Interactive Transcript
0:01
So this is the same patient that presented
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to our institution a few months later,
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in regards to their presumed mucocele.
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Remember too that mucoceles can range from
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the benign mucinous cystadenoma to malignant
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variety, which is the cystadenocarcinoma, with
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any kind of level in between, including LAM,
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which is a low-grade appendiceal mucinous tumor.
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So same patient, you'll recognize this
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mucocele, you'll see that calcification in the
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center of it, some in the walls right here.
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But something happened in the interim.
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So we scroll through it.
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It looks pretty much similarly dilated.
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There's not really any inflammation around it.
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We don't have an acute appendicitis
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component of this, but you do now have
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this almost loculated fluid anterior to it.
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And if you're looking closely at the
0:45
wall, we've lost the wall right here.
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So in between those several months of when that
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patient presented to the outside institution
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and then came to our institution for surgery
0:56
and for purposes of planning their surgery.
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Okay.
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This mucous cyst ruptured.
0:59
You have loss of integrity
1:00
of the wall right here.
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You can also tell this isn't an abscess.
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This is the mucous cyst
1:04
itself by handful of units.
1:06
It's virtually identical.
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If you put them on, there's no enhancing wall.
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However, this does look loculated.
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It's not like free fluid that
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should flow into the pelvis.
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You can see here, there really is no
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free fluid layering in the pelvis.
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And that's because this isn't free fluid.
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This is mucus.
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So it's going to kind of sit where it
1:23
ruptured from, but it's not an abscess.
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There's no thick wall.
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There's nothing enhancing right here.
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So it's kind of this in
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between sort of appearance.
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In this case, the mucous cyst ruptured,
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which is very important for the surgeon to
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know, because it goes from a simple, uh,
1:37
Appendectomy, partial colectomy, take this out.
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This hasn't spread anywhere, so this
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is clearly spread into the peritoneum.
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And now you might have to consider further
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therapies such as beyond just cytoreductive
1:49
therapy, where you get out all the deposits
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that you can, but you might need HIPEC, which
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is hypothermic intraperitoneal chemotherapy.
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This is still a little bit
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tricky and controversial.
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This therapy itself, but at our
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institution, it's pretty, pretty standard
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for what we'll do in cases like this.
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So this person did end up going to get their
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mucosal taken out and it had ruptured as
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you know, it was very clear on the CT scan
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itself and they did end up getting HIPEC
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and this ended up being a low-grade
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appendiceal mucinous neoplasm, but as you
2:20
can tell, given that this is here, this
2:22
kind of gelatinous mucinous material, it's
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going to be much trickier, longer surgery,
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with possible recurrence simply because you
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cannot clear out all of that very easily
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in a surgery, whereas you can just take
2:33
the appendix out if it hasn't ruptured yet.
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