Irfan Shukr.
Mucinous cyst adenoma of appendix, of unusual size in a young man.
Pak Armed Forces Med J Jan ;56(2):201-3.

Thirty four years old, male, presents with abdominal swelling and constipation off and on of 6 months duration. Patient noticed painless swelling in the abdomen 6 months ago, which was of the size of a football, when one of his relatives pointed towards his abdominal distention, which he never thought wrong off. The swelling gradually increased in size. With increase in size of swelling patient felt non-specific abdominal discomfort and early abdominal fullness after eating food. Examination revealed patient had normal vital signs. He had a protruding abdomen with a large intra abdominal mass approx 27 into 19 cm in size, extending from epigastric region into pelvis and across both iliac regions. It was nontender, had smooth surface, with indistinct edges. Lower limit was not palpable. It had limited mobility and firm consistency. Ultra sound abdomen showed a large predominantly cystic mass with internal echoes, compressing th e sigmoid colon, raising doubt of food particles in it or hydatid cyst. Echinococcus antibodies were not present. Barium enema was normal except narrowing of sigmoid colon due to extrinsic compression. Ultrasound guided Fine Needle Aspiration Cytology was non-diagnostic. CT scan confirmed that it was a large cystic mass indenting upper surface of urinary bladder, compressing right ureter and causing mild right hydronephrosis. At places gut interface was indistinct. Calcification was seen at places in the wall of the cyst. Laparotomy was done on June 20 2004. Patient had a large mass, 25 into 16 cm originating from the distil portion of the appendix. It was adherent with small intestine, right ureter and sigmoid colon. Appendicectomy was done with excision of the mass after separating it from adjacent adherent structures with blunt and sharp dissection. Histopathology of the specimen confirmed it to be mucinous cyst adenoma of the appendix. Patient had uneventful recovery.

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