Tubulo-villous adenoma of the appendix: A case report and review of the literature
•Tubulo-villous adenoma is a rare benign appendiceal neoplasm.•This neoplasm is often asymptomatic and occasionally discovered at surgery.•Acute appendicitis is the most common clinical presentation.•Pre-operative diagnosis, even with the help of radiological imaging, is difficult.•Appendectomy is c...
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| Published in: | International journal of surgery case reports Vol. 61; pp. 60 - 63 |
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| Main Authors: | , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Netherlands
Elsevier Ltd
01-01-2019
Elsevier |
| Subjects: | |
| Online Access: | Get full text |
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| Summary: | •Tubulo-villous adenoma is a rare benign appendiceal neoplasm.•This neoplasm is often asymptomatic and occasionally discovered at surgery.•Acute appendicitis is the most common clinical presentation.•Pre-operative diagnosis, even with the help of radiological imaging, is difficult.•Appendectomy is considered the correct treatment.
Tubulo-villous adenoma is a rare benign appendiceal neoplasm often asymptomatic with the most clinical manifestation that resembles acute appendicitis. Pre-operative diagnosis is difficult by its rarity and the absence of typical symptoms. Adequate treatment is surgical resection.
A 69-year-old male was admitted to the Emergency Department with a two-day history of abdominal pain associated with constipation. Abdominal examination revealed abdominal pain localized, at deep palpation, in the right iliac fossa and in hypogastrium without obvious muscle guarding or rebound tenderness. Laboratory tests showed a normal white blood cell count with 82.3% neutrophils and high C-reactive protein level. After a negative abdominal ecography, the patient was evaluated by abdominal computed tomography, which revealed acute appendicitis. The patient was submitted to surgery and open appendectomy was performed. The post-operative course was uneventful and the patient was discharged on the 5th post-operative day.
Acute appendicitis may be a clinical manifestation of a benign appendiceal neoplasm. Pre-operative radiological investigations not always are useful for an early diagnosis that is mandatory because of the potential risk of malignant degeneration. Appropriate treatment of acute appendicitis is debated: some surgeons suggest operative treatment, but others advocate for non-operative management. In our case the patient was submitted to surgery avoiding the risk of diagnostic delay of neoplasm.
Appendiceal tubulo-villous adenoma is a rare neoplasm difficult to diagnose and suspect because of lack of pathognomonic symptoms and specific diagnostic signs. Acute appendicitis is the most common clinical presentation. Appendectomy is the appropriate treatment. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| ISSN: | 2210-2612 2210-2612 |
| DOI: | 10.1016/j.ijscr.2019.06.061 |