Local Protocol for Management of Low-Grade Appendiceal Mucinous Neoplasm (LAMN)


The management and surveillance of low-grade appendiceal mucinous neoplasm (LAMN) is a confusing topic in the colorectal MDM. This study was aiming to provide a local protocol for our trust for such cases. From prospectively maintained database, patients who underwent appendicectomy between 2011 and 2017 were identified. Those with histological confirmation of LAMN were included. Retrospective analysis of operative notes, investigations and follow-up, return to theatres or development of pseudomyxoma peritonei (PMP) was performed. Four thousand six hundred twenty-eight patients had appendicectomy; 36 were diagnosed with LAMN. Age range was 30–88 (20 females). Fifteen had their operation as emergency and 13 elective, either for abnormal-looking appendix on CT scan or as part of elective right hemicolectomy. In 8 patients, LAMNs were diagnosed incidentally during other surgery either intraoperatively or on histology. Two patients had mucus in the peritoneal cavity (not sampled). The remaining 34 had either contained mucocele or inflamed appendix. Regarding follow-up, 28 patients had CT scans only, and 2 had ultrasound scan (USS). Two had both CT and USS. Three had CT and MRI scans. One patient did not have radiological investigations. Eighteen patients had colonoscopies (50%). Three patients had no follow-up, while 33 had 5-year follow-up. Ten patients are still currently under follow-up. None of the 36 patients required further surgeries related to LAMN, and none has developed PMP to date of the study. We have developed a local protocol based on our findings and literature review for management and surveillance of LAMN in line with national centres.

This is a preview of subscription content, log in to check access.


  1. 1.

    Yakan S, Caliskan C, Uguz A, Korkut MA, Çoker A (2011) A retrospective study on mucocele of the appendix presented with acute abdomen or acute appendicitis. Hong Kong J Emerg Med 18(3):144–149

    Article  Google Scholar 

  2. 2.

    Shaib WL, Assi R, Shamseddine A, Alese OB, Staley C III, Memis B, Adsay V, Bekaii-Saab T, El-Rayes BF (2018) Appendiceal mucinous neoplasms: diagnosis and management. Oncologist 23(1):137–137

    Article  Google Scholar 

  3. 3.

    Tirumani SH, Fraser-Hill M, Auer R, Shabana W, Walsh C, Lee F, Ryan JG (2013) Mucinous neoplasms of the appendix: a current comprehensive clinicopathologic and imaging review. Cancer Imaging 13(1):14–25

    Article  Google Scholar 

  4. 4.

    Carr NJ, Cecil TD, Mohamed F, Sobin LH, Sugarbaker PH, González-Moreno S, Taflampas P, Chapman S, Moran BJ, Peritoneal Surface Oncology Group International (2016) A consensus for classification and pathologic reporting of pseudomyxoma peritonei and associated appendiceal neoplasia: the results of the Peritoneal Surface Oncology Group International (PSOGI) modified Delphi process. Am J Surg Pathol 40(1):14–26

    Article  Google Scholar 

  5. 5.

    Misdraji J (2015) Mucinous epithelial neoplasms of the appendix and pseudomyxoma peritonei. Mod Pathol 28:S67–S79

    Article  Google Scholar 

  6. 6.

    Rajesh C, Kulbhushan S, Somraj M, Ankit S, Umesh D, Kaundal V (2017) Low-grade appendiceal mucinous neoplasm; a lesser known entity with significant morbidity: case report. JOJ Case Stud 2(1):555578

    Google Scholar 

  7. 7.

    Motsumi MJ, Motlaleselelo P, Ayane G, Sesay SO, Valdes JR (2017) A case report of a giant appendiceal mucocele and literature review. Pan Afr Med J 28:106

    Article  Google Scholar 

  8. 8.

    Abuoğlu H, Yıldız MK, Kaya B, Odabaşı M (2017) Clinicopathological analysis of patients operated for appendiceal mucocele. Ulus Travma Acil Cerrahi Derg 23(3):230–234

    PubMed  Google Scholar 

  9. 9.

    Pai RK, Beck AH, Norton JA, Longacre TA (2009) Appendiceal mucinous neoplasms: clinicopathologic study of 116 cases with analysis of factors predicting recurrence. Am J Surg Pathol 33:1425–1439

    Article  Google Scholar 

  10. 10.

    Carr NJ, McCarthy WF, Sobin LH (1995) Epithelial noncarcinoid tumors and tumor-like lesions of the appendix. A clinicopathologic study of 184 patients with a multivariate analysis of prognostic factors. Cancer 75:757–768

    CAS  Article  Google Scholar 

  11. 11.

    Yantiss RK, Shia J, Klimstra DS, Hahn HP, Odze RD, Misdraji J (2009) Prognostic significance of localized extra-appendiceal mucin deposition in appendiceal mucinous neoplasms. Am J Surg Pathol 33:248

    Article  Google Scholar 

  12. 12.

    Honoré C, Caruso F, Dartigues P et al (2015) Strategies for preventing pseudomyxoma peritonei after resection of a mucinous neoplasm of the appendix. Anticancer Res 35:4943

    PubMed  Google Scholar 

  13. 13.

    Lo NS, Sarr MG (2003) Mucinous cystadenocarcinoma of the appendix. The controversy persists: a review. Hepatogastroenterology 50:432

    PubMed  Google Scholar 

  14. 14.

    Demetrashvili Z, Chkhaidze M, Khutsishvili K, Topchishvili G, Javakhishvili T, Pipia I, Qerqadze V (2012) Mucocele of the appendix: case report and review of literature. Int Surg 97:266

    Article  Google Scholar 

  15. 15.

    Barrios P, Losa F, Gonzalez-Moreno S, Rojo A, Gómez-Portilla A, Bretcha-Boix P, Ramos I, Torres-Melero J, Salazar R, Benavides M, Massuti T, Aranda E (2016) Recommendations in the management of epithelial appendiceal neoplasms and peritoneal dissemination from mucinous tumours (pseudomyxoma peritonei). Clin Transl Oncol 18:437–448

    CAS  Article  Google Scholar 

  16. 16.

    Choudry HA, Pai RK (2018) Management of Mucinous Appendiceal Tumors. Ann Surg Oncol 25:2135–2144

    Article  Google Scholar 

  17. 17.

    Arnason T, Kamionek M, Yang M, Yantiss RK, Misdraji J (2015) Significance of proximal margin involvement in low-grade appendiceal mucinous neoplasms. Arch Pathol Lab Med 139:518

    CAS  Article  Google Scholar 

  18. 18.

    Misdraji J (2015) Mucinous epithelial neoplasms of the appendix and pseudomyxoma peritonei. Mod Pathol 28 Suppl 1:S67

    Article  Google Scholar 

  19. 19.

    Guaglio M, Sinukumar S, Kusamura S, Milione M, Pietrantonio F, Battaglia L, Guadagni S, Baratti D, Deraco M (2018) Clinical surveillance after macroscopically complete surgery for low-grade appendiceal mucinous neoplasms (LAMN) with or without limited peritoneal spread: long-term results in a prospective series. Ann Surg Oncol 25(4):878–884

    Article  Google Scholar 

  20. 20.

    Asenov Y, Korukov B, Penkov N et al (2015) Appendiceal mucocele -case report and review of the literature. Chirurgia (Bucur) 110:565–569

    CAS  Google Scholar 

  21. 21.

    Padmanaban V, Morano WF, Gleeson E, Aggarwal A, Mapow BL, Stein DE, Bowne WB (2016) Incidentally discovered low-grade appendiceal mucinous neoplasm: a precursor to pseudomyxoma peritonei. Clin Case Rep 4:1112–1116

    Article  Google Scholar 

  22. 22.

    McFarlane ME, Plummer JM, Bonadie K (2013) Mucinous cystadenoma of the appendix presenting with an elevated carcinoembryonic antigen (CEA): report of two cases and review of the literature. Int J Surg Case Rep 4:886–888

    CAS  Article  Google Scholar 

  23. 23.

    Gündoğar Ö, Kımıloğlu E, Komut N, Cin M, Bektaş S, Gönüllü D, İlgün AS, Erdoğan N (2018) Evaluation of appendiceal mucinous neoplasms with a new classification system and literature review. Turk J Gastroenterol 29(5):532–542

    Article  Google Scholar 

  24. 24.

    Stocchi L, Wolff BG, Larson DR, Harrington JR (2003) Surgical treatment of appendiceal mucocele. Arch Surg 138(6):585

    Article  Google Scholar 

  25. 25.

    Nitecki SS, Wolff BG, Schlinkert R, Sarr MG (1994) The natural history of surgically treated primary adenocarcinoma of the appendix. Ann Surg 219(1):51

    CAS  Article  Google Scholar 

  26. 26.

    Rutledge RH, Alexander JW (1992) Primary appendiceal malignancies: rare but important. Surgery 111(3):244

    CAS  PubMed  Google Scholar 

  27. 27.

    Soweid AM, Clarkston WK, Andrus CH, Janney CG (1998) Diagnosis and management of appendiceal mucoceles. Dig Dis 16(3):183

    CAS  Article  Google Scholar 

  28. 28.

    Arnason T, Kamionek M, Yang M, Yantiss RK, Misdraji J (2014) Significance of proximal margin involvement in low-grade appendiceal mucinous neoplasms. Arch Pathol Lab Med 139(4)

  29. 29.

    Glasgow SC, Gaertner W, Stewart D, Davids J, Alavi K, Paquette IM, Steele SR, Feingold DL (2019) The American Society of Colon and Rectal Surgeons, Clinical practice guidelines for the management of appendiceal neoplasms. Dis Colon Rectum 62(12):1425

    Article  Google Scholar 

  30. 30.

    Michael J Overman, Carolyn C Compton, Kanwal Raghav (2020) Appendiceal mucinous lesions. https://www.uptodate.com/contents/appendiceal-mucinous-lesions?search=appendiceal/mucinous/lesions&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1. Accessed 11 March 2020

  31. 31.

    Nikolaos S. Salemis, Georgios Nakos, Ilias Katikaridis, Andreas Zografidis Synchronous occurrence of appendiceal mucinous cystadenoma, with colon adenocarcinoma and tubulovillous rectal adenoma: management and review of the literature

Download references

Author information




MB has performed data analysis, literature search and writing the manuscript. MT shared in the study design, data collection and reviewed the manuscript. AH critiqued and edited the manuscript. NP designed the study, reviewed and edited the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mohamed Boshnaq.

Ethics declarations

Competing Interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Boshnaq, M., Toeima, M., Hamade, A. et al. Local Protocol for Management of Low-Grade Appendiceal Mucinous Neoplasm (LAMN). Indian J Surg Oncol (2020). https://doi.org/10.1007/s13193-020-01147-x

Download citation


  • Appendiceal
  • Mucinous
  • Neoplasm
  • Management
  • Follow-up