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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diverticulosis of the appendix is a relatively rare pathological finding. The majority are acquired pseudodiverticula. True congenital diverticula are very rare. Appendiceal diverticulosis is usually an incidental finding and clinically asymptomatic. When symptomatic, it is usually complicated by acute or chronic diverticulitis with or without acute appendicitis. It presents with atypical abdominal signs and symptoms, mostly in adult males. Appendiceal diverticulitis is a distinct entity with several clinical and pathological differences from acute appendicitis. It has a more rapid progression to perforation and a higher rate of mortality. Therefore, appendiceal diverticulitis should be considered in the clinical differential diagnosis, especially in adult males with chronic abdominal pain. Appendiceal diverticulosis demonstrates a significant association with obstructing or incidental appendiceal neoplasms. It may play an important role in the development of pseudomyxoma peritonei, which is associated with appendiceal mucinous tumors. Therefore, meticulous gross examination and thorough histological examination of the entire appendicectomy specimen are essential. When discovered either by preoperative radiological investigations or during an exploratory operation, prophylactic appendicectomy is advocated to prevent the risk of complications and to rule out the possibility of a coexisting neoplasm.
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PMID:Diverticulosis and diverticulitis of the appendix. 1923 60

Primary appendiceal carcinoma is extremely rare and is found in approximately 1% of appendectomy specimens. When cancer is present, the most frequent histology is mucinous adenocarcinoma. Neoplasms of the appendix that secrete mucin such as adenocarcinoma may rupture, leading to intraperitoneal seeding of the peritoneum and producing the clinical picture of pseudomyxoma peritonei (PMP). PMP is characterized by mucin-producing neoplastic cells that have seeded the peritoneum from the ruptured viscous and continue to secrete copious amounts of gelatinous material that accumulates in the abdomen producing the characteristic "jelly belly." A review of the medical literature revealed no cases of PMP diagnosed at time of cesarean section. A previously healthy gravida 5, para 3 underwent cesarean section. Upon opening of the peritoneum, copious amounts of gelatinous, yellow-tinged mucoid material was noted. A general surgeon was consulted, and grossly necrotic-appearing appendix was noted. The patient underwent appendectomy with right hemicolectomy. Pathology showed well-differentiated mucinous adenocarcinoma of the appendix. PMP is associated with gastrointestinal and ovarian carcinomas. Although somewhat rare, these cancers may occur in pregnancy. Because nonspecific abdominal pain and increasing abdominal girth are common in pregnancy, patients' complaints may go ignored. Early diagnosis of a potentially life-threatening disease requires that clinicians expand the differential diagnosis and consider the possibility of a malignant neoplasm presenting in the pregnant female.
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PMID:Incidental finding of pseudomyxoma peritonei at primary cesarean section. 1939 8

Pseudomyxoma peritonei is a poorly understood and uncommon tumor that is known for its production of mucin in the abdominal cavity and mucinous implants, diffusely involving the peritoneal surfaces. A 60-year-old female presented to us with post-op complaints of diffuse abdominal pain and distension. On work-up, she was diagnosed as a case of Pseudomyxoma peritonei (with residual disease). She received chemotherapy in the form of oral capecitabine for residual disease. She was totally asymptomatic till the last follow-up. This case is being reported on account of its rarity and to emphasize a simple alternative treatment option as compared to the standard one.
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PMID:Pseudomyxoma peritonei: An uncommon tumor. 2120 66

Primary splenic mucinous cystadenocarcinoma (MCCa) is extremely rare, and only six cases appear to have been reported previously. We present herein a case of primary splenic MCCa resulting in pseudomyxoma peritonei (PMP). A 66-year-old Japanese woman presented to a hospital with a chief complaint of upper abdominal pain and a 7-year history of splenic cyst. Cyst rupture was noted on computed tomography, and splenectomy was performed. The abdominal cavity was filled with a large amount of gelatinous ascites, with the appearance of PMP. On the cut surface, multiple cysts containing mucinous material were found within and outside the spleen. Microscopically, splenic parenchyma was occupied by large mucinous pools focally lined with mucinous epithelial cells and mesothelial cell-like cells, which were considered benign. Outside the spleen, a low-grade MCCa component was found. No ectopic pancreatic or intestinal tissue was identified. Although most PMP cases are known to be caused by low-grade mucinous appendiceal tumor, the present case represents the first report of a splenic MCCa resulting in PMP.
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PMID:A case of splenic low-grade mucinous cystadenocarcinoma resulting in pseudomyxoma peritonei. 2126 1

Mucocele of the appendix due to mucinous cystadenoma is a rare clinical finding. Approximately half of the patients are asymptomatic. It's defined as the dilatation of the appendiceal lumen due to abnormal accumulation of mucus in to it. The pseudomyxoma peritonei, as a result of rupture of the appendix, is the most dangerous complication. We present two case reports of patients that were presented in our Department with different clinical findings. The first patient was presented with symptoms of acute appendicitis, while the second patient showed with atypical symptoms such as abdominal pain, a palpable mass in the right iliac fossa and a diagnosed mucocele of the appendix with the use of computerized tomography. In both patients was performed an appendicectomy and the final histopathology diagnosis confirmed the presence of the mucinous cystadenoma of the appendix which caused the creation of the mucocele. In conclusion mucocele is a rare tumor which must be considered in the differential diagnosis of a mass in the right lower quadrant of the abdomen.
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PMID:Mucinous cystadenoma of the appendix. A diagnostic dilemma? 2169 67

Appendiceal mucocele is a rare disease (0.3% of all appendectomy) and is characterized by the accumulation of mucoid material in the appendiceal lumen. Etiopathogenesis can be inflammatory or neoplastic. Four entities can be distinguished on the basis of histopathologic epithelial characteristics: simple appendiceal mucocele (AM), mucocele with epithelial hyperplasia, cystadenoma and cystadenocarcinoma; the last two subgroups represent neoplastic forms. Dissemination of neoplastic cells and mucoid material in abdominal cavity, caused by appendiceal perforation, clinically results in pseudomyxoma peritonei which is the dramatic evolution in 10-15% of cases. Clinically it can remain either asymptomatic for long time or it can manifest with abdominal pain that can be associated with the presence of a palpable mass. The most common clinical manifestation is pain in the right iliac fossa. Preoperative diagnosis is rare, while it is more frequently intraoperative. Therapy is fundamentally surgical: appendectomy is curative for simple AM, for AM with epithelial hyperplasia and for cystadenoma with intact appendiceal base; cecum resection is indicated for cystadenoma with larger base of implantation; right hemicolectomy has been the elective treatment in case of cystadenocarcinoma for several years although Gonzalez-Moreno and Sugarbaker have recently demonstrated its validity as definitive treatment only if it is performed in order to obtain complete cytoreduction, if there is lymph node involvement, or if histopathological examination indicates non-mucinous type. We report the case of a 60-year-old woman that presented with cystic neoformation in the right iliac fossa, that was preoperatively considered deriving from the ovary. We intraoperatively found the presence of appendiceal mucocele that histological examination defined as mucinous cystadenoma.
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PMID:Appendiceal mucocele. A case report and literature review. 2178 May 69

Inflammatory myofibroblastic tumor (IMT) has been described as a pseudosarcomatous proliferation of spindled myofibroblasts admixed with lymphoplasmacytic cells. The various terminologies like inflammatory pseudotumor, plasma cell granuloma, and inflammatory myofibrohistiocytic proliferation, used to describe this entity, highlight the controversial etiopathogenesis of this relatively indolent neoplasm. IMT has now been described in different anatomic locations. However, cases occurring in the gastrointestinal tract are rare with very few cases described in the appendix. We present a case of inflammatory myofibroblastic tumor appendix with mucosal dysplasia in a 41-year-old male, presenting with abdominal pain and lump in the right iliac fossa. Aspiration cytology yielded few atypical epithelial cells and spindle cells in a mucinous background, suggesting the possibility of pseudomyxoma peritonei. Awareness of IMT appendix with rare presence of mucosal dysplasia may help in preventing overzealous resection, especially in situations that on preoperative evaluation may suggest malignancy.
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PMID:Inflammatory myofibroblastic tumor appendix with concomitant mucosal dysplasia, simulating pseudomyxoma on preoperative aspiration cytology. 2284 87

Pseudomyxoma peritonei is a rare clinical condition that causes the accumulation of mucinous ascites, which gradually results in the compression of intra-abdominal organs. Most published reports of pseudomyxoma peritonei concern the mass effect of the resulting ascites, which presents as abdominal pain or intestinal ileus in severe cases. However, few reports of renal complications of the disease have been published. Here, we present a case of oliguric acute kidney injury caused by external compression by pseudomyxoma peritonei. After decompression with external drainage, the patient's renal function rapidly improved.
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PMID:Pseudomyxoma peritonei: a rare cause of oliguric acute kidney injury. 2401 72

Alimentary tract duplications are rare congenital anomalies. They most often become symptomatic in childhood and rarely undergo malignant transformation. Pseudomyxoma peritonei (PMP) is an equally uncommon condition, most frequently originating from a primary appendiceal mucinous neoplasm. We report an extremely unusual case of PMP arising from an intestinal duplication. A 67-year-old woman presented with vague upper abdominal pain, and, unexpectedly, explorative laparoscopy revealed diffuse jelly-like peritoneal implants. The histopathological diagnosis of a low-grade PMP or "disseminated peritoneal adenomucinosis" was made. At that moment, no primary tumor was found. During later surgery, a cystic lesion located in the mesentery of the small bowel could be resected. Histologically, the cyst wall clearly showed the concentric layering of a normal bowel wall. The mucosa, however, displayed a diffuse low-grade villous adenoma. We concluded that this histological picture was most consistent with a small intestinal duplication, containing a low-grade villous adenoma. The adenoma caused a mucocele, which subsequently leaked or ruptured, giving rise to noninvasive mucinous peritoneal implants or low-grade PMP, also known as "disseminated peritoneal adenomucinosis" (DPAM).
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PMID:Pseudomyxoma peritonei originating from an intestinal duplication. 2402 58

Pseudomyxoma peritonei (PMP, ORPHA26790) is a clinical syndrome characterized by progressive dissemination of mucinous tumors and mucinous ascites in the abdomen and pelvis. PMP is a rare disease with an estimated incidence of 1-2 out of a million. Clinically, PMP usually presents with a variety of unspecific signs and symptoms, including abdominal pain and distention, ascites or even bowel obstruction. It is also diagnosed incidentally at surgical or non-surgical investigations of the abdominopelvic viscera. PMP is a neoplastic disease originating from a primary mucinous tumor of the appendix with a distinctive pattern of the peritoneal spread. Computed tomography and histopathology are the most reliable diagnostic modalities. The differential diagnosis of the disease includes secondary peritoneal carcinomatoses and some rare peritoneal conditions. Optimal elimination of mucin and the mucin-secreting tumor comprises the current standard of care for PMP offered in specialized centers as visceral resections and peritonectomy combined with intraperitoneal chemotherapy. This multidisciplinary approach has reportedly provided a median survival rate of 16.3 years, a median progression-free survival rate of 8.2 years and 10- and 15-year survival rates of 63% and 59%, respectively. Despite its indolent, bland nature as a neoplasm, PMP is a debilitating condition that severely impacts quality of life. It tends to be diagnosed at advanced stages and frequently recurs after treatment. Being ignored in research, however, PMP remains a challenging, enigmatic entity. Clinicopathological features of the PMP syndrome and its morbid complications closely correspond with the multifocal distribution of the secreted mucin collections and mucin-secreting implants. Novel strategies are thus required to facilitate macroscopic, as well as microscopic, elimination of mucin and its source as the key components of the disease. In this regard, MUC2, MUC5AC and MUC5B have been found as the secreted mucins of relevance in PMP. Development of mucin-targeted therapies could be a promising avenue for future research which is addressed in this article.
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PMID:Secreted mucins in pseudomyxoma peritonei: pathophysiological significance and potential therapeutic prospects. 2488 59


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