa is almost tubulovillous adenoma superficially. b and c. Microscopic examination of the resected specimen indicated a tubulovillous adenoma with local high-grade intraepithelial neoplasia (b: hematoxylin/eosin [H&E], original magnification × 100; c: H&E original magnification × 200)](publication/337182785/figure/fig1/AS:824221802442753@1573521199411/Postoperative-findings-a-The-appendiceal-mucosa-was-completely-everted-and-the.png)
Postoperative findings. a. The appendiceal mucosa was completely everted, and the appendix measured 11 × 1.5 × 1.5 cm. The entire appendix mucosa is almost tubulovillous adenoma superficially. b and c. Microscopic examination of the resected specimen indicated a tubulovillous adenoma with local high-grade intraepithelial neoplasia (b: hematoxylin/eosin [H&E], original magnification × 100; c: H&E original magnification × 200)
Source publication
Background:
Appendiceal inversion with neoplasia in adults is an extremely rare event with a reported incidence of < 0.01%. Preoperative diagnosis is very important for surgical treatment; however, it is very difficult to be exact.
Case presentation:
The patient was a 60-year-old woman with complaints of intermittent abdominal pain. Computed tom...
Contexts in source publication
Context 1
... gross pathology, the appendix measured approximately 11 cm in length and 1.5 cm in external diameter. The extroverted mucosa was diffusely thickened and granular in appearance (Fig. 3a). Histopathology confirmed tubulovillous adenoma of the appendix with local high-grade intraepithelial neoplasia (Fig. 3b, ...
Context 2
... gross pathology, the appendix measured approximately 11 cm in length and 1.5 cm in external diameter. The extroverted mucosa was diffusely thickened and granular in appearance (Fig. 3a). Histopathology confirmed tubulovillous adenoma of the appendix with local high-grade intraepithelial neoplasia (Fig. 3b, ...
Context 3
... gross pathology, the appendix measured approximately 11 cm in length and 1.5 cm in external diameter. The extroverted mucosa was diffusely thickened and granular in appearance (Fig. 3a). Histopathology confirmed tubulovillous adenoma of the appendix with local high-grade intraepithelial neoplasia (Fig. 3b, ...
Context 4
... gross pathology, the appendix measured approximately 11 cm in length and 1.5 cm in external diameter. The extroverted mucosa was diffusely thickened and granular in appearance (Fig. 3a). Histopathology confirmed tubulovillous adenoma of the appendix with local high-grade intraepithelial neoplasia (Fig. 3b, ...
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Citations
... The proposed advantages of stump inversion include double closure of the cecal wall, decreased contamination from an intra-peritoneal stump, and minimized risk of adhesions [3]. However, there are reports of an appendiceal stump harboring a neoplasm [4][5]. As a result, appendiceal inversion, or what appears as a cecal polyp at the appendiceal orifice on imaging or colonoscopy, must be further investigated and differentiated from a pathologic process. ...
... With malignancy on the differential, the patient underwent cecal resection for tissue diagnosis and the final pathology of the surgical specimen revealed a benign inverted appendix. Although appendiceal inversion may be benign, as in our patient's case, it may harbor appendiceal mucinous neoplasms, neuroendocrine tumors, and other malignant pathology with an incidence of less than 1% [4,5,8,9]. Imaging findings suggestive of malignancy include ileocecal thickening greater than 3 mm and calcifications [5,6]. As such, further diagnostic steps should be undertaken to rule out malignancy and guide surgical management in cases of suspected appendiceal inversion. ...
Appendiceal inversion is uncommon. It may be a benign finding or seen in association with malignant pathology. When detected, it masquerades as a cecal polyp which poses a diagnostic dilemma with malignancy in the differential. In this report, we highlight a case of a 51-year-old patient with an extensive surgical history as a newborn in the setting of omphalocele and intestinal malrotation, who was found to have a 4 cm cecal polypoid growth on screening colonoscopy. He underwent a cecectomy for tissue diagnosis. Ultimately, the polyp was found to be an inverted appendix without evidence of malignancy. Currently, suspicious colorectal lesions which cannot be removed by polypectomy are primarily addressed with surgical excision. We reviewed the literature for available diagnostic adjuncts to better differentiate benign from malignant colorectal pathology. The application of advanced imaging and molecular technology will allow for improved diagnostic accuracy and subsequent operative planning.
... [2][3][4] Most AMNs, however, are asymptomatic and are usually found incidentally during appendectomies for appendicitis, and can even be found during colonoscopies, such as in this case. 5,6 Low-grade AMNs are distinguished from appendiceal mucinous adenocarcinomas by their lack of wall invasion. 7 Additionally, low-grade AMNs have a very good prognosis as even neoplasms that have spread outside of the appendix have a 5-year overall survival rate of 79 to 86%. 8 These lowgrade neoplasms also have extremely low rates of recurrence after resection. ...
... 11 Appendiceal inversion is a rare finding in adults with an estimated prevalence of 0.01%. 6 Not only is appendiceal inversion rare in and of itself, it is even more rarely found in combination with appendiceal neoplasms. 6 Other causes of appendiceal inversion include intussusception, acute appendicitis, appendiceal nodule, or even iatrogenic due to appendectomy. ...
... 6 Not only is appendiceal inversion rare in and of itself, it is even more rarely found in combination with appendiceal neoplasms. 6 Other causes of appendiceal inversion include intussusception, acute appendicitis, appendiceal nodule, or even iatrogenic due to appendectomy. [12][13][14] While appendiceal inversion can be completely benign, because these morphological changes of the appendix can resemble a polyp, these lesions are often biopsied and/or resected. ...
Background:
Appendiceal mucinous neoplasms (AMNs) are rare adenomatous primary tumors of the appendix. Although of low malignant potential, these neoplasms can cause serious potentially fatal complications such as bowel obstruction and pseudomyxoma peritonei, making prompt identification and removal of utmost importance. AMNs often present with nonspecific gastrointestinal symptoms or are asymptomatic and found incidentally.
Case presentation:
A patient aged 72 years presented with generalized weakness and appeared on imaging to have acute appendicitis complicated by rupture. On colonoscopy, the patient was found to have an inverted appendix that after appendectomy was revealed to harbor a perforated low-grade AMN.
Conclusions:
Although AMNs are rare, physicians should still consider it when imaging suggests appendicitis. Having AMNs as part of the differential diagnosis is especially necessary in cases, such as this one, in which the patient has appendiceal inversion, is aged > 50 years, and has concurrent colorectal neoplasms.
