A Patient with Mucinous Cystadenoma of the Appendix and Myxoglobulosis with Perforation into the Iliopsoas Muscle

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 49; no. 12; pp. 1252 - 1260
• Main Authors: Sugito, Nobuyoshi, Muramoto, Masayuki, Hasegawa, Takeshi, Komori, Tetsuya, Hori, Keiichi, Matsuo, Yoichi, Takeyama, Hiromitsu
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 01.12.2016
• Subjects: low-grade appendiceal mucinous neoplasm; mucinous cystadenoma of the appendix; myxoglobulosis
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.2016.0022

A 65-year-old man was diagnosed with acute appendicitis and treated conservatively with antibiotics by a local physician. Temporary improvement was achieved, but he was evaluated at our hospital because of recurrence. Abdominal examination revealed a palpable, hard, elastic mass the size of a hen’s egg in the right lower quadrant. The patient reported back discomfort when raising the right leg. CT revealed a mass with non-uniform contrast enhancement in the right lower quadrant and a 3×4-cm low-density area dorsally in the iliopsoas muscle. Abdominal US showed a patchy non-uniform area in the iliopsoas muscle. Acute appendicitis with abscess perforation into the iliopsoas muscle was diagnosed, and surgery was performed. As expected preoperatively, the tip of the appendix had perforated into the iliopsoas muscle, but no pus was present inside. Instead, a discharge of 2- to 3-mm pearl-like globules was seen. The appendix was resected, the globules were removed, and the inside of the iliopsoas muscle was rinsed. A drain was then placed and surgery was completed. Histopathology showed moderate atypia, but no evidence of malignancy. The diagnosis was mucinous cystadenoma of the appendix with myxoglobulosis. As of about 5 years after surgery, no recurrence has been identified.