2022, Number 3-4
Controversy in the use of intraperitoneal chemotherapy for the treatment of low-grade appendiceal mucinous neoplasia: apropos of a clinical case
Villalobos-Rubalcava EJ, Hernández-López A, Jiménez-Barri R
Full text
10.35366/110661
Language: Spanish
References: 12
Page: 84-88
PDF size: 295.81 Kb.
ABSTRACT
Introduction: appendicular neoplasms represent 1% of all colorectal cancers, one of the histological variants is appendiceal mucinous neoplasm, formerly known as mucocele. The clinical presentation is largely similar to that of acute appendicitis, so its preoperative diagnosis is rare. Clinically, patients present different symptomatology depending on the stage they are in, the most common manifestations are pain in the right iliac fossa, fever, palpable mass, abdominal distension, weight loss, anemia, chronic abdominal pain, infertility, among others. The defining pathologic characteristic of evidence of low-grade appendiceal mucinous neoplasm (LAMN) is invasion of the appendiceal wall, the presence of irregularity in the wall of the observed and the increase in thickness of the soft tissues can predict the malignancy of the tumor. Peritoneal involvement at the time of diagnosis can be up to 53%. The possibility of disease progression to pseudomyxoma peritoneal exists if dissemination occurs by rupture of the lesion and release of mucin into the peritoneal cavity. The treatment of LAMN always requires surgical management and the use of hyperthermic intraoperative chemotherapy in case of peritoneal involvement is still under debate. Case presentation: this case deals with a patient, 41 years old, who after three months with abdominal pain in the right iliac fossa, is taken to the operating room for a diagnostic laparoscopy due to the suspicion of a mucinous neoplasm, no mucinous lesions were found, an appendectomy plus cecectomy was performed. With stapler, pathology reported LAMN with serial involvement (pT4) and at six months a control laparoscopy with no evidence of mucinous lesions. The involvement of the serosa opened the discussion on whether hyperthermic intraperitoneal chemotherapy is necessary when there are no visible mucinous lesions and there was no mucin contamination. Conclusions: the literature to date has no clear evidence on the prognosis of this type of injury and whether it is useful or not. The challenge of this diagnosis will be to have a multicenter prospective study that allows the development of care protocols with strategic treatments.REFERENCES
Hegg KS, Mack LA, Bouchard-Fortier A, Temple WJ, Gui X. Macroscopic and microscopic characteristics of low grade appendiceal mucinous neoplasms (LAMN) on appendectomy specimens and correlations with pseudomyxoma peritonei development risk. Ann Diagn Pathol. 2020; 48: 151606. doi: 10.1016/j.anndiagpath.2020.151606.