Low-Grade Appendiceal Mucinous Neoplasm as an Incidental Finding During Cesarean Section: A Case Report

BACKGROUND Appendiceal mucinous neoplasm (AMN) is a rare tumor, representing 0.2-0.7% of all appendiceal neoplasms. Low-grade AMN (LAMN) occurs more often in women and is often misdiagnosed as appendicitis due to its vague symptoms. It involves mucin accumulation causing appendiceal dilation and carries a risk of pseudomyxoma peritonei (PMP). Prognosis depends on disease extent, with survival rates declining once the tumor spreads beyond the appendix. During pregnancy, diagnosis is challenging because of non-specific symptoms and limited imaging options, highlighting the importance of clinical vigilance and thorough intraoperative evaluation to ensure timely diagnosis and management. CASE REPORT This report describes the case of a 45-year-old woman with LAMN, incidentally discovered during an elective cesarean section at 40 weeks of gestation, and is the first documented report of this type in Serbia. The patient was asymptomatic, with unremarkable prenatal screenings. Intraoperative inspection revealed approximately 400 ml of thick gelatinous material (PMP) in the abdominal cavity and a tumor-like mass on the appendix. Following the initial appendectomy and biopsy, confirmed LAMN and elevated CA125 led to a secondary operation: extended right hemicolectomy and total omentectomy. This procedure confirmed mucin dissemination, highlighting the urgent need for oncologic intervention despite the tumor's low grade. CONCLUSIONS Incidental discovery of LAMN during a cesarean section is extremely rare. This case demonstrates the need for intraoperative vigilance, thorough abdominal assessment, and multidisciplinary management to ensure accurate diagnosis and optimal outcomes for both mother and neonate in such complex situations.