A case of locally advanced appendicular mucinous adenocarcinoma

Locally advanced mucinous neoplasms of the appendix are rarely seen to present as extraperitoneal disease without pseudomyxoma peritonei or peritoneal carcinomatosis. We present a case of advanced appendicular mucinous neoplasm with fungating abdominal wall growth. A 72-year-old female with a history of a laparoscopic appendectomy two years back developed an intra-abdominal collection one year back, which was drained, resulting in a persistent discharging sinus in the lateral abdominal wall. It slowly developed into fungating growth with jellylike substances. The treating physician found that the appendectomy specimen following previous surgery had high grade mucinous neoplasm. A computed tomographic scan showed circumferential enhancing mural thickening of the appendicular stump that was communicating with a subcutaneous collection in the adjacent abdominal wall, along with a hypodense lesion that also encroached on the ascending colon. However, there was no evidence of intraperitoneal spread. Positron emission tomography and computed tomography (PET-CT) didn’t show any distant metabolic activity. She was planning for surgery, along with a prior consultation with plastic and reconstructive surgery, as an abdominal defect was expected to require reconstruction. At surgery, there was no evidence of peritoneal dissemination, but a localized ulcerous-proliferative growth with infiltration of the parietal wall and direct extension into the cecum and ascending colon. Right hemicolectomy, along with wide local excision, was done. The defect was closed by placement of mesh that was further reinforced by myocutaneous free flap reconstruction. She had an uneventful post-operative period and was discharged in stable condition.