Appendiks Mukoseli: Tanı ve Tedavi
Özet
Apendiks mukoseli nadir görülen bir klinik durum olup, apendiks lümeni içerisinde mukus birikimi nedeniyle apendiksin obstruktif dilatasyonu olarak tanımlanabilir. Apendiks lümeninde mukus birikimine neden olan başlıca nedenler; retansiyon kistleri, mukozal hiperplazi, kistadenomlar ve kistadenokarsinomlardır. Apendiks mukoseli nadir görülen bir klinik durum olup, apendiks spesmenlerinin yaklaşık %0.2-0.7’sinde tespit edilir.
Vakaların yaklaşık %50’si asemtomatik olarak seyreder ve insidental olarak tanı konulur. Semptomatik hastalarda en sık şikayet karın ağrısıdır. Hastalarda spesifik muayene bulgusu olmayıp bazen sağ alt kadranda hassasiyet ve rebound görülebilir ve akut apandisit ile karışabilir.
Apendiks mukoseli çoğu hastada asemptomatik seyrettiği için tanı genellikle insidental olarak konulur. Özellikle sağ alt kadranda ağrı ve ele gelen kitlesi olan hastalarda ilk basamak görüntüleme yöntemi ultrasonografidir (USG). USG’de mukusun birikimine bağlı olarak değişken ekojeniteye sahip kistler görülebilir. Bilgisayarlı tomografi (BT) apendiks mukoseli tanısında kullanılan diğer bir görüntüleme yöntemi olup, BT ile apendiks lümen dilatasyonu, lümen içerisinde biriken mukus materyali kapsüllü kistik kitle şeklinde görülebilir ve vakaların %50’sinde apendiks duvarının kalsifikasyonu tespit edilebilir.
Dünya Sağlık Örgütü'nün 2019 yılında güncellenen patolojik sınıflandırmasına göre, mukoselin neoplastik nedenleri arasında tırtıklı lezyonlar/polipler, low grade apendiks musinöz neoplazmalar, high grade apendiks mukosel neoplazmaları ve musinöz adenokarsinomlar yer almaktadır.
Apendiks mukoselinin en önemli ve ciddi komplikasyonu apendiks perforasyonuna bağlı olarak gelişen ve karın içerinde musin birkimine ve assite neden olan Psodomiksomaperitoni adı verilen durumdur.
Appendiceal mucocele is a rare clinical condition and can be defined as obstructive dilatation of the appendix due to mucus accumulation in the appendix lumen. The main causes of mucus accumulation in the appendix lumen are retention cysts, mucosal hyperplasia, cystadenomas and cystadenocarcinomas. Appendiceal mucocele is a rare clinical condition and is detected in approximately 0.2-0.7% of appendix specimens.
Approximately 50% of cases are asymptomatic and diagnosed incidentally. The most common complaint in symptomatic patients is abdominal pain. Patients do not have specific examination findings, but sometimes tenderness and rebound may be seen in the right lower quadrant and can be confused with acute appendicitis.
Since appendiceal mucocele is asymptomatic in most patients, the diagnosis is usually made incidentally. Especially in patients with pain and a palpable mass in the right lower quadrant, the first-line imaging method is ultrasonography (USG). Cysts with variable echogenicity due to mucus accumulation can be seen on USG. Computed tomography (CT) is another imaging method used in the diagnosis of appendiceal mucocele, and with CT, appendiceal lumen dilatation, mucus material accumulated in the lumen can be seen as an encapsulated cystic mass, and calcification of the appendix wall can be detected in 50% of cases.
According to the pathological classification updated by the World Health Organization in 2019, neoplastic causes of mucocele include serrated lesions/polyps, low-grade appendiceal mucinous neoplasms, high-grade appendiceal mucocele neoplasms and mucinous adenocarcinomas.
The most important and serious complication of appendiceal mucocele is a condition called Pseudomyxomaperitoneum, which develops due to appendix perforation and causes mucin accumulation and ascites in the abdomen.
Referanslar
Bailey L. (2018) Short Practice of Surgery. 27th ed. Florida: Taylor & Francis; 1314–1317.
Townsend M. (2017). Sabiston Textbook of Surgery. 20th ed. Philadelphia: Elsevier;1308–1309.
Brunicardi F. (2015). Schwartz’s Principles of Surgery. 10th ed. New York: McGraw Hill; 1257–1259.
Rokitansky CF. A manual of pathological anatomy. Vol 2. English translation of the Vienna edition (1842). Philadelphia: Blancard and Lea; 1855.
Demetrashvili Z & et al. (2012). Mucocele of the appendix: case report and review of literature. Int Surg;97:266–9.
Marudanayagam R, Williams GT & Rees BI. (2006). Review of the pathological results of 2660 appendectomy specimens. J Gastroenterol.41:745–9.
M. Yilmaz & et al. (2013).Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis, World J. Gastroenterol. 19: (25);4015-4022.
J. Ruiz-Tovar & et al. (2007). Mucocele of the appendix, World J. Surg. 31:(3);542-548.
F.Benidix & et al. (2010). Primary appendiceal carcinomaeepidemiology, surgery and survival: results of a German multi-center study, Eur. J. Surg. Oncol. 36:(8); 763-771.
A. Dixit, J & et al. (2007). Appendiceal mucocoeles and pseudomyxoma peritonei, World J. Gastroenterol. 13: (16); 2381-2384.
E. Kelemouridou & et al. (2011). Mucinous cystadenoma of the appendix. A diagnostic dilemma? Chir. (Bucur) 106 (2);251-254.
K. Caliskan & et al. (2008). Mucinous cystadenoma of the appendix: a rare cause of acute abdomen, Ulus. Travma Acil Cerrahi Derg. 14:(4); 303-307.
Lien WC & et al. (2006). Appendiceal outer diameter as an indicator for differentiating appendiceal mucocele from appendicitis. Am J Emerg Med. 24(7):801-805.
Caspi B & et al. (2004). The onion skin sign: a specific sonographic marker of appendiceal mucocele. J Ultrasound Med. 23(1):117-121.
M.L. Zhou & et al. (2006). Mucinous cystadenoma of the appendix: CT findings, Chin. Med. J. Engl. 119 (15):1300-1303.
Karakaya K & et al. (2008). Appendiceal mucocele: case reports and review of current literature. World J Gastroenterol. 14:2280.
Zanati SA & et al. (2005).Colonoscopic diagnosis of mucocele of the appendix. Gastrointest Endosc. 62:452–6.
C.P. Carmignani, R & et al. (2004). Utility of CEA and CA 19-9 tumor markers in diagnosis and prognostic assessment of mucinous epithelial cancers of the appendix, J. Surg. Oncol. 87 (4): 162-166.
Koç C, Akbulut S & Akatlı AN. (2020). Nomenclature of appendiceal mucinous lesions according to the 2019 WHO Classification of Tumors of the Digestive System. Turk J Gastroenterol. 31:64957.
Rymer B, Forsythe RO & Husada G. (2015). Mucocoele and mucinous tumours of the appendix: A review of the literatüre. Int J Surg. 18:132-135.
Dhage-Ivatury S & Sugarbaker PH. (2006). Update on the surgical approach to mucocele of the appendix. J Am Coll Surg. 202(4):680–684
Referanslar
Bailey L. (2018) Short Practice of Surgery. 27th ed. Florida: Taylor & Francis; 1314–1317.
Townsend M. (2017). Sabiston Textbook of Surgery. 20th ed. Philadelphia: Elsevier;1308–1309.
Brunicardi F. (2015). Schwartz’s Principles of Surgery. 10th ed. New York: McGraw Hill; 1257–1259.
Rokitansky CF. A manual of pathological anatomy. Vol 2. English translation of the Vienna edition (1842). Philadelphia: Blancard and Lea; 1855.
Demetrashvili Z & et al. (2012). Mucocele of the appendix: case report and review of literature. Int Surg;97:266–9.
Marudanayagam R, Williams GT & Rees BI. (2006). Review of the pathological results of 2660 appendectomy specimens. J Gastroenterol.41:745–9.
M. Yilmaz & et al. (2013).Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis, World J. Gastroenterol. 19: (25);4015-4022.
J. Ruiz-Tovar & et al. (2007). Mucocele of the appendix, World J. Surg. 31:(3);542-548.
F.Benidix & et al. (2010). Primary appendiceal carcinomaeepidemiology, surgery and survival: results of a German multi-center study, Eur. J. Surg. Oncol. 36:(8); 763-771.
A. Dixit, J & et al. (2007). Appendiceal mucocoeles and pseudomyxoma peritonei, World J. Gastroenterol. 13: (16); 2381-2384.
E. Kelemouridou & et al. (2011). Mucinous cystadenoma of the appendix. A diagnostic dilemma? Chir. (Bucur) 106 (2);251-254.
K. Caliskan & et al. (2008). Mucinous cystadenoma of the appendix: a rare cause of acute abdomen, Ulus. Travma Acil Cerrahi Derg. 14:(4); 303-307.
Lien WC & et al. (2006). Appendiceal outer diameter as an indicator for differentiating appendiceal mucocele from appendicitis. Am J Emerg Med. 24(7):801-805.
Caspi B & et al. (2004). The onion skin sign: a specific sonographic marker of appendiceal mucocele. J Ultrasound Med. 23(1):117-121.
M.L. Zhou & et al. (2006). Mucinous cystadenoma of the appendix: CT findings, Chin. Med. J. Engl. 119 (15):1300-1303.
Karakaya K & et al. (2008). Appendiceal mucocele: case reports and review of current literature. World J Gastroenterol. 14:2280.
Zanati SA & et al. (2005).Colonoscopic diagnosis of mucocele of the appendix. Gastrointest Endosc. 62:452–6.
C.P. Carmignani, R & et al. (2004). Utility of CEA and CA 19-9 tumor markers in diagnosis and prognostic assessment of mucinous epithelial cancers of the appendix, J. Surg. Oncol. 87 (4): 162-166.
Koç C, Akbulut S & Akatlı AN. (2020). Nomenclature of appendiceal mucinous lesions according to the 2019 WHO Classification of Tumors of the Digestive System. Turk J Gastroenterol. 31:64957.
Rymer B, Forsythe RO & Husada G. (2015). Mucocoele and mucinous tumours of the appendix: A review of the literatüre. Int J Surg. 18:132-135.
Dhage-Ivatury S & Sugarbaker PH. (2006). Update on the surgical approach to mucocele of the appendix. J Am Coll Surg. 202(4):680–684
