Mucinous cystadenocarcinoma of appendix with pseudomyxoma peritonei presents as an inguinal hernia - A case report and literature review

A 45-year-old man presented with a right inguinal hernia. At herniorrhaphy, unexpectedly, large amount of gelatinous matter was drained from the peritoneal cavity via the hernia sac. Subsequently, exploratory laparotomy revealed an appendiceal tumor, which pathologically proved to be mucinous cystadenocarcinoma with pseudomyxoma peritonei. Two weeks later, a secondary procedure of right hemicolectomy and omentectomy was performed, which revealed no residual tumor cells of appendiceal stump, cecal wall, or mesenteric lymph nodes. Convalescence was uneventful and no evidence of tumor recurrence was found at the one year follow-up. Involvement of the inguinal hernia sacs by neoplastic processes has been reported in patients with malignant or benign tumors. However, it rarely occurs in an appendiceal mucinous cystadenocarcinoma, with only four cases being reported in the previous English literature. Here, we add another case to illustrate this rare disease entity.