付属器由来と思われた嚢胞性病変が腹腔鏡下手術で虫垂由来と判明した1例

抄録

Objective: There are many opportunities to distinguish between an ovarian cyst, a paroophoritic cyst, and a hydrosalpinx via imaging studies. We report a case of low-grade appendiceal mucinous neoplasm preoperatively diagnosed as paroophoritic cyst or hydrosalpinx.

Case: The patient is a 25-year-old woman. Preliminary examination confirmed a 77×27 mm cystic lesion near the right ovary; thus, she was diagnosed with the right paroophoritic cyst or hydrosalpinx. Tumor markers were found normal. We performed laparoscopic surgery for further diagnosis and treatment. A clubbed cystic tumor was revealed, which involved the right fallopian tube twisted by 720 degrees. Upon the release of the twist, the cystic tumor reached the ileocecum. We diagnosed the tumor origin as the appendix. We ligated and cut the appendix root and collected it into the pouch to avoid leakage of the contents of the cystic tumor in the abdominal cavity. When the cystic tumor was opened, it was found to be filled with a yellow transparent jelly-like mucus. The histologic diagnosis was low-grade appendiceal mucinous neoplasm. The patient was continuously followed up at our clinic.

Conclusion: In case of leakage of the cyst contents during operation, mucinous tumors may cause pseudomyxoma peritonei, which disseminates into the intraperitoneal cavity. Using laparoscopic surgery, we diagnosed that the cystic tumor originated from the appendix and removed and treated it with minimally invasive methods. Furthermore, for a favorable prognosis, it is essential to monitor a cautious manipulation without rupture of the mucinous cystic tumor.