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PubMed1983

[Torsion of appendix of testis and epididymis: a report of 4 cases].

We report our clinical and pathological observations on four patients with torsion of appendix testis or epididymis, and reviewed 72 cases of torsion of the appendages of intrascrotal organs collected from the Japanese literature; 35 cases of torsion of appendix testis, 36 cases of torsion of appendix epididymis and 1 case of torsion of paradidymis . Case 1 was a 10-year-old boy visiting us because of pain and swelling in his right scrotum continuing for the past ten days. His right scrotum was found to contain a hen-egg sized tender mass. The testis and epididymis could not be differentiated by palpation. The blood count disclosed 10,000 white blood cells. At operation, two appendix epididymis were found in his right scrotum. One of them was twisted 360 degrees clockwise and 10 x 8 x 5 mm in size. Case 2 was a 11-year-old boy with complaint of pain in his left lower abdomen and left scrotum for the past three days. Palpation of his left scrotal contents revealed a slightly hard testis and tender epididymis. At operation, we found his left spermatic cord to be twisted 90 degrees counterclockwise and appendix epididymis 180 degrees counterclockwise. The twisted appendix epididymis was 10 x 8 x 7 mm in size. Case 3 was a 13-year-old boy whose complaint was left scrotal pain. The upper pole of his left testis was found to be swollen and tender by palpation. The exposure of his left scrotum at operation revealed that his left epididymis was abnormally attached to his left testis and had two appendices. One of these appendix epididymis was twisted 180 degrees clockwise and measured 10 x 10 x 8 mm. Case 4 was a 19-year-old male who suffered from right testicular pain for the past seven days. He had a history of three intermittent episodes of similar right testicular pain during the past two years. His right testis was enlarged and palpated slightly hard and tender. We explored his right scrotum surgically and found the appendix testis twisted and enlarged to little-finger's head size. However, it was impossible to determine whether the rotation was clockwise or counterclockwise because the twisted appendix was too severely damaged. The preoperative diagnosis was correct in one case and three were erroneously diagnosed as having torsion of spermatic cord. All four cases were treated by surgery which relieved all patients of discomfort.

Adolescent↗
PubMed1995

Mucinous cystadenoma of appendix concomitant with perityphlic granuloma.

We describe a case of mucinous cystadenoma of the appendix with perityphlic granuloma. The patient developed a hard palpable mass in the right lower quadrant and barium enema induced irregular bowel wall at the cecum. Based on a preoperative diagnosis of carcinoma of the appendix, we performed a laparotomy. On operation, we found a tumor mass in the region of the appendix; the mass adhered strongly to the retroperitoneum and cecum. Right hemicolectomy was carried out on a diagnosis of carcinoma of the appendix. Microscopic examination revealed mucinous cystadenoma of the appendix with perityphlic granuloma. Mucinous cystadenoma in the appendix is a rare tumor. In this patient, the tumor was accompanied by granuloma formation in adjacent tissues because of mucin expelled from the appendix. This case emphasizes that granuloma formation can make of difficult to differentiate mucinous cystadenoma in the appendix from cancer.

Appendiceal Neoplasms↗
PubMed2004

Developing neonatal rabbit appendix, a primary lymphoid organ, is seeded by immature blood-borne B cells: evidence for roles for CD62L/PNAd, CCR7/CCL21, alpha4beta1 and LFA-1.

Young rabbit appendix is a homologue of chicken bursa of Fabricius; both are crucial sites for preimmune B-cell repertoire development. We describe here some of the molecules involved in the multi-step recruitment of blood-borne B cells into neonatal rabbit developing appendix. Sialyl-Lewis-x, CD62L and integrins such as LFA-1 and alpha4beta1 were detected on B cells in peripheral blood. Peripheral lymph node addressin (PNAd), a CD62L counter-receptor was observed on appendix HEV. We also detected chemokine receptor CCR7 on peripheral blood B cells and one of the CCR7 ligands, CCL21, on appendix HEV but not in appendix follicles. Higher levels of CXCR5 expression compared to CCR7 on appendix B cells suggest that CXCR5 may be involved in recruitment of B cells into follicles. The proportions of appendix B cells expressing CD62L, sialyl-Lewis-x and alpha4beta1 declined between day 3 and 4 weeks after birth while percentages of Lewis-x+ appendix B cells increased. These changes correlate with the stage of repertoire diversification by gene conversion in both rabbits and chickens. The cross-reactivity of antibodies to mouse or human adhesion molecules described in this study indicates that some of the structures of these important molecules are conserved across species.

Animals↗
PubMed1996

Is a histologically normal appendix following emergency appendicectomy alway normal?

BACKGROUND: Appendixes removed from patients with suspected appendicitis often appear normal on histological examination. We examined appendix specimens for expression of abnormal amounts of cytokines, an indicator of an inflammatory response. METHODS: Tumour necrosis factor alpha (TNFalpha) and interleukin-2 (IL-2) expression was measured by in-situ hybridisation in ten specimens from patients with acute appendicitis, 12 normal appendix specimens removed from patients undergoing elective abdominal surgery, and 31 appendix specimens from patients with a clinical diagnosis of appendicitis but an appendix histologically classified as normal. Cytokine-specific RNA antisense probes were prepared by in-vitro transcription and digoxigenin (DIG) labelled. In-situ hybridisation was done on 5 micrometer paraffin sections. Tissue sections hybridised by sense probes acted as negative control for each cytokine. Following hybridisation, the probes were detected by alkaline phosphatase labelled anti-DIG monoclonal antibody and visualised by nitroblue tetrazolium staining. FINDINGS: All histologically proven acute appendicitis specimens demonstrated intense cellular TNFalpha mRNA expression in germinal centres and moderate levels of expression throughout the mucosa. IL-2 mRNA was strongly expressed in the lamina propria and only moderately expressed in germinal centres. Normal appendixes all showed almost complete absence of TNFalpha and IL-2 mRNA expression. Seven of the 31 histologically classified normal appendix specimens from patients with a clinical diagnosis of appendicitis demonstrated TNFalpha and IL-2 mRNA expression similar to acute appendicitis specimens in germinal centres, submucosa, and lamina propria layers. INTERPRETATION: TNFalpha and IL-2 mRNA expression is a sensitive marker of inflammation in appendicitis. A substantial proportion of histologically normal appendixes showed clear evidence of an inflammatory response in the form of increased cytokine expression.

Appendectomy↗
PubMed1999

Anomalies of the vermiform appendix and prevalence of acute appendicitis in Khartoum.

OBJECTIVE: To investigate certain anatomical features of the vermiform appendix and the prevalence of acute appendicitis among Sudanese citizens in Khartoum province. DESIGN: A prospective descriptive study of consecutive patients operated by a particular doctor. SETTING: Omdurman and Khartoum Teaching Hospitals from November 1995 to February 1996. INTERVENTION: Appendicectomy and recording particular characteristics of the appendix. MAIN OUTCOME MEASURES: (i) appendix position, (ii) variations of mesopharynx and (iii) length of appendix. RESULTS: Acute appendicitis was found to be more common in males than in females and among adults than children. The average length was 8.9 cm in males and 9.4 cms in females. The appendix was commonly found to be retrocaecal (58.3%) on pelvic (21.7%) or paracaecal (11.7%). Anomalies of the appendix were more common in children than adults and occurred in 47% of cases. CONCLUSION: Average length of the vermiform appendix was longer in females than in males. Ectopic positions such as left-sided appendix were not detected in this study.

Acute Disease↗
PubMedDate not supplied

[Ultrasonography of normal vermiform appendix].

The aim of this study was the detection and visualisation of the normal vermiform appendix and its characteristics by ultrasonography in adults with no clinical suggestion of acute or chronic abdominal disease. A prospective study was performed in 200 subjects. The graded-compression ultrasonography technique was used to explore the lower right quadrant of the abdomen and the pelvis. The examination was performed using a 4 MHz sector array and 7.5 MHz linear array transducer. In a few cases, a 10 MHz linear array transducer was used. The appendix was visualized in 54% of patients. In all cases where the appendix was visualized it was found to be either on the ileo-psoas muscle or directly beneath the abdominal wall. The ileo-caecal valve was visualized in 78% of cases. The transverse diameter was found to be no greater than 6.5 mm except in three cases that had a diameters ranging from 7 to 9 mm. Diameter variability along the length of the same appendix was demonstrated in 5% of subjects. Wall thickness was no greater than 2.5 mm. Our experience suggests that graded-compression ultrasonography is a valuable procedure for detecting the vermiform appendix more frequently than has been previously reported. The patients physical constitution and the anatomical location of the vermiform appendix were found to be important factors affecting the ability to visualize the vermiform appendix. The ability to visualise the normal vermiform appendix ultrasonographically supports the clinical diagnosis and excludes acute appendicitis.

Adolescent↗
PubMed1991

[Rare anomalies in the development of the appendix].

Anomalies of the appendix are extremely uncommon. Cases of complete agenesia have been reported only few times. Even "lucky" surgeons usually do not have the opportunity of seeing in more than once in ca career. Abnormal development of the appendix usually takes the form of a double appendix. About 60 such cases have been reported so far describing several types of the abnormality. Type A is described as a single appendix with the body or tip branching, or, alternatively, completely divided like a double-barreled gun. Type Bis described as occurrence of completely separated appendices with bases also being located on different sites of the cecum (the avian type) or with both bases springing from the intestinal tenia (tenia-coli type). Type C is a doubled cecum, each containing its own appendix. Type D is a horseshoe appendix with two openings at the common cecum All these anomalies are of great practical importance, and a surgeon has to bear them in mind during an operation, since in case he overlooks them the operated patient may experience grave consequences. They also may be the forensic issue in cases when repeated explorative laparotomy reveals "previously removed" vermiform appendix. We report a case of a horseshoe appendix with mesenterial incarceration of the terminal ileum and resulting partial intestinal gangrene necessitating intestinal resection and terminolateral ileotransversostomy. The postoperative course was characterised with partial gangrene of the cecom and fistula of the intestines on a completely intact part of the intestinal wall which could be explained by possible presence of anomalous vascularization in the area.

Aged↗
PubMed2000

Laparoscopic antegrade continence enema in situ appendix procedure for refractory constipation and overflow fecal incontinence in children with spina bifida.

PURPOSE: The antegrade continence enema procedure allows patients with neurogenic bowel to administer large volume enemas through a right lower quadrant stoma to flush the colon every other day. This procedure results in freedom from refractory constipation and diapers required by unexpected episodes of overflow fecal incontinence. We present a simplified laparoscopic technique using in situ appendix. MATERIALS AND METHODS: A total of 6 male and 10 female children with a mean age of 12 years (range 4 to 21) and neurogenic bowel secondary to myelomeningocele underwent the antegrade continence enema in situ appendix procedure. The procedure was done with laparoscopic assistance, and associated with other bladder and bladder outlet reconstructive surgery in 5 patients. In 3 patients, a purely laparoscopic antegrade continence enema in situ appendix procedure was performed. The appendix and cecum were mobilized, and the tip of the appendix was anastomosed directly to the skin of the right lower quadrant through 1 of the 5 mm. lower quadrant port sites. The continence mechanism is simply a function of the appendix length and the mucosal coaptation of the appendiceal lumen. A 6Fr silicone Foley catheter is used to stent the mucocutaneous anastomosis. Concomitant procedures included ileocystoplasty, ileovesicostomy, sigmoidovesicostomy or ureterovesicostomy, and/or pubovaginal sling done through a low Pfannenstiel incision after laparoscopic mobilization of the appendix and cecum. RESULTS: The 3 patients treated with the laparoscopic antegrade continence enema procedure ate the day of surgery and were discharged home the next morning. Constipation and fecal incontinence resolved in all cases. All antegrade continence enema stomas were catheterized easily with a 6 or 8Fr feeding tube and were continent. Complications in the 8 laparoscopic and laparoscopic assisted cases included stomal stenosis requiring dilation in the office and obstructive volvulus associated with malrotation requiring segmental resection. Patient mothers in particular were gratified by this procedure at a mean followup of 11/2 years. CONCLUSIONS: The simplified antegrade continence enema in situ appendix procedure works well for refractory constipation and overflow fecal incontinence in children with neurogenic bowel secondary to spina bifida. Coaptation of the appendiceal lumen and use of small catheters allow for persistent continence without a formal surgically constructed valve mechanism. The combined antegrade continence enema and either ileovesicostomy or sigmoidovesicostomy continent urinary diversion procedures allow children to control bowel and bladder evacuation programs. A laparoscopic approach is reasonable particularly in cases requiring no other procedures.

Adolescent↗
PubMed2000

The primate appendix: a reassessment.

The presence of a vermiform appendix is often cited as a shared, derived character uniting the Hominoidea (apes and humans). However, appendix-like structures have been reported for many other primate taxa. A review of the literature reveals that the confusion arises because several different, and sometimes contradictory, criteria are enlisted to distinguish an appendix. The measures most frequently used to define this structure are gross shape and certain aspects of histology (e.g., lymphoid concentration). Unfortunately, descriptions of shape lack quantification, and histological thin-sections have not been studied for many primate taxa. In addition, although lymphoid concentration in the human appendix is known to vary considerably with age, this information is rarely reported in the primate literature. Given these complications, additional studies on the morphology and ontogeny of this region are warranted. This research will lead to a more accurate definition of the vermiform appendix. Most authors currently describe this feature as a narrow diverticulum of the cecum with thick walls and concentrated lymphoid tissue. However, the presence of thick mucosal layers and appreciable lymphoid tissue in taxa lacking appendices (e. g., Saguinus, Cercocebus) suggests that these features may be primitive primate traits. If so, wall thickness and lymphoid concentration cannot be used to define the vermiform appendix. These results suggest that a more rigorous definition of the appendix is requisite for this feature to be used in primate systematics.

Animals↗
PubMed1994

The appendix functions as a mammalian bursal equivalent in the developing rabbit.

In this paper we present genomic DNA sequence and histological evidence that the appendix is a site of diversification of the rabbit's primary antibody repertoire. By 6 weeks after birth, the B cell follicular regions of the rabbit appendix and the distribution of the resident lymphoid cells bear a strong morphological resemblance to similar regions within two primary lymphoid tissues, the chicken bursa and the sheep ileal Peyer's patch. However, similarities between the rabbit appendix, chicken bursa and sheep ileal Peyer's patch end as these animals reach adulthood. The rabbit appendix undergoes morphological and cellular distribution changes as it matures taking on the appearance of a secondary lymphoid tissue, while the sheep ileal Peyer's patch and the chicken bursa both involute. We determined DNA sequences of PCR amplified rearranged variable region genes from germinal center B cells of 6 week old rabbits isolated from several different appendix dark zones and light zones. There was a trend toward a higher degree of diversification from the germ-line VH gene DNA sequence in dark zones than light zones. It is likely that both gene conversion and somatic hypermutation are responsible for the nucleotide changes we observed. Our findings suggest that the rabbit appendix functions as a mammalian bursal equivalent early in development. As the rabbit matures, the appendix appears to evolve into a secondary lymphoid tissue resembling secondary GALT in appearance and possibly in function.

Amino Acid Sequence↗
PubMed1983

Vermiform appendix located within the cecal wall. Anomalies and bizarre locations.

The unusual finding of an acute appendix located within the posterior wall of the cecum, beneath the serosa, and its surgical removal is described. In order to remove the appendix, the cecal wall had to be incised. The appendix had no serosal covering, and had the gross appearance of a peeled seedless grape. The anatomy and embryology of the vermiform appendix, including this aberration, are presented briefly. A discussion of the difficult-to-find appendix is presented. The possibility exists that some of the reported cases of agenesis of the appendix could have been an overlooked intracecal appendix.

Adolescent↗
PubMed2004

Interaction of pathogenic bacteria with rabbit appendix M cells: bacterial motility is a key feature in vivo.

Rabbit appendix consists mainly of lymphoid follicles (LF) covered by M cells, the specialized antigen-sampling cells of the mucosal immune system, and surrounded by glandular epithelium. Until now, these M cells have been characterized morphologically and histologically by using cellular markers. Here, the adhesion and transport of pathogenic bacteria were investigated to assess the function of M cells of the appendix. We used the enteroinvasive motile Salmonella typhimurium and the rabbit enteropathogenic non-motile Escherichia coli RDEC-1, which are known to target specifically rabbit M cells of Peyer's patches (PPs). We found that S. typhimurium efficiently attached and was transported through appendix M cells in vivo. In contrast to S. typhimurium, RDEC-1 targeted M cells only ex vivo, when bacteria were allowed to have direct contact with the surface of the follicle. The difference in interaction of the two bacteria with appendix M cells led us to investigate whether this could be correlated with the lack of motility of RDEC-1. We used an aflagellate mutant of S. typhimurium and found that it had the same infection phenotype as RDEC-1. Gene complementation restored the efficiency of infection to that of S. typhimurium wild-type strain. In conclusion, we show that M cells of the appendix display features of the canonical M cells of PP, since they efficiently sample luminal pathogenic bacteria. However, due to the morphology of the appendix, motile bacteria appear to be more potent in their interactions with appendix M cells.

Animals↗
PubMed1997

[Ultrasonography of the normal vermiform appendix].

AIM: To study the detectability and the appearance of the vermiform appendix with ultrasound in asymptomatic adults. METHODS: A prospective study was performed on 300 patients, selected without regard to age, sex and weight. We tried to visualize the appendix with a 3.5 MHz annular array and a 5 MHz linear array transducer. RESULTS: In 63% of the patients the appendix was clearly visualised. The main reasons for non-visualisation were obesity with insufficient ultrasound penetration (38%) and the caecum laying in pelvic or atypical position (24%). In 31%, no cause was apparent but we assume that the appendix often lies behind the caecum. The sonographic image showed an aperistaltic target originating at the caecum, and ending blindly. In 42% of cases the appendix was ovoid in transverse section; in 32%, round; and in 26% both forms were found within one appendix. Intraluminal gas was visible in 86%. The mean transverse diameter was 5.2 mm (min. 3 mm, max. 13 mm) and in 76% the transverse diameter was lower than 6 mm. CONCLUSION: The sonographic detectability, the appearance and the size of the normal appendix show considerable variations.

Adult↗
PubMed1997

Urinary reconstruction using appendix as a urinary and catheterizable conduit in 12 patients.

BACKGROUND: The appendix vermiformis can provide an excellent urinary conduit or a catheterizable outlet in continent urinary reservoirs in selected cases. We report our clinical experience using the appendix in urinary reconstruction in adult patients. METHODS: A total of 12 patients underwent urinary reconstruction using the appendix. The indications were pelvic malignancies except for 1 patient with neurogenic bladder and difficulty in self-catheterization via urethra. The appendix was used as a catheterizable conduit in 8 patients, and as a urinary conduit in 4 patients. The in situ submucosally embedded method was used in 6 patients and the Mitrofanoff method was used in 2 patients. Follow-up ranged from 3 to 41 months (mean, 22). RESULTS: Early complications occurred in 3 patients (wound infection, false passage and intestinal anasotomotic leak). Late complications occurred in 3 (slight hydronephrosis, ileus, stomal stenosis). Emergent colostomy and pouchstomy with resection of the appendix was performed in the patient with anastomotic leak. The isoperistaltic Kock nipple valve was reconstructed for continence in this case. Prolonged ileus in 1 patient was treated by open surgery. Other complications were managed conservatively. End results were excellent in 8 patients, good in 3, and poor in 1. CONCLUSIONS: The appendix can be used advantageously as an outlet of continent urinary reservoirs or for a urinary conduit when the ureter is too short to reach the skin. Complete continence and easy catheterization can be obtained, and the appendix construction can be used as a urinary conduit instead of the ileal conduit in poor risk patients.

Aged↗
PubMed2002

Frequency of visualization and thickness of normal appendix at nonenhanced helical CT.

PURPOSE: To evaluate the frequency of visualization, thickness, and features of the normal appendix at nonenhanced helical computed tomography (CT). MATERIALS AND METHODS: Three radiologists blinded to patient surgical history retrospectively reviewed CT scans obtained for renal colic assessment in 187 consecutive patients. No contrast material was administered. The frequency of visualization and the two-wall thickness of normal appendices were recorded. Interobserver agreement and effect of adequacy of intraperitoneal fat on identification of the appendix were assessed. RESULTS: The prevalence of appendectomy was 10.7% (20 of 187 patients). The means for the three reviewers' sensitivity, specificity, positive and negative predictive values, and accuracy of visualization of normal appendix were 79% (CI: 73%, 84%), 90% (CI: 78%, 96%), 98% (CI: 97%, 99%), 34% (CI: 22%, 47%), and 80% (CI: 74%, 86%), respectively. There was no significant difference among the three reviewers (P >.05) according to conditional logistic regression and exact McNemar test results. For all reviewers, the frequency of appendix visualization was significantly lower in patients with less intraperitoneal fat (P =.01-.001, chi(2) test). The mean thickness of normal appendix if no intraluminal content was visualized was 6.6 mm +/- 1.0 (SD), and the mean thickness, excluding visualized intraluminal content, was 3.6 mm +/- 0.8. The nonweighted kappa value for interobserver agreement for normal appendix visualization was 0.69-0.75 among the three reviewers, which indicated good to excellent agreement. CONCLUSION: Most normal appendices are seen at nonenhanced helical CT. The thickness of normal appendix, when the content is not recognizable, overlaps the values currently used to diagnose appendicitis at CT.

Adolescent↗
PubMed2004

Appendix in children with cystic fibrosis: US features.

PURPOSE: To evaluate the ultrasonographic (US) appearance of the appendix in children with cystic fibrosis but who were asymptomatic for appendicitis. MATERIALS AND METHODS: Between March 2001 and March 2002, 31 children (14 boys, 17 girls; mean age, 9.5 years; range, 2-16 years) with cystic fibrosis underwent graded-compression US of the appendix. The recordings were analyzed in consensus by two radiologists specialized in US. The overall appendiceal diameter and change in diameter during graded compression, wall dimensions, contents of material in the lumen, and periappendicular fat were evaluated. The exclusion criterion was abdominal pain at the time of investigation. RESULTS: In all but one patient, the appendix was visualized with US. The diameter of the appendix ranged from 4.0 to 14.5 mm (mean, 8.3 mm). In 25 patients (83.3%), the appendix measured more than 6.0 mm. In six patients, the diameter of the appendix changed when graded compression was applied. Mucoid material was found in the lumen in 27 of 30 patients. No wall thickening occurred, and concentric layer structures of the wall were intact. No involvement of the neighboring mesenteric or omental fat was encountered. CONCLUSION: The appendiceal diameter was enlarged in the majority of children examined. The lumen contained mucoid contents. Therefore, the diameter of the appendix alone may not be a parameter for diagnosing appendicitis in patients with cystic fibrosis.

Adolescent↗
PubMed2003

Prepro-endothelin-1 mRNA and its mature peptide in human appendix.

Because the precise immunopathological events occurring in appendicitis are not completely understood, possible local production of endothelin-1 (ET-1) in human appendix was investigated. We used immunohistochemistry and in situ hybridization to detect the presence, distribution, and phenotype of ET-1-positive cells and prepro-ET-1 (pp-ET-1) mRNA-expressing cells. ET-1-positive stromal cells and pp-ET-1 mRNA-expressing cells were detected with different distributions and relative frequencies in normal control appendix, histologically normal appendix, and inflamed appendix. Six of 20 histologically normal appendixes from patients with a clinical diagnosis of acute appendicitis had many ET-1-positive stromal cells and high pp-ET-1 mRNA expression, similar to inflamed appendix. Forty percent of the pp-ET-1 mRNA-expressing cells were neutrophils, and the other positive cells were mast cells and macrophages. We suggest that local production of ET-1 by neutrophils and other inflammatory cells could be a molecular sign of focal inflammation in histologically normal appendixes and that ET-1 could be implicated, with other cytokines, in the pathogenesis of appendicitis by inducing appendiceal ischemia through vasoconstriction.

Appendicitis↗
PubMedDate not supplied

Mucinous cystadenoma of the appendix in a patient with systemic lupus erythematosus.

A 38-year-old female with systemic lupus erythematosus presented with abdominal pain, diarrhea and iron-deficient anemia. Computed tomogram showed a 2 x 4 cm inhomogeneous lesion of the right adnexa. An unusual mass was identified extending from the appendiceal orifice at colonoscopy, and an 8 cm tubular appendix, apparently prolapsed into the cecum, was identified at celiotomy. An appendectomy with cecectomy was performed. On cut section, mucin was extruded from the lumen of the appendix. A mucinous neoplasm of the appendix with mucinous dissection to the serosal surface was reported at the time of frozen section. No gross ovarian pathology or peritoneal implants were noted. Cystadenoma with associated mucocele formation was verified by permanent histology. Mucocele of the vermiform appendix is a rare condition associated with neoplastic transformation in approximately 75% of all cases. Benign mucinous cystadenoma of the appendix should be differentiated from cystadenocarcinoma by frozen section at the time of celiotomy to ensure appropriate treatment. While systemic lupus erythematosus can lead to cutaneous mucinosis, an association with mucinous cystadenoma of the appendix has not been previously reported. Surveillance for metachronous colonic neoplasms is warranted in patients diagnosed with a mucinous neoplasm of the appendix.

Adult↗