Mucinous Appendiceal Adenocarcinoma Penetrated the Quadratus Lumborum Muscle Posteriorly and Presented as Gluteal Absces
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CASE REPORT
Mucinous Appendiceal Adenocarcinoma Penetrated the Quadratus Lumborum Muscle Posteriorly and Presented as Gluteal Abscess Managed Aggressively with Drainage Followed by Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Combined with Intraoperative Radiotherapy. a Case Report and Review of the Literature Ayman Zaki Azzam 1,2
&
Fatimah Hassan Al-Hamadah 2 & Kareem Ayman Azzam 3 & Tarek Mahmoud Amin 2
Received: 22 June 2019 / Accepted: 7 May 2020 / Published online: 21 May 2020 # Indian Association of Surgical Oncology 2020
Abstract Appendiceal mucinous adenocarcinoma is a term that was given for invasive appendiceal tumors. It is always present with pseudomyxoma peritonei which is a complex disease. These tumors have the tendency to surround the primary tumor then extend primarily and extensively all over the peritoneal cavity as the primary site of metastases. The invasion through the abdominal wall muscles is rare but the penetration and passing through these muscles to the subcutaneous tissue are extremely rare. A 62-year-old male patient known to have pseudomyxoma peritonei presented with gluteal abscess. After 2 weeks from the abscess drainage, the patient underwent cytoreductive surgery (CRS) combined with intraoperative radiotherapy (IORT) and hyperthermic intraperitoneal chemotherapy (HIPEC). He tolerated the operation well and discharged home in a good condition. Even with extensive appendiceal mucinous neoplasms presented with the penetration of the abdominal wall muscles, still aggressive management should be considered. Keywords Mucinous appendiceal adenocarcinoma . Quadratus lumborum muscle . Gluteal abscess . Cytoreductive surgery . Hyperthermic intraperitoneal chemotherapy . Intraoperative radiotherapy
Introduction
* Ayman Zaki Azzam
Fatimah Hassan Al-Hamadah [email protected] Kareem Ayman Azzam [email protected] Tarek Mahmoud Amin [email protected] 1
General Surgery Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
2
Surgical Oncology Department, Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
3
Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have proved to be an effective management for extensive peritoneal disease from appendiceal adenocarcinoma. [1–3] A very rare presentation for mucinous appendiceal neoplasms is abdominal wall muscle invasion. [4] This manuscript reports the clinical scenario and the CT scan image of the patient at presentation as a very rare form of presentation and encourages the aggressive resection and management with CRS combined with IORT and HIPEC. Case Report A 62-year-old male medically free was referred to surgical oncology clinic at KFSH&RC complaining of right lower abdominal pain since 2 months getting worse gradually radiating to the right flak. This was associated with weight loss and loss of appetite. On examination, there was a slightly tender
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