Discrepancies between preoperative diagnosis of tumors and the right uterine appendage and intraoperative data. Appendiculare mucocele, which manifests itself in the form of an appendage formation. Clinical case





right uterine appendages, mucocele, appendix, pyosalpinx


Tumor formations of the tubes, hydrosalpinxes, pyosalpixes have a number of discrepancies in outpatient service examinations and intraoperative clinical diagnosis.

Purpose - to report a unique case with discrepancies between the preoperative diagnosis (pyosalpinx, hydrosalpinx) and the intraoperative and postoperative definitive findings (appendicular tumor, mucocele).

Clinical case. A 50-year-old woman, a 3-year-old Mirena IUD wearer, applied for examination for pain in the right iliac region and a slight rise in temperature to 37-37.5 over the past 10 days. The examination showed the movement of the tumor on the right up to 7-4 cm, sensitive on palpation, uterine fibroids, and appendices on the left without features. Other history, physical examination, and laboratory tests were not remarkable, and there was no leukocytosis as in inflammatory processes. Ultrasound and MRI showed neoplasms of the right appendages of 7-5-4 cm, avascular and uterine fibroids - 3 subserosal nodes of 10-5 mm each. Intraoperatively Intact 2 fallopian tubes were detected, a tumor formation of the appendix 3-2-3 cm without adhesions was isolated. Laparoscopic appendectomy was performed along with conservative myomectomy and bilateral salpingectomy. Histopathology showed mucocele without atypia, myomas nodules, and fallopian tubes without features.

Conclusions. In the formation of the right appendages of the uterus, a thorough preoperative diagnosis is required, which does not always give a definitive answer to the clinical diagnosis. Diagnostic laparoscopy, visual and operational clinical experience of the surgeon, cytological and histological examination of intra- and postoperative results make it possible to carry out adequate surgical treatment. Patients should be informed about doubts between outpatient and intraoperative diagnosis, possible changes in the intraoperative surgical plan. Prompt care should be provided in institutions with appropriate teams and equipment.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Author Biography

V.О. Sklyarovа, Danylo Halytsky Lviv National Medical University

Lviv Regional Hospital of War Veterans and Repressed named after Y. Lypa, Ukraine


Agha RA, Borrelli MR, Farwana R, Koshy K, Fowler A, Orgill DP et al. (2018). The SCARE 2018 statement: updating consensus Surgical CAse REport (SCARE) Guidelines. Int. J. Surg. 60: 132-136. Epub 2018 Oct 18. https://doi.org/10.1016/j.ijsu.2018.10.028; PMid:30342279

Agrusa A, Romano G, Galia M, Cucinella G, Sorce V, Di Buono G. (2016). Appendiceal mucinous neoplasms: an uncertain nosological entity. Report of a case. G. Di Chir. 37: 86-89. https://doi.org/10.11138/gchir/2016.37.2.086; PMid:27381696 PMCid:PMC4938228

Aho A, Heinonen R, Laurén P. (1973). Benign and malignant mucocele of the appendix. Histological types and prognosis. Acta Chir. Scand. 139: 392-400.

Akman L, Hursitoglu BS, Hortu I, Sezer T, Oztekin K, Avsargil BD. (2014). Large mucinous neoplasm of the appendix mimicking adnexal mass in a postmenopausal woman. Int. J. Surg. Case Rep. 5: 1265-1267. https://doi.org/10.1016/j.ijscr.2014.11.050; PMid:25498566 PMCid:PMC4275782

Aleter A, El Ansari W, Toffaha A, Ammar A, Shahid F, Abdelaal A. (2021). Epidemiology, histopathology, clinical outcomes and survival of 50 cases of appendiceal mucinous neoplasms: Retrospective cross-sectional single academic tertiary care hospital experience. Ann. Med. Surg. (Lond). 64: 102199. https://doi.org/10.1016/j.amsu.2021.102199; PMid:33815784 PMCid:PMC8010208

Alsubaie NR, Ibrahim MA, Nassar MA, Alsalama MI. (2023). Appendicular mucinous cystadenoma: a case report. J. Surg. Case Rep. 3: rjad097. https://doi.org/10.1093/jscr/rjad097; PMid:36926628 PMCid:PMC10014171

American college of obstetricians and gynecologists' committee on practice bulletins - gynecology. (2016). Practice bulletin No. 174: evaluation and management of adnexal masses. Obstet. Gynecol. 128: e210-e226. https://doi.org/10.1097/AOG.0000000000001768; PMid:27776072

Ayadi C, Naggar A, Andour H, Chraa FZ, Jerguigue H, Latib R, Omor Y. (2022). Appendiceal mucocele with pseudomyxoma peritonei mimicking ovarian tumor with peritoneal carcinomatosis. Radiol. Case Rep. 17 (9): 3000-3004. https://doi.org/10.1016/j.radcr.2022.05.028; PMid:35755120 PMCid:PMC9217994

Butt MQ, Chatha SS, Farooq M, Ghumman AQ. (2014). Mucocele of appendix secondary to mucinous cystadenoma. J. Coll. Physicians. Surg. Pak. 24: S14-15.

Cristian DA, Grama FA, Becheanu G, Pop A, Popa I, Şurlin V. (2015). Low-grade appendiceal mucinous neoplasm mimicking an adnexal mass. Rom. J. Morphol. Embryol. 56: 837-842.

Derbal S, Klapczynski C, Charissoux A, Durand Fontanier S, Taibi A. (2023). Management of mucocele of the appendix with peritoneal dissemination in pregnant women: a case report and literature review. Acta Chir Belg. 123 (2): 185-191. https://doi.org/10.1080/00015458.2021.1956800; PMid:34266364

Dhage-Ivatury S, Sugarbaker PH. (2006). Update on the surgical approach to mucocele of the appendix. J. Am. Coll. Surg. 202: 680-684. https://doi.org/10.1016/j.jamcollsurg.2005.12.003; PMid:16571440

Dos Santos S, Mongin C, Humeau M. (2022). Volvulus of the appendix secondary to appendicular mucocele. J. Visc. Surg. 159 (4): 347-348. https://doi.org/10.1016/j.jviscsurg.2021.11.008; PMid:34848161

Givens V, Mitchell GE, Harraway-Smith C, Reddy A, Maness DL. (2009, Oct 15). Diagnosis and management of adnexal masses. Am Fam Physician. 80 (8): 815-820. PMID: 19835343.

Hassan Y, Anees A, Peer JA, Yadav M. (2022). Three Cases of Appendiceal Mucocele: From Diagnosis to Management. Saudi J. Med. Med. Sci. 10 (3): 276-280. https://doi.org/10.4103/sjmms.sjmms_646_21; PMid:36247061 PMCid:PMC9555033

Jelev G, Vassilev I, Usheva S, Yanev T, Sedloev T. (2023). А case of a mucocele of the appendix - A diagnostic and therapeutic dilemma. Int. J. Surg. Case. Rep. 105: 108082. https://doi.org/10.1016/j.ijscr.2023.108082; PMid:37001374 PMCid:PMC10070622

Khan A, Al Subaie RS, Almohammed Saleh AA. (2023). Mucocele of the Appendix: A Case Report and Review of Literature. Cureus. 9: 15 (6): 40168. https://doi.org/10.7759/cureus.40168

Paladino E, Bellantone M, Conway F, Sesti F, Piccione E, Pietropolli A. (2014). Large mucocele of the appendix at laparoscopy presenting as an adnexal mass in a postmenopausal woman: a case report. Case Rep. Obstet. Gynecol: 1-4. https://doi.org/10.1155/2014/486078; PMid:24804128 PMCid:PMC3997859

Papoutsis D, Protopappas A, Belitsos P, Sotiropoulou M, Antonakou A, Loutradis D. (2012). Mucocele of the vermiform appendix misdiagnosed as an adnexal mass on transvaginal sonography. J. Clin. Ultrasound. 40: 522-525. https://doi.org/10.1002/jcu.20858; PMid:21739436

Ruiz-Tovar J, Teruel DG, Castiñeiras VM, Dehesa AS, Quindós PL, Molina EM. (2007). Mucocele of the appendix. World J. Surg. 31: 542-548. https://doi.org/10.1007/s00268-006-0454-1; PMid:17318706

Sekkat H, El Hamzaoui J et al. (2023). A colic mesothelial cyst, mimicking an appendicular mucocoele in an elderly patient: A case report and a literature review. J Minim. Access. Surg: 10. https://doi.org/10.4103/jmas.jmas_199_22; PMCid:PMC10246625

Toffaha A, El Ansari W, Aleter A. (2020). What you see might not be what you get: Discrepancies between intraoperative findings and preoperative diagnosis of ovarian tumors. Appendicular mucocele presenting as an adnexal mass - Case report and review of literature. Int. J. Surg. Case. Rep. 75: 543-549. https://doi.org/10.1016/j.ijscr.2020.09.112; PMid:32981881 PMCid:PMC7567046