Incidental High-Grade Appendiceal Mucinous Neoplasm.

BACKGROUND: High-grade appendiceal mucinous neoplasm (HAMN) is an uncommon epithelial neoplasm of the appendix, and it is a median risk lesion that can be placed between benign low-grade appendiceal mucinous neoplasm (LAMN) and malignant adenocarcinoma. The diagnosis can be both incidental during surveillance imaging or clinically similar to acute appendicitis, which presents as pain in the right lower quadrant, or local pressure on adjacent organs. It carries the potential to progress to cancer if left untreated. Our aim is to review the literature and to report this rare tumor with outlining its clinical presentation, histologic features, and management.

CASE DESCRIPTION: A 50-year-old man with end-stage renal disease (ESRD) on hemodialysis underwent evaluation for kidney transplantation. A noncontrast CT abdomen revealed an incidental appendiceal mass during routine pretransplant imaging. The patient was asymptomatic with no gastrointestinal complaints. We performed a robotic appendectomy with partial cecectomy. The size of the mass was 10 × 5.5 × 3.5 cm. Pathology confirmed HAMN limited to the appendix, stage pTis (HAMN), with a negative margin and negative lymph nodes involvement pN0. The patient recovered well, and he will be monitored for recurrence while awaiting the renal transplant.

CONCLUSION: HAMN is a recently recognized diagnosis. It can progress to an aggressive nature if left untreated. A standard appendectomy is performed for appendix limited lesions with right hemicolectomy in the presence of invasive characteristics. A comprehensive screening and vigilant clinical evaluation are essential before transplantation.