Large Mucocele of the Appendix at Laparoscopy Presenting as an Adnexal Mass in a Postmenopausal Woman: A Case Report

A 79-year-old female was referred to our Gynecologic Department presenting with a pelvic magnetic resonance imaging (MRI), showing an adnexal mass, later confirmed at the pelvic examination. The patient’s routine laboratory tests were normal. A sonographic examination was performed with inconclusive results. Although the ultrasonography excluded the presence of vascularization and malignant degeneration, the adnexal localization appeared to be dubious. The laparoscopy and the subsequent histologic examination revealed the presence of a mucocele of the appendix. The following case report focuses the attention on a misdiagnosis of appendiceal mucocele. The misdiagnosis caused no negative impact on the treatment that in this case was adequate and successful. 1. Introduction Mucocele of the appendix is a rare pathology with an incidence of approximately 0.2 to 0.3% of all appendicectomy specimens [1–4]. Mucocele of the appendix was first described by Rokitansky in 1842. Today, the modern classification defines four subgroups of mucoceles: a simple retention cyst determined by intraluminal accumulation of mucoid material, rarely greater than 2？cm; mucosal hyperplasia, a mild dilatation with areas of hyperplastic epithelium; mucinous cystadenoma characterized by a dilatation of the lumen up to 6？cm with low grade dysplasia; mucinous cystadenocarcinoma with stromal invasion and intraperitoneal spread, similar to that of ovarian mucinous cystadenocarcinoma. The symptomatology of mucoceles is not specific and sometimes they can be asymptomatic [3–8]. 2. Case Presentation A 79 year-old woman was referred to our department with a magnetic resonance imaging (MRI) requested during her last gynecological examination, when a pelvic mass had been incidentally detected by office ultrasonography. The MRI showed a well capsulated cystic mass on the right ovary with a maximum diameter of 8？cm, homogeneous fluid content, and smooth regular walls without inner vegetations. The patient did not complain of any symptoms and her clinical history was characterized only by episodes of atrial fibrillation. No documentation of previous surgeries was reported. The pelvic examination was negative except for the presence of a palpable mass appreciated at the right vaginal fornix. Laboratory tests were all negative as well as tumor markers (Cea, Ca125, Ca15.3, and Ca19.9 were 1.26？ng/mL, 8.10？U/mL, 14.10？U/mL, and 3.44？U/mL, resp.). The sonographic examination pointed out the presence, in the right adnexal region, of an oblong, well capsulated, uniloculated mass, characterized by