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RACS ASC 2025
Delivery of an Incidental Appendiceal Mucinous Neoplasm
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Institution: Ipswich Hospital - Queensland, Australia

Low-grade appendiceal mucinous neoplasms (LAMNs) are rare, non-invasive tumors of the appendix, accounting for 0.2-0.7% of appendiceal specimens. We present a case of a 38-year-old pregnant woman with an incidental LAMN identified during an emergency cesarean section. Intra-operatively, a dilated, fluid-filled appendix measuring 120 x 40mm was noted. She underwent resection via a stapled caecectomy. Histopathology confirmed a LAMN confined to the submucosa with no extracellular mucin or atypical epithelium on the serosal surface. There was extracellular mucin with inflammatory cells at the proximal margin and so she subsequently underwent a laparoscopic right hemicolectomy. This revealed benign histology only. LAMNs are rare epithelial proliferations that exhibit an absence of infiltrative growth. Histologically, their hallmark feature is a villous or flat proliferation of mucinous epithelium with low-grade atypia. They can be found incidentally, either radiologically or surgically, or can present with non-specific symptoms such as abdominal pain, a palpable mass, weight loss or with complications such as appendicitis, intestinal obstruction, or intussusception Despite having a relatively good prognosis, their most concerning complication, pseudomyxoma peritonei (PMP), is secondary to seeding of mucin into the adjacent peritoneum or rupture during surgical excision. Treatment typically involves appendectomy, with right hemicolectomy reserved for cases with malignant features or positive margins. This case underscores the importance of meticulous surgical handling to prevent mucin spillage, particularly in emergency situations such as cesarean sections.
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Dr Madison Bowles -