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Saeed A, Abuzaid Y, Hammad M. Prevalence of, Subtypes of, and the Role of Age in Incidental Appendiceal Neoplasms in Acute Appendicitis: A Single-Institute Study from Bahrain. Cureus 2024; 16:e60150. [PMID: 38864054 PMCID: PMC11166375 DOI: 10.7759/cureus.60150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Primary appendiceal neoplasms (ANs) are rare entities that can present with acute appendicitis symptoms. Accurate diagnosis of these diverse subtypes is crucial for prognosis and proper management. AIMS AND OBJECTIVES This descriptive retrospective study aims to determine the prevalence and pathological subtypes of incidental ANs in patients presenting with acute appendicitis symptoms at Salmaniya Medical Center (SMC) in Bahrain between the period of January 2020 and March 2024. Particular focus was placed on investigating whether advanced age is a significant risk factor for these neoplasms. MATERIALS AND METHODS The study included 38,643 patients (aged 15 years and above) who underwent appendectomy for suspected acute appendicitis during the study period. Demographic data, clinical diagnoses, preoperative imaging findings, histopathological reports, and management details were analyzed. Medical records of patients were retrieved from ISEHA system. Statistical analysis was done using Microsoft Excel. RESULTS The results showed that 12 patients (0.04% per year) had different subtypes of appendiceal tumors. Neuroendocrine tumors were the most common, identified in nine patients (75%), including nine cases of well-differentiated neuroendocrine carcinoma (NEC). Other histopathological subtypes included low-grade appendiceal mucinous neoplasm (LAMN), adenocarcinoma, and goblet cell adenocarcinoma, each found in one patient. Additionally, two patients had confirmed appendiceal mucocele. The mean age of patients with ANs was 30 years (range: 19-52 years), and 66.6% were younger than 38 years. Conclusion: These findings highlight the importance of considering ANs in the differential diagnosis of acute appendicitis, especially in older patients. Further research is warranted to confirm the role of age as a risk factor and guide clinical decision-making.
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Affiliation(s)
- Ahmed Saeed
- Surgery, Salmaniya Medical Complex, Manama, BHR
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Ladel L, Tan WY, Jeyakanthan T, Sailo B, Sharma A, Ahuja N. The Promise of Epigenetics Research in the Treatment of Appendiceal Neoplasms. Cells 2023; 12:1962. [PMID: 37566041 PMCID: PMC10417136 DOI: 10.3390/cells12151962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/23/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
Appendiceal cancers (AC) are a rare and heterogeneous group of malignancies. Historically, appendiceal neoplasms have been grouped with colorectal cancers (CRC), and treatment strategies have been modeled after CRC management guidelines due to their structural similarities and anatomical proximity. However, the two have marked differences in biological behavior and treatment response, and evidence suggests significant discrepancies in their respective genetic profiles. In addition, while the WHO classification for appendiceal cancers is currently based on traditional histopathological criteria, studies have demonstrated that histomorphology does not correlate with survival or treatment response in AC. Due to their rarity, appendiceal cancers have not been studied as extensively as other gastrointestinal cancers. However, their incidence has been increasing steadily over the past decade, making it crucial to identify new and more effective strategies for detection and treatment. Recent efforts to map and understand the molecular landscape of appendiceal cancers have unearthed a wealth of information that has made it evident that appendiceal cancers possess a unique molecular profile, distinct from other gastrointestinal cancers. This review focuses on the epigenetic landscape of epithelial appendiceal cancers and aims to provide a comprehensive overview of the current state of knowledge of epigenetic changes across different appendiceal cancer subtypes, highlighting the challenges as well as the promise of employing epigenetics in the quest for the detection of biomarkers, therapeutic targets, surveillance markers, and predictors of treatment response and survival in epithelial appendiceal neoplasms.
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Affiliation(s)
- Luisa Ladel
- Surgical Oncology Research Laboratories, Division of Surgical Oncology, Department of Surgery, Yale School of Medicine, Yale University, New Haven, CT 06519, USA; (L.L.); (W.Y.T.); (T.J.); (B.S.); (A.S.)
- Affiliated Internal Medicine Residency Program at Norwalk Hospital, Department of Internal Medicine, Norwalk Hospital, Yale University, Norwalk, CT 06850, USA
| | - Wan Ying Tan
- Surgical Oncology Research Laboratories, Division of Surgical Oncology, Department of Surgery, Yale School of Medicine, Yale University, New Haven, CT 06519, USA; (L.L.); (W.Y.T.); (T.J.); (B.S.); (A.S.)
- Affiliated Internal Medicine Residency Program at Norwalk Hospital, Department of Internal Medicine, Norwalk Hospital, Yale University, Norwalk, CT 06850, USA
| | - Thanushiya Jeyakanthan
- Surgical Oncology Research Laboratories, Division of Surgical Oncology, Department of Surgery, Yale School of Medicine, Yale University, New Haven, CT 06519, USA; (L.L.); (W.Y.T.); (T.J.); (B.S.); (A.S.)
- Affiliated Internal Medicine Residency Program at Norwalk Hospital, Department of Internal Medicine, Norwalk Hospital, Yale University, Norwalk, CT 06850, USA
| | - Bethsebie Sailo
- Surgical Oncology Research Laboratories, Division of Surgical Oncology, Department of Surgery, Yale School of Medicine, Yale University, New Haven, CT 06519, USA; (L.L.); (W.Y.T.); (T.J.); (B.S.); (A.S.)
| | - Anup Sharma
- Surgical Oncology Research Laboratories, Division of Surgical Oncology, Department of Surgery, Yale School of Medicine, Yale University, New Haven, CT 06519, USA; (L.L.); (W.Y.T.); (T.J.); (B.S.); (A.S.)
| | - Nita Ahuja
- Surgical Oncology Research Laboratories, Division of Surgical Oncology, Department of Surgery, Yale School of Medicine, Yale University, New Haven, CT 06519, USA; (L.L.); (W.Y.T.); (T.J.); (B.S.); (A.S.)
- Department of Pathology, Yale School of Medicine, New Haven, CT 06519, USA
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Yilmaz S, Bolukbasi H. Appendiceal neoplasms: Suspected findings and reports of 14 cases. Indian J Cancer 2023; 60:331-336. [PMID: 36861689 DOI: 10.4103/ijc.ijc_1121_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Background Neoplastic lesions of the vermiform appendix are still considered to be rare, some studies suggest that appendix cancer may be on the rise, with an estimated incidence of 0.08-0.1% of all appendiceal specimens. The lifetime incidence of malignant appendiceal tumors ranges from 0.2 to 0.5%. Patients and Methods Our study is applied at the Department of General Surgery at tertiary training and research hospital; 14 patients who had appendectomy or right hemicolectomy between December 2015 and April 2020 were evaluated. Results The mean age of the patients was 52.3 ± 15.1 (range, 26-79) years. Gender of the patients were: five (35.7%) men and nine (64.3%) women. The clinical diagnosis was appendicitis without suspected findings in 11 (78.6%), appendicitis with suspected findings (appendiceal mass, etc.) in three (21.4%) of the patients, and there is no patient with asymptomatic or other rare findings. Surgeries applied for the patients were: nine (64.3%) underwent open appendectomy, four (28.6%) underwent laparoscopic appendectomy, and one (7.1%) underwent open right hemicolectomy. Histopathologic results were as follows: five (35.7%) neuroendocrine neoplasm, eight (57.1%), noninvasive mucinous neoplasm, and one (7.1%) adenocarcinoma. Conclusion While diagnosis and management of appendiceal pathology, surgeons should be familiar with suspected findings of appendiceal tumors and discuss them with patients to the possibility of histopathologic results.
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Affiliation(s)
- Serhan Yilmaz
- University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, General Surgery, Istanbul, Turkey
| | - Hakan Bolukbasi
- University of Health Sciences, Kanuni Sultan Süleyman Training and Research Hospital, General Surgery, Istanbul, Turkey
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Bardakçi O, Bahçecioğlu İB, Tatli F, Özgönül A, Güldür ME, Uzunköy A. Does one of the two most commonly used scoring systems have a decisive advantage over the other in diagnosing acute appendicitis in pregnant women? Medicine (Baltimore) 2023; 102:e33596. [PMID: 37115072 PMCID: PMC10145901 DOI: 10.1097/md.0000000000033596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
This study aimed to compare the accuracy and reliability of Alvarado Score (AS) and Appendicitis Inflammatory Response Score (AIRS) in pregnant women undergoing surgery for acute appendicitis (AA). The files of 53 pregnant women with a diagnosis of AA who underwent surgery in our clinic between February 2014 and December 2018 were examined retrospectively. The patients were divided into 3 groups as follows: first trimester between 0 and 14 weeks, second trimester between 15 and 28 weeks, and third trimester between 29 and 42 weeks. The AS and AIRS values were calculated according to preoperative physical examination and laboratory results. The mean age of the patients was 28.58 (18-44) years. According to the pathology results, appendicitis was detected in 16 of 23 patients in the first trimester, in 22 of 25 patients in the second trimester, and in 2 of 5 patients in the third trimester. The AIRS was ≥ 9 in 9 patients and the AS was ≥ 7 in 19 of the 23 patients in the 1st trimester, while the AIRS was ≥ 9 in 11 patients and the AS was ≥ 7 in 19 of the 25 patients in the 2nd trimester. However, in the 3rd trimester, the AIRS was ≥ 9 in 2 patients and AS was ≥ 7 in 4 of the 5 patients. In conclusion, when the data obtained from the present study were evaluated, it was determined that both AS and AIRS are effective methods for diagnosing AA in pregnant women.
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Affiliation(s)
- Osman Bardakçi
- Department of Surgical Oncology, Ankara Gülhane Research and Training Hospital, Ankara, Turkey
| | | | - Faik Tatli
- Department of General Surgery, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Abdullah Özgönül
- Department of General Surgery, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Muhammet Emin Güldür
- Department of Pathology, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Ali Uzunköy
- Department of General Surgery, Harran University Faculty of Medicine, Sanliurfa, Turkey
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5
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Foote MB, Walch H, Chatila W, Vakiani E, Chandler C, Steinruecke F, Nash GM, Stadler Z, Chung S, Yaeger R, Braghrioli MI, Shia J, Kemel Y, Maio A, Sheehan M, Rousseau B, Argilés G, Berger M, Solit D, Schultz N, Diaz LA, Cercek A. Molecular Classification of Appendiceal Adenocarcinoma. J Clin Oncol 2023; 41:1553-1564. [PMID: 36493333 PMCID: PMC10043565 DOI: 10.1200/jco.22.01392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/09/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Appendiceal adenocarcinomas (ACs) are rare, histologically diverse malignancies treated as colorectal cancers despite having distinct biology and clinical behavior. To guide clinical decision making, we defined molecular subtypes of AC associated with patient survival, metastatic burden, and chemotherapy response. PATIENTS AND METHODS A comprehensive molecular analysis was performed in patients with AC to define molecular subtypes. Associations between molecular subtype and overall survival, intraoperative peritoneal cancer index, and first-line chemotherapy response were assessed adjusting for histopathologic and clinical variables using multivariable Cox proportional hazards, linear regression, and logistic regression models. RESULTS We defined distinct molecular lineages of mucinous appendiceal adenocarcinoma (MAAP) from co-occurring mutations in GNAS, RAS, and TP53. Of 164 MAAP tumors, 24 were RAS-mutant (mut) predominant (RAS-mut/GNAS-wild-type [wt]/TP53-wt) with significantly decreased mutations and chromosomal alterations compared with tumors with GNAS mutations (GNAS-mut predominant) or TP53 mutations (TP53-mut predominant). No patient with RAS-mut predominant subtype metastatic MAAP died of cancer, and overall survival in this subgroup was significantly improved compared with patients with GNAS-mut (P = .05) and TP53-mut (P = .004) predominant subtypes. TP53-mut predominant subtypes were highly aneuploid; increased tumor aneuploidy was independently (P = .001) associated with poor prognosis. The findings retained significance in patients with any metastatic AC. RAS-mut predominant metastases exhibited reduced peritoneal tumor bulk (P = .04) and stromal invasion (P < .001) compared with GNAS-mut or TP53-mut predominant tumors, respectively. Patients with RAS-mut predominant MAAP responded more to first-line chemotherapy (50%) compared with patients with GNAS-mut predominant tumors (6%, P = .03). CONCLUSION AC molecular patterns identify distinct molecular subtypes: a clinically indolent RAS-mut/GNAS-wt/TP53-wt subtype; a chemotherapy-resistant GNAS-mut predominant subtype; and an aggressive, highly aneuploid TP53-mut predominant subtype. Each subtype exhibits conserved clinical behavior irrespective of histopathology.
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Affiliation(s)
- Michael B. Foote
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Henry Walch
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Walid Chatila
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
- Marie-Josee and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Chris Chandler
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Felix Steinruecke
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Garrett M. Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Zsofia Stadler
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sebastian Chung
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rona Yaeger
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria Ignez Braghrioli
- Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yelena Kemel
- Niehaus Center for Inherited Cancer Genomics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anna Maio
- Niehaus Center for Inherited Cancer Genomics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Margaret Sheehan
- Niehaus Center for Inherited Cancer Genomics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Benoit Rousseau
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Guillem Argilés
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael Berger
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
- Marie-Josee and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David Solit
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
- Marie-Josee and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nikolaus Schultz
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY
- Marie-Josee and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Luis A. Diaz
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andrea Cercek
- Division of Solid Tumor Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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Lesi O, Walton SJ, Ballanamada Appaiah NN, Rasheed N, Dahanayaka J, Ideawor P, Saad Abdalla Al-Zawi A. Prevalence of Carcinoma in Appendectomy Specimens for Patients Presenting With Acute Appendicitis: A Single-Center Study. Cureus 2021; 13:e19611. [PMID: 34956748 PMCID: PMC8674459 DOI: 10.7759/cureus.19611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Acute appendicitis is the most common general surgical emergency globally. Its etiology includes the presence of luminal obstruction by faecoliths, lymphoid hyperplasia, impacted stool, and rarely by appendiceal or caecal cancer. Malignancy related to acute appendicitis is usually seen in the older age group. Aim To identify the subset rate of patients operated for acute appendicitis who have appendiceal carcinoma and analyze the outcome of their post-operative management. Material and methods A retrospective study of a cohort of 529 patients aged > 40 diagnosed with acute appendicitis with subsequent appendectomy in the period between 1 January 2014 and 31 December 2019 at Basildon and Thurrock University Hospital, Essex, United Kingdom was conducted. We analyzed the clinical data of the cohort including demographic information, diagnosis, pre-operative imaging, histological diagnosis as well as post-operative management where indicated. Results The median age of patients was 54.5 years (range 40-92). The male to female ratio in the appendicectomy cohort was 1:1.1. About 45% were aged 40-49 years, 24.8% were aged 50-59 and 30.2% were ≥60 years. Post-operative histology revealed acute appendicitis in 82.4% of the group. In 11% of the patients, the histology revealed the presence of other benign pathology as mucocele of the appendix, acute diverticulitis, follicular hyperplasia, and fibrous obliteration. The diagnosis of appendicular malignancy was seen in 1.9%. Conclusion Incidental appendiceal cancers in the resected specimens after acute appendicitis are rare but may be associated with a poor prognosis. It is recommended to consider such diagnosis in particular when dealing with acute appendicitis in older patients with longer symptom history, and in presence of peri-appendicular mass.
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Affiliation(s)
- Omotara Lesi
- General and Colorectal Surgery, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | - Sarah-Jane Walton
- General and Colorectal Surgery, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | | | - Noreen Rasheed
- Radiology, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | - Jayasiri Dahanayaka
- General and Breast Surgery, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | - Philip Ideawor
- Pathology, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | - Abdalla Saad Abdalla Al-Zawi
- General and Breast Surgery, Basildon and Thurrock University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, GBR
- General and Breast Surgery, Anglia Ruskin University, Chelmsford, GBR
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Ruiz SG, Geraghty F, Padron D, Chacon D, Kahane G. The Appendix: A Rare Case of an Appendiceal Collision Tumor. Cureus 2021; 13:e17050. [PMID: 34522528 PMCID: PMC8428163 DOI: 10.7759/cureus.17050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/12/2022] Open
Abstract
Appendicitis is a common cause of right lower quadrant pain. However, appropriate diagnostic evaluation and a high clinical suspicion can reveal alternative etiologies that are not so commonly encountered. In this report, we present a rare case of an appendiceal collision tumor involving two distinct neoplasms as the source of the patient's pain and describe how thoughtful clinical maneuvering led to its diagnosis and treatment.
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Affiliation(s)
- Samuel G Ruiz
- General Surgery, Kendall Regional Medical Center, Miami, USA
| | | | - Dalina Padron
- Anesthesiology, Mount Sinai Medical Center of Florida, Miami Beach, USA
| | | | - Gerardo Kahane
- General Surgery, Aventura Hospital and Medical Center, Aventura, USA
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Bekki T, Fukuda T, Moriuchi T, Namba Y, Okimoto S, Mukai S, Saito Y, Oishi K, Nishida T, Ohdan H. Appendicitis with submucosal fecalith mimicking a submucosal tumor: a case report. Surg Case Rep 2021; 7:105. [PMID: 33905033 PMCID: PMC8079595 DOI: 10.1186/s40792-021-01169-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Submucosal fecalith(s) mimicking submucosal tumors of the gastrointestinal lumen are rare. Moreover, accurate preoperative diagnosis of these entities is exceedingly difficult, and the mechanism(s) of their formation remains unclear. Case presentation A 40-year-old woman visited the authors’ hospital due to lower abdominal pain and diarrhea. She had previously been treated for endometriosis. Laboratory investigation revealed increased C-reactive protein levels. Abdominal contrast-enhanced computed tomography revealed thickening of the appendix wall and dilation of the small intestine. The patient was diagnosed with paralytic ileus caused by appendicitis, and interval appendectomy was scheduled. She underwent laparoscopic-assisted appendectomy after conservative treatment. Partial cecal resection was selected due to the presence of an elastic mass in the cecum. The final pathological diagnosis was submucosal fecalith, not submucosal tumor. On day 5, the patient was discharged without any postoperative complications. Conclusions In cases of appendicitis with fecalith(s) that appear as submucosal tumor(s) on colonoscopy, submucosal fecalith mimicking submucosal tumor should be considered in the differential diagnosis.
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Affiliation(s)
- Tomoaki Bekki
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Toshikatsu Fukuda
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan. .,Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | | | - Yosuke Namba
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Sho Okimoto
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Shoichiro Mukai
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Yasufumi Saito
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Koichi Oishi
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | | | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Al-Wiswasy MKM, Al-Balas H, Al-Saffar RAS, Al-Balas M. Synchronous primary adenocarcinoma of the appendix and colon: Case report and literature review. Int J Surg Case Rep 2020; 77:628-633. [PMID: 33395861 PMCID: PMC7708860 DOI: 10.1016/j.ijscr.2020.11.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/12/2020] [Accepted: 11/12/2020] [Indexed: 01/06/2023] Open
Abstract
Primary adenocarcinoma of appendix is rare pathology that is discovered usually on histopathologic examination of resected appendix. It is important to report all pathologic reports to the primary physician in order to confirm primary diagnosis and discuss it with their patients. If a diagnosis of PAA is reported, a surveillance lifelong colonoscopy screening is mandatory to rule out synchronous or metachronous occurrence of colonic malignances.
Introduction Primary adenocarcinoma of the appendix (PAA) is rare with fewer than 300 cases reported from 1882 Up to 2004. Synchronous occurrence of PAA with a second primary colonic carcinoma is even more unusual. Literature review shows a total of 40 reported synchronous cases in the English literature from the first case reported in1947 up to 2017. Hereby, an additional case is presented, which is the first case reported in Jordan. Presentation of case A 39-year-old woman presented in October 2016 with persistent right lower quadrant abdominal pain diagnosed clinically as acute appendicitis. Abdominal computed tomography showed an oval shaped 3 × 3.4 cm mass at the sub-hepatic region, associated with increased attenuation of surrounding mesenteric fat and multiple enlarged lymph nodes. Three days later, a right hemicolectomy was carried out. A diagnosis of invasive primary adenocarcinoma of the ascending colon with an incidental, microscopic primary adenocarcinoma of the distal part of the appendix was reported. Discussion Primary appendiceal adenocarcinoma is rare pathology with an incidence ranges from 0.01% to 0.3% that is characterized by presence of adenocarcinomatous cells originating in the appendix that are in direct continuity with the normal appendiceal mucosa. Even it is less common, synchronous primary adenocarcinoma of the appendix and the colon has been reported in literature, with less than 37 cases being reported in literature so far. PAA are seldom suspected in preoperative phase or even intraoperatively, and it is diagnosed based on histopathologic examination of the resected appendix. Once PAA is diagnosed, a lifelong surveillance with colonoscopy is mandatory to detect synchronous or metachronous colonic malignancies. Conclusions Once a diagnosis of primary appendiceal adenocarcinoma is proved histologically, it is it is warranted to perform surveillance for synchronous or metachronous tumors because of the increased risk of a second primary malignancy in the gastrointestinal tract.
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Affiliation(s)
- Mohammad K M Al-Wiswasy
- Department of Basic Medical Sciences/Pathology, Faculty of Medicine, Hashemite University, Zarqa, Jordan; Department of Histopathology, Prince Hamza Teaching Hospital, Amman, Jordan.
| | - Hamzeh Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, Jordan.
| | - Raith A S Al-Saffar
- Department of Basic Medical Sciences/Pathology, Faculty of Medicine, Hashemite University, Zarqa, Jordan.
| | - Mahmoud Al-Balas
- Department of General and Special Surgery, Faculty of Medicine, Hashemite University, Zarqa, Jordan; Department of General Surgery, Prince Hamza Teaching Hospital, Amman, Jordan.
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10
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Shannon AB, Song Y, Roses RE, Fraker DL, Miura JT, Karakousis GC. National trends in the presentation of surgically resected appendiceal adenocarcinoma over a decade. J Surg Oncol 2020; 123:606-613. [PMID: 33169840 DOI: 10.1002/jso.26295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/12/2020] [Accepted: 11/01/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rates of nonoperative management of acute appendicitis and appendiceal adenocarcinoma have increased over a decade, but the presentation and outcomes of appendiceal adenocarcinoma over this period is not well-characterized. METHODS Patients with surgically resected Stage I-III appendiceal adenocarcinoma were identified from the 2006 to 2015 National Cancer Data Base and classified into two cohorts, 2006-2010 and 2011-2015, based on year of diagnosis. Three-year overall survival (OS) was analyzed using Cox proportional hazards regression and Kaplan-Meier survival estimates. RESULTS Of 4233 patients, 1369 (32.3%) and 2864 (67.7%) were diagnosed in 2006-2010 and 2011-2015, respectively. Following multivariable analysis, patients in 2011-2015 were more likely to be <40 years of age (6.4% vs. 4.7%, odds ratio [OR] 1.53, p .015), present with pT4 tumors (40.2% vs. 34.4%, OR 1.46, p .004), and undergo hyperthermic intraperitoneal chemotherapy (4.4% vs. 2.4%, OR 1.97, p .001). Comparing patients diagnosed in 2011-2015 to 2006-2010, adjusted 3-year OS was no different among all patients (81.1% vs. 79%, p .778). CONCLUSIONS There has been an increase in the proportion of patients with pT4 appendix tumors over time, primarily among older (≥60 years) patients. Even so, these shifts in presentation have not resulted in differences in survival outcomes.
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Affiliation(s)
- Adrienne B Shannon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yun Song
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert E Roses
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas L Fraker
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - John T Miura
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Giorgos C Karakousis
- Division of Endocrine and Oncologic Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Ajani M, Omenai S, Iyapo O. Neoplasms of the appendix: An experience of a tertiary hospital in Southwestern Nigeria. JOURNAL OF CLINICAL SCIENCES 2020. [DOI: 10.4103/jcls.jcls_19_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Bolmers MDM, de Jonge J, van Rossem CC, van Geloven AAW, Bemelman WA. Appendicular neoplasms and consequences in patients undergoing surgery for suspected acute appendicitis. Int J Colorectal Dis 2020; 35:2065-2071. [PMID: 32638091 PMCID: PMC7541364 DOI: 10.1007/s00384-020-03673-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION In patients treated with an appendectomy for acute appendicitis, the specimen is generally sent for histological evaluation. In an era of increasing non-operative treatment for acute appendicitis, it is important to know the incidence, the diagnostic accuracy, and treatment consequences of appendicular neoplasms that are found in acute appendicitis. We hypothesize that pre- and intra-operative parameters might predict an appendicular neoplasm. METHODS Data was used from our previous prospective observational cohort study. All patients undergoing surgery for suspected acute appendicitis were included. The primary outcome was the incidence of appendicular neoplasms in patients operated for acute appendicitis. Secondary outcomes were pre-operative diagnostics and imaging outcomes, intra-operative surgical judgment, and postoperative management and outcome. Possible predictors of an appendicular neoplasm were identified and used in multivariable logistic regression. Patients with an appendicular neoplasm were followed for 3 years after initial appendectomy. RESULTS A total of 1975 patients underwent surgery for suspected acute appendicitis and in 98.3% (1941/1975) the appendix was removed. In 1.5% (30/1941) of these patients, an appendicular neoplasm was found. Among the malignant neoplasms, the majority were grade 1 neuroendocrine tumors (NET) in 65% (13/20). On pre-operative imaging, there was no suspicion of malignancy. In three cases, there was an intra-operative suspicion of malignancy. Multivariable analysis showed only age as an independent predictor for appendicular neoplasms. No recurrent or new malignancy was found during follow-up. DISCUSSION The incidence of appendicular neoplasm in patients undergoing an acute appendectomy is very low and clinical risk factors could not be identified.
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Affiliation(s)
- M. D. M. Bolmers
- Department of surgery, Tergooi Hospital Hilversum, P.O. Box 10016, 1201 DA Hilversum, The Netherlands
| | - J. de Jonge
- Department of surgery, Tergooi Hospital Hilversum, P.O. Box 10016, 1201 DA Hilversum, The Netherlands
| | - C. C. van Rossem
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - A. A. W. van Geloven
- Department of surgery, Tergooi Hospital Hilversum, P.O. Box 10016, 1201 DA Hilversum, The Netherlands
| | - W. A. Bemelman
- Department of surgery, Academic Medical Center, Amsterdam, The Netherlands
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Solomon D, Bekhor E, Leigh N, Maniar YM, Totin L, Hofstedt M, Aycart SN, Carr J, Ballentine S, Magge DR, Golas BJ, Pai RK, Polydorides AD, Bartlett DL, Labow DM, Choudry HA, Sarpel U. Surveillance of Low-Grade Appendiceal Mucinous Neoplasms With Peritoneal Metastases After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: Are 5 Years Enough? A Multisite Experience. Ann Surg Oncol 2019; 27:147-153. [PMID: 31385130 DOI: 10.1245/s10434-019-07678-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Low-grade appendiceal mucinous neoplasms (LAMNs) are tumors that often present with widespread mucin in the peritoneal cavity (pseudomyxoma peritonei [PMP]). Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are effective treatment, but no published recommendations exist regarding surveillance. METHODS Data from prospective databases of patients who underwent CRS-HIPEC from 2001 to 2017 at two high-volume institutions were retrospectively analyzed. Patients who underwent complete CRS-HIPEC for PMP secondary to LAMN were included in the analysis. Pathologic examination confirmed the diagnosis of LAMN. Cases of mucinous adenocarcinomas and neuroendocrine tumors (goblet cell carcinoids) were excluded. RESULTS The study enrolled 156 patients. The median peritoneal cancer index (PCI) was 18 (interquartile range IQR1-3, 12-23), and 125 patients (80.1%) had a CC0 cytoreduction. According to American Joint Committee on Cancer (AJCC) grading, 152 patients (97.4%) presented with acellular mucin or G1 implants, 2 patients (1.3%) presented with G2 disease, and 2 patients (1.3%) presented with G3 disease. During the follow-up period (median, 45 months; IQR1-3 23-76 months), 23 patients (14.7%) experienced recurrence. All the recurrences were peritoneal and occurred within 5 years. The 1-, 3-, and 5-year disease-free survival (DFS) rates were respectively 95.5%, 83.4%, and 78.3%. Univariate Cox regression analysis showed that higher PCI scores (p < 0.001), a CC1 cytoreduction (p = 0.005), and higher preoperative levels of carcinoembryonic antigen (CEA) (p = 0.012) and CA-125 (p = 0.032) correlated with a shorter DFS. Only higher PCI scores independently predicted earlier recurrences (p < 0.001). CONCLUSION Most patients had recurrence within 3 years after CRS-HIPEC, and none after 5 years. High PCI was the only independently significant variable. The study findings support intensive surveillance (every 3-6 months) with tumor markers and imaging methods during the first 3 years, and annual surveillance thereafter, with follow-up assessment after 5 years yielding limited benefit.
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Affiliation(s)
- Daniel Solomon
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eliahu Bekhor
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Natasha Leigh
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yash M Maniar
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Linsay Totin
- Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Margaret Hofstedt
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha N Aycart
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jacquelyn Carr
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel Ballentine
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deepa R Magge
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin J Golas
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reetesh K Pai
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - David L Bartlett
- Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Daniel M Labow
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Haroon A Choudry
- Surgical Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Umut Sarpel
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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14
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Onyemkpa C, Davis A, McLeod M, Oyasiji T. Typical carcinoids, goblet cell carcinoids, mixed adenoneuroendocrine carcinomas, neuroendocrine carcinomas and adenocarcinomas of the appendix: a comparative analysis of survival profile and predictors. J Gastrointest Oncol 2019; 10:300-306. [PMID: 31032098 DOI: 10.21037/jgo.2018.11.08] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Goblet cell carcinoids (GCC) and other atypical neuroendocrine tumors (NET) of the appendix as well as appendiceal adenocarcinoma are usually managed with the same algorithm as colon cancers. This study investigates clinicopathological features that are predictive of survival outcomes for appendiceal NET and adenocarcinoma. Survival profiles for the histologic subtypes of appendiceal NET and adenocarcinoma were compared. Methods A retrospective review of appendiceal NET and adenocarcinoma for patients who are 18 years and above in the SEER database from 2010 to 2014. Results Females outnumbered males in a 1.3 to 1 ratio in the NET subgroup and 1.1 to 1 ratio in the adenocarcinoma group. The mean age at diagnosis for all NET was 50.3±17 years while that of adenocarcinomas was 60.8±14.1 years. Within the NET subgroups, the mean ages for typical carcinoids (TC), GCC, NEC and MANEC were 42.9±17.3, 56.7±13.7, 45.6±17.4 and 59.7±12.8 years, respectively. Overall survival for adenocarcinoma was 86.3%, 73.5%, 65.7%, and 57.6% for 1-, 2-, 3- and 4-year OS, respectively. For NET, TC showed better survival profile with 1- and 4-year overall survival of 97.4% and 95.7%, respectively while MANEC had the worst survival outcome with 1- and 4-year OS of 88.6% and 62.2%, respectively. GCC had a better 1-year OS compared to NEC (95.5% versus 92.9%) but showed slightly worse 4-year OS (82% versus 84.8%). Age at diagnosis (HR 1.03), African-American race (HR 1.47) and stage IV disease (HR 9.58) were independent predictors of survival for appendiceal adenocarcinoma. For NET, advanced age at diagnosis, advanced disease stage and the African-American race were identified as negative independent predictors of survival. Conclusions While prior studies have suggested that atypical NET (GCC, NEC and MANEC) are more likely to present at more advanced stages, this study showed that most cases of GCC, MANEC and NEC were diagnosed at stages I and II. Appendiceal adenocarcinoma, on the other hand, presented mostly at stage IV. With respect to OS, atypical histologic subtypes of NET have worse outcome compared to TC. Although better OS was noted for GCC, NEC and MANEC when compared to adenocarcinoma, this benefit was lost in stage IV disease where adenocarcinoma recorded better 1- and 4-year OS. Prospective and randomized studies which provide granular details of treatment are needed to better define treatment algorithm for appendiceal NET.
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Affiliation(s)
| | - Alan Davis
- Department of Surgery, Michigan State University, Lansing, MI, USA
| | - Michael McLeod
- Department of Surgery, Michigan State University, Lansing, MI, USA
| | - Tolutope Oyasiji
- Department of Surgery, Michigan State University, Lansing, MI, USA.,Barbara Ann Karmanos Cancer Institute at McLaren Flint, Department of Oncology, Wayne State University, Detroit, MI, USA
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Unver N, Coban G, Arıcı DS, Buyukpınarbasılı N, Gucin Z, Malya FÜ, Onaran OI, Topalan K. Unusual Histopathological Findings in Appendectomy Specimens: A Retrospective Analysis of 2047 Cases. Int J Surg Pathol 2018; 27:142-146. [DOI: 10.1177/1066896918784650] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background. In this study, we retrospectively evaluated cases of patients who had undergone appendectomy in our hospital and aimed to present the efficiency of diagnostic tests and demographic data of cases. Pathological reports were analyzed for the following parameters: age, gender, and pathological diagnosis. In addition, the demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and reanalysis of archived resected appendix specimens was carried out. Methods. Files of 2047 patients (1329 males, 718 females, sex ratio: 1.85, age range: 1-87 years, mean age: 26, 50 years), who had been operated with a diagnosis of acute appendicitis in the emergency department of Bezmialem Vakıf University Medical Faculty from November 2011 to June 2014, were retrospectively evaluated. Results. Cases were separated into 2 groups. Cases with histopathologic examination reported as acute appendicitis constituted group 1 (n = 2013, 98.34%), and cases with pathologic findings other than acute appendicitis constituted group 2 (n = 34, 1.66%). The second group consisted of 8 low-grade mucinous neoplasms, 7 mucoceles, 6 carcinoid, 5 granulomatous inflammation, 4 intraluminal Enterobius vermicularis, 1 endometriosis externa, 1 adenocarcinoma infiltrated to serosa, 1 mesenteric cyst, and 1 low-grade adenocarcinoma formed in mucinous cystic neoplasm background. Conclusion. Acute appendicitis is the most common emergency surgical condition. Although most of the resected appendectomy specimens showed typical histopathologic findings, some (1.66%) showed unusual histopathologic findings. Even if the macroscopic appearance of the specimen is normal or acute appendicitis, we suggest routine histopathological examination.
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Affiliation(s)
- Nurcan Unver
- Bezmialem Vakif University, Faculty of Medicine, Department of Pathology, Turkey
| | - Ganime Coban
- Bezmialem Vakif University, Faculty of Medicine, Department of Pathology, Turkey
| | - Dilek Sema Arıcı
- Bezmialem Vakif University, Faculty of Medicine, Department of Pathology, Turkey
| | - Nur Buyukpınarbasılı
- Bezmialem Vakif University, Faculty of Medicine, Department of Pathology, Turkey
| | - Zuhal Gucin
- Bezmialem Vakif University, Faculty of Medicine, Department of Pathology, Turkey
| | - Fatma Ümit Malya
- Bezmialem Vakif University, Faculty of Medicine, Department of General Surgery, Turkey
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Morales-Miranda A, Rosado ID, Núñez CC, Montero FC. Appendiceal carcinoma associated with microsatellite instability. Mol Clin Oncol 2018; 8:694-698. [PMID: 29725538 DOI: 10.3892/mco.2018.1596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/02/2018] [Indexed: 11/05/2022] Open
Abstract
Approximately 15% of colorectal cancer (CRC) cases exhibit microsatellite instability (MSI), which appears to be associated with unique biological behavior. The present study presents a case of appendiceal carcinoma associated with MSI that responded well to adjuvant chemotherapy. Clinical, pathological and immunohistochemical (IHC) characteristics have been described. The 60-year-old male patient had suffered from recurrent lower abdominal pain associated with abdominal distention for 6 months; then, following an acute attack, he was subjected to laparoscopic appendectomy. The histopathological examination revealed moderately differentiated appendiceal adenocarcinoma with mucinous areas, without lymphovascular or perineural invasion. The IHC examination was positive for keratin-20 and caudal type homeobox 2, and negative for MutL Homolog 1, MutS Homolog (MSH) 2 and MSH-6. A postoperative colonoscopy revealed diverticulosis, without the presence of polyps or tumors. However, an abdominal axial computerized tomography scan revealed thickening of the distal portion of the appendix, increased density of the greater omentum, and metastases to the liver capsule, spleen and peritoneum. The treatment of choice was right hemicolectomy with peritoneal debulking, followed by 10 cycles of chemotherapy with 5-fluorouracil, leucovorin and oxaliplatin (FOLFOX regimen). After 5 years of follow-up, the patient remains in good condition, without clinical or radiological signs of recurrence. The good response to chemotherapy corresponds with the observations made in other colon cancers with MSI. Therefore, testing for MSI in appendiceal carcinomas may provide useful information on prognosis and predict response to chemotherapy.
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Affiliation(s)
- Angélica Morales-Miranda
- Department of Reproductive Biology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City 14080, Mexico
| | - Ismael Domínguez Rosado
- Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City 14080, Mexico
| | - Carlos Chan Núñez
- Department of Surgery, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City 14080, Mexico
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17
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Vukovic J, Vrebalov Cindro P, Tomic S, Tonkic A. Signet Ring Carcinoma of the Appendix Presenting as Crohn's Disease in a Young Male. Case Rep Gastroenterol 2018; 12:277-285. [PMID: 30022916 PMCID: PMC6047566 DOI: 10.1159/000489298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/17/2018] [Indexed: 01/17/2023] Open
Abstract
Primary signet ring cell carcinoma is a rare event in surgery. It looks like acute appendicitis and it is difficult to diagnose it on clinical grounds alone. The diagnosis is always confirmed by histopathology of a surgically removed appendix. A young man, 22 years old, presented with vomiting, diarrhea, and cramps in his abdomen without abdominal tenderness (mild abdominal discomfort in the right lower abdominal quadrant without signs of peritoneal irritation) during the previous month. The first endoscopic results showed only changes of mucosa that could be attributed to endoscopic and clinical representation of Crohn's disease. A few days after the initiation of the therapy with aminosalicylates and corticosteroids, the patient went into ileus and was transferred to the Department of Surgery, where he underwent an emergency right-sided hemicolectomy with resection of the transversal colon and forming of an ileostoma. The first pathohistological diagnosis was pseudomembranous colitis. Because the patient's condition was deteriorating, a revision of the pathohistological diagnosis was done. After careful revision and extensive sampling, a signet ring cell carcinoma arising in the appendix with infiltration of the ileocecal region was found. Immunohistochemically, tumor cells were positive for CDX-2 CK7, CK20, CK19, and carcinoembryonic antigen and negative for chromogranin A. Sixteen isolated lymph nodes were negative. Although the patient had a disease that was localized to the appendix and ileocecal region with no apparent distal metastasis, his clinical condition was worsening rapidly and he died after 2 months. This case shows the aggressive biological behavior of the appendix signet ring cell carcinoma. Scrupulous histopathological examination of the appendix is an obligatory procedure. Elimination of the signet ring cell carcinoma from other carcinoma subtypes is of special importance as it has an exceptionally poor prognosis and is generally diagnosed in its advanced stages.
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Affiliation(s)
- Jonatan Vukovic
- University of Split, School of Medicine, Split, Croatia
- Department of Gastroenterology and Hepatology, University Hospital of Split, Split, Croatia
| | - Pavle Vrebalov Cindro
- Department of Gastroenterology and Hepatology, University Hospital of Split, Split, Croatia
| | - Snjezana Tomic
- University of Split, School of Medicine, Split, Croatia
- Department of Pathology, University Hospital of Split, Split, Croatia
| | - Ante Tonkic
- University of Split, School of Medicine, Split, Croatia
- Department of Gastroenterology and Hepatology, University Hospital of Split, Split, Croatia
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Ng JL, Wong SL, Mathew R. Appendiceal diverticulosis: a harbinger of underlying primary appendiceal adenocarcinoma? J Gastrointest Oncol 2018; 9:E1-E5. [PMID: 29755780 DOI: 10.21037/jgo.2017.08.18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Diagnosis of primary appendiceal adenocarcinoma (PAA) is hindered by its rarity and largely asymptomatic nature. Appendiceal diverticulosis (AD) is equally rare. We report an unusual case of PAA presenting with perforated appendiceal diverticulitis, and discuss a review of the literature about its association, and its surgical and pathological implications. A middle-aged man was admitted with right iliac fossa (RIF) pain and a corresponding tender abdominal mass for 5 days. Computerised tomography (CT) scan demonstrated a thickened appendix with 3 cm abscess at its base. During laparoscopic appendicectomy, the appendiceal phlegmon was adhered to the surrounding bowel. Histology showed a perforated diverticulum near the appendiceal tip, and a primary appendiceal well-differentiated adenocarcinoma located proximal to it with clear margins. Up to 48% of ADs are associated with appendiceal neoplasms, but its coexistence with PAA is reported in fewer than ten instances worldwide. Obstructing appendiceal tumours, by raising intraluminal pressure, can predispose to AD formation. Intestinal-type PAA is often managed like its colorectal counterpart, although controversies about management of PAA in a perforated AD remain. Recognition of the association of AD and PAA is critical to ensure meticulous oncological resection and histological examination.
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Affiliation(s)
- Jia Lin Ng
- Department of Colorectal Surgery, Division of Pathology, Singapore General Hospital, Singapore
| | - Shing Lih Wong
- Department of Anatomical Pathology, Division of Pathology, Singapore General Hospital, Singapore
| | - Ronnie Mathew
- Department of Colorectal Surgery, Division of Pathology, Singapore General Hospital, Singapore
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Teixeira FJR, Couto Netto SDD, Akaishi EH, Utiyama EM, Menegozzo CAM, Rocha MC. Acute appendicitis, inflammatory appendiceal mass and the risk of a hidden malignant tumor: a systematic review of the literature. World J Emerg Surg 2017; 12:12. [PMID: 28286544 PMCID: PMC5343298 DOI: 10.1186/s13017-017-0122-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 02/08/2017] [Indexed: 01/13/2023] Open
Abstract
Introduction Acute appendicitis is significantly common. Despite the increased use of computed tomography, the number of perforated cases has been stable in the past three decades. Between 2% and 6% of patients with acute appendicitis present appendiceal mass, often described as inflammatory phlegmon or abscess. Malignant tumors are confirmed by pathological analysis in 0.9–1.4% of all appendectomies performed to treat acute appendicitis. However, recent series demonstrate an elevated incidence of malignancies, ranging from 5.9 to 12%, in patients with inflammatory appendiceal mass. Methods The analysis was based on a systematic review of the literature. The articles were searched in PubMed for the period from 1987 to 2016. Articles presenting the incidence of the hidden malignancy among patients with appendiceal inflammatory mass were selected. Variables as age, interval appendectomy rate, the incidence of neoplasm, time to surgery, minimally invasive assessment, histology, right colectomy rate and morbidity were analyzed. Results A total of 13.244 patients were described as presenting acute appendicitis. Appendiceal tumor is present in approximately 1% of the appendectomies, while the rate of neoplasm varies from 10 to 29% in patients presenting appendiceal inflammatory mass. Interval appendectomies, despite been the minority of the procedures, disregard the higher morbidity associated with right sided colectomies. The review of literature also describes oncologic, histologic and clinical aspects of patients presenting appendiceal neoplasm, describing the most frequent histologic subtypes of this illness. Conclusion Hidden appendiceal neoplasm in acute appendicitis are rare, fortunately. However, its incidence is much higher in patients presenting appendiceal inflammatory mass. Hence, interval appendectomy should be considered in this subgroup of patients.
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Affiliation(s)
- Frederico José Ribeiro Teixeira
- Surgical Oncology Group from the III Surgical Clinic Division, Hospital das Clínicas of the University of São Paulo (USP), School of Medicine, Rua Dr. Ovídio Pires de Campos, 255, 8 th floor, room 8131, Cerqueira César, 05403-010 São Paulo Brazil
| | - Sérgio Dias do Couto Netto
- Surgical Oncology Group from the III Surgical Clinic Division, Hospital das Clínicas of the University of São Paulo (USP), School of Medicine, Rua Dr. Ovídio Pires de Campos, 255, 8 th floor, room 8131, Cerqueira César, 05403-010 São Paulo Brazil.,Emergency Surgical Service, Hospital das Clínicas of the University of São Paulo (USP), School of Medicine, Rua Dr. Ovídio Pires de Campos, 255, 8 th floor, room 8131, Cerqueira César, 05403-010 São Paulo Brazil.,850, Francisco Matarazzo Avenue, apt 181, Bloco 2, Zip Code 05001-200 Perdizes, São Paulo Brazil
| | - Eduardo Hiroshi Akaishi
- Sarcoma and Melanoma Surgery group - São Paulo Cancer Institute, University of São Paulo, School of Medicine, Cerqueira César, Brazil
| | - Edivaldo Massazo Utiyama
- General and Trauma Surgery - III Surgical Clinic Division, Hospital das Clínicas of the University of São Paulo (USP), School of Medicine, Rua Dr. Ovídio Pires de Campos, 255, 8 th floor, room 8131, Cerqueira César, 05403-010 São Paulo Brazil
| | - Carlos Augusto Metidieri Menegozzo
- General Surgery Senior Resident - III Surgical Clinic Division, Hospital das Clínicas of the University of São Paulo, School of Medicine, São Paulo, Brazil
| | - Marcelo Cristiano Rocha
- Chief of Staff of the Emergency Surgical Service - III Surgical Clinic Division, Hospital das Clínicas of the University of São Paulo, School of Medicine, São Paulo, Brazil
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Kalpande S, Pandya J, Sharma T. Adenocarcinoma mimicking appendicular lump: a diagnostic dilemma-a case report. World J Surg Oncol 2016; 14:283. [PMID: 27835997 PMCID: PMC5106774 DOI: 10.1186/s12957-016-1036-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/04/2016] [Indexed: 11/18/2022] Open
Abstract
Background Primary appendiceal adenocarcinoma is a rare tumor, mucinous variety being common. This case is reported to highlight the unusual presentation and diagnostic difficulty of appendiceal adenocarcinoma. Case presentation Patient presented with acute appendicitis with ill-defined tender lump which responded to conservative management. Conclusions High index of suspicion should be kept in mind for elderly patients presenting with appendicular lump. Every effort should be made during elective appendectomy to remove stump in case of sloughed out appendix.
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Affiliation(s)
- Sanket Kalpande
- Department of General Surgery, TNMC & BYL Nair Ch Hospital, Mumbai, Maharashtra, India
| | - Jayashri Pandya
- Department of General Surgery, TNMC & BYL Nair Ch Hospital, Mumbai, Maharashtra, India.
| | - Tushar Sharma
- Department of General Surgery, TNMC & BYL Nair Ch Hospital, Mumbai, Maharashtra, India
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21
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Interval Appendectomy: Finding the Breaking Point for Cost-Effectiveness. J Am Coll Surg 2016; 223:632-43. [PMID: 27502367 DOI: 10.1016/j.jamcollsurg.2016.07.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 12/29/2022]
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Shang J, Ruan LT, Dang Y, Wang YY, Song Y, Lian J. Contrast-enhanced ultrasound improves accurate identification of appendiceal mucinous adenocarcinoma in an old patient: A case report. Medicine (Baltimore) 2016; 95:e4637. [PMID: 27583883 PMCID: PMC5008567 DOI: 10.1097/md.0000000000004637] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Adenocarcinoma of appendiceal origin is far rarer than other colorectal carcinomas and its preoperative diagnosis is challenging. To our knowledge, utility of contrast-enhanced ultrasound (CEUS) to diagnose it is much less. METHOD A 61-year-old man presented with abdominal pain in the right lower quadrant for 20 days. In order to fulfill an accurately preoperative diagnosis, he received laboratory and imaging tests such as carcinoembryonic antigen (CEA), computer tomography (CT), CEUS and endoscope. DIAGNOSIS AND INTERVENTION He was initially suspected of suffering appendicitis, while his white blood cell count was normal and carcinoembryonic antigen (CEA) in serum was remarkably increased. Both routine ultrasound and computer tomography (CT) examinations supported suppurative appendicitis. The overall data, however, failed to excluded neoplastic pathology thoroughly. Therefore, CEUS was carried out and showed an inhomogeneous enhancement intra the lesion located in the body of the appendix, which made our consideration of neoplasm. The result of the follow-up biopsy guided by endoscope was consistent with appendiceal tumor. The patient received laparoscopic right hemicolectomy. Histopathology confirmed as well differentiated mucinous adenocarcinoma of appendix origin. His postoperative course was uneventful, and he had a regular diet again without any complaint. RESULT Serum CEA was remarkably increased (12.00 ng/mL). Both routine ultrasound and CT examinations supported suppurative appendicitis. However, CEUS examination showed an inhomogeneous enhancement intra the lesion located in the body of the appendix, which made our consideration of neoplasm. The follow-up biopsy guided by endoscope and surgical specimens confirmed as well differentiated mucinous adenocarcinoma of appendix origin. CONCLUSION Most mucinous adenocarcinoma mimicking appendicitis results in difficult diagnosis preoperatively. Clinician and radiologist should be aware of it when old patient presented with appendicitis especially along with high level of CEA.
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Affiliation(s)
| | - Li-tao Ruan
- Department of Ultrasound Medicine
- Correspondence: Li-tao Ruan, The Department of Ultrasound Medicine, The First Affiliated Hospital, Xi’an Jiaotong University, No 277, Yanta West Road, Xi’an, Shaanxi Province 710061, China (e-mail: )
| | | | | | - Yan Song
- Department of Ultrasound Medicine
| | - Jie Lian
- Department of Pathological Diagnosis, The First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, China
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Sönmez Y, Bayhan Z, Yaylak F, Ekici MF, Değer AN. Appendix adenocarcinoma in an elderly patient from a nursing home. ULUSAL CERRAHI DERGISI 2016; 32:149-51. [PMID: 27436927 DOI: 10.5152/ucd.2014.2335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 02/05/2014] [Indexed: 11/22/2022]
Abstract
Appendiceal malignancies are rare clinic entities. The clinical presentation of appendiceal malignancies is often atypical. Acute abdominal pain and acute appendicitis, which requires early surgical intervention, are the most common clinical presentations of appendiceal malignancies. In this case report, an adenocarcinoma of the appendix in a 64-year-old male from a nursing home has been presented. He had right lower quadrant pain for the last 5 days. On physical examination, he had significant guarding. Intravenous contrast-enhanced abdominopelvic tomography revealed no pathological features. Laparotomy under general anesthesia was scheduled. During exploration, a perforated appendicitis was observed. Formal appendectomy was performed. The patient was lost due to pneumonia and septic shock 5 days after surgical intervention. In addition, the natural history of the disease and its basic diagnostic and therapeutic aspects are discussed. Preoperative or intraoperative diagnosis may not be available for some patients. Thus, routine histopathological examination is essential for adequate diagnosis and treatment.
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Affiliation(s)
- Yalçın Sönmez
- Clinic of General Surgery, Ministry Health Dumlupınar University Evliya Çelebi Training and Research Hospital, Kütahya, Turkey
| | - Zülfü Bayhan
- Department of General Surgery, Dumlupınar University School of Medicine, Kütahya, Turkey
| | - Faik Yaylak
- Department of General Surgery, Dumlupınar University School of Medicine, Kütahya, Turkey
| | - Mehmet Fatih Ekici
- Clinic of General Surgery, Ministry Health Dumlupınar University Evliya Çelebi Training and Research Hospital, Kütahya, Turkey
| | - Ayşe Nur Değer
- Department of Pathology, Dumlupınar University School of Medicine, Kütahya, Turkey
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Costa M, Ivanova E, Esteves J. Adenocarcinoma of the appendix detected by colonoscopy. Acta Clin Belg 2016; 71:190-1. [PMID: 27075783 DOI: 10.1080/17843286.2015.1105610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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León Arellano M, González-Domínguez Y, Molina-Ortiz F, Garceau MAH, Cantero R, Rodríguez-Montes JA. Primary adenocarcinoma of the appendix: Experience at La Paz University Hospital of Madrid (1967–2014). INTERNATIONAL JOURNAL OF SURGERY OPEN 2016. [DOI: 10.1016/j.ijso.2016.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Taggart MW, Abraham SC, Overman MJ, Mansfield PF, Rashid A. Goblet cell carcinoid tumor, mixed goblet cell carcinoid-adenocarcinoma, and adenocarcinoma of the appendix: comparison of clinicopathologic features and prognosis. Arch Pathol Lab Med 2015; 139:782-90. [PMID: 26030247 DOI: 10.5858/arpa.2013-0047-oa] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
CONTEXT The prognosis of appendiceal goblet cell carcinoid tumors (GCTs) is believed to be intermediate between appendiceal adenocarcinomas and conventional carcinoid tumors. However, GCTs can have mixed morphologic patterns, with variable amount of adenocarcinoma. OBJECTIVE To evaluate the behavior of GCTs and related entities with variable components of adenocarcinoma. DESIGN We classified 74 cases of appendiceal tumors into 3 groups: group 1, GCTs or GCTs with less than 25% adenocarcinoma; group 2, GCTs with 25% to 50% adenocarcinoma; group 3, GCTs with more than 50% adenocarcinoma; and a comparison group of 68 adenocarcinomas without a GCT component (group 4). Well-differentiated mucinous adenocarcinomas were excluded. Clinicopathologic features and follow-up were obtained from computerized medical records and the US Social Security Death Index. RESULTS Of the 142 tumors studied, 23 tumors (16%) were classified as group 1; 27 (19%) as group 2; 24 (17%) as group 3; and 68 (48%) as group 4. Staging and survival differed significantly among these groups. Among 140 patients (99%) with available staging data, stages II, III, and IV were present in 87%, 4%, and 4% of patients in group 1 patients; 67%, 7%, and 22% of patients in group 2; 29%, 4%, and 67% of patients in group 3; and 19%, 6%, and 75% of patients in group 4, respectively (P = .01). Mean (SD) overall survival was 83.8 (34.6), 60.6 (30.3), 45.6 (39.7), and 33.6 (27.6) months for groups 1, 2, 3, and 4, respectively (P = .01). By multivariate analysis, only stage and tumor category were independent predictors of overall survival. CONCLUSION Our data highlight the importance of subclassifying the proportion of adenocarcinoma in appendiceal tumors with GCT morphology because that finding reflects disease stage and affects survival.
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Affiliation(s)
- Melissa W Taggart
- From the Departments of Pathology (Drs Taggart, Abraham, and Rashid), Medical Oncology (Dr Overman), and Surgical Oncology (Dr Mansfield), MD Anderson Cancer Center, University of Texas, Houston
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Guraya SY. Do We Still Need to Perform Routine Histological Examination of Appendectomy Specimens? J Clin Diagn Res 2015; 9:PL01. [PMID: 26266169 DOI: 10.7860/jcdr/2015/13989.6134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/30/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Salman Yousuf Guraya
- Consultant Colorectal Surgeon, Department of Surgery, College of Medicine, Taibah University , Saudi Arabia
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Kulkarni RV, Ingle SB, Siddiqui S. Primary signet ring cell carcinoma of the appendix: A rare case report. World J Clin Cases 2015; 3:538-541. [PMID: 26090376 PMCID: PMC4468902 DOI: 10.12998/wjcc.v3.i6.538] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 03/18/2015] [Indexed: 02/05/2023] Open
Abstract
Primary adenocarcinoma of the appendix is a rare malignancythat constitutes < 0.5% of all gastrointestinalneoplasms. Moreover, primary signet ring cell carcinomaof the appendix is an exceedingly rare entity. In the present report, we describe a rare case of primary signet ring cell carcinoma of the appendix with ovarian metastasesand unresectable peritoneal dissemination occurring in a 45-year-old female patient. She was clinically misdiagnosed as torsion of ovarian cyst. She underwent appendicectomy and unilateral salpingo-oophorectomy.Histopathology revealed signet ring cell carcinoma and a right hemicolectomy was done. She then received palliative systemic chemotherapy with 12 cycles of oxaliplatin, 5-fluorouracil, and leucovorin (FOLFOX-4). The patient is doing well till today on follow up without progression of disease 10 mo after beginning chemotherapy.
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Intramucosal carcinoma of the appendix arising from traditional serrated adenoma. Case Rep Surg 2015; 2015:297450. [PMID: 25977829 PMCID: PMC4421026 DOI: 10.1155/2015/297450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 02/25/2015] [Indexed: 11/17/2022] Open
Abstract
Introduction. Serrated adenomas of the appendix are rare and usually found during appendectomy or autopsies. The preoperative diagnosis of these tumors is uncommon. This report describes a case of a sessile serrated adenoma located in the appendix diagnosed by a screening colonoscopy and successfully treated by laparoscopic removal. Presentation of Case. An 86-year-old woman underwent colonoscopy to investigate the cause of her diarrhea, weight loss, and anemia. During the colonoscopy, an expansive and vegetating mass of 1.5 cm in diameter was identified, protruding through the appendicular ostium with slightly lateral growth to the cecum. The patient was referred for laparoscopic surgical resection due to the location of the lesion, which did not allow its removal by colonoscopy. She underwent wedge removal of the cecum without complications and was discharged on the 4th postoperative day. Histopathological examination showed the presence of a sessile serrated adenoma with an intramucosal adenocarcinoma. The patient is currently well one year after surgery, without endoscopic signs of relapse. Conclusion. Despite serrated adenomas being a possibility rarely described in appendix it should be recognized and properly treated because it is presenting a higher risk of cancer.
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Terada T. Primary minute mucinous adenocarcinoma of vermiform appendix arising from appendiceal diverticulosis. HUMAN PATHOLOGY: CASE REPORTS 2015. [DOI: 10.1016/j.ehpc.2014.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Ahmed MU, Bilal M, Anis K, Khan AM, Fatima K, Ahmed I, Khatri AM, Shafiq-ur-Rehman. The Frequency of Enterobius Vermicularis Infections in Patients Diagnosed With Acute Appendicitis in Pakistan. Glob J Health Sci 2015; 7:196-201. [PMID: 26156929 PMCID: PMC4803892 DOI: 10.5539/gjhs.v7n5p196] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 01/19/2015] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The main aim of this study was to determine the frequency of Enterobius vermicularis infections and other unique histopathological findings in patients diagnosed with acute appendicitis. MATERIALS This retrospective study was conducted in a tertiary care hospital of Karachi, Pakistan over a time period of 9 years from 2005 to 2013. The recorded demographic and histopathological data for the 2956 appendectomies performed during this time frame were extracted using a structured template form. Negative and incidental appendectomies were excluded from the study. RESULTS Out of the 2956 patients diagnosed with acute appendicitis, 84 (2.8%) patients had Enterobius vermicularis infections. Malignancy (n=2, 0.1%) and infection with Ascaris (n=1, 0.1%) was found very rarely among the patients.Eggs in lumen (n=22, 0.7%), mucinous cystadenoma (n=28, 1.0%), mucocele (n=11, 0.4%), lymphoma (n=9, 0.3%), obstruction in lumen (n=17, 0.6%) and purulent exudate (n=37, 1.3%) were also seldom seen in the histopathological reports. CONCLUSION Enterobius vermicularis manifestation is a rare overall but a leading parasitic cause of appendicitis. Steps such as early diagnosis and regular de worming may help eradicate the need for surgeries.
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Nash GM, Smith JD, Tang L, Weiser MR, Temple LK, O'Reilly E, Saltz LB, Guillem JG, Paty PB. Lymph Node Metastasis Predicts Disease Recurrence in a Single-Center Experience of 70 Stages 1-3 Appendix Cancers: A Retrospective Review. Ann Surg Oncol 2015; 22:3613-7. [PMID: 25663593 DOI: 10.1245/s10434-015-4415-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND Previous reports on the surgical management of appendix cancer show high recurrence rates among patients initially presenting with localized disease. This study sought to characterize predictors of outcome among patients treated for stages 1-3 appendix cancer at the authors' institution. METHODS Patients with nonmetastatic appendix cancer undergoing definitive surgery at a single cancer center from 1994 to 2013 were retrospectively reviewed. Patients with appendiceal adenomas, cystadenomas, or classical carcinoids were excluded from the study. The median follow-up period was 5.2 years (interquartile range 2.9-6.7 years). RESULTS The study identified 70 patients, 49 % of whom were women. The median age was 52 years (range 20-84 years). All were explored by an expert surgeon who had treated at least 20 appendiceal cancers. The procedures were appendectomy (n = 2), right hemicolectomy (n = 66), and diagnostic laparoscopy and placement of an intraperitoneal port (n = 2). The final pathology showed that transmural (30 T4, 32 T3, 4 T2, 4 T1) and node-negative disease (80 %) were common. Goblet cell carcinoid (GCC) features were identified in 54 % of the tumors. These were smaller and more likely to present as acute appendicitis than appendiceal adenocarcinoma (AA), but were otherwise similar in clinical presentation and outcome. The presence of lymph node (LN) metastasis was associated with a higher risk of recurrence than of stage 2 appendix cancer (78 vs. 4 % at 5 years; p < 0.0001). A total of 12 patients experienced recurrence (5 GCC, 7 AA): 9 in the peritoneum, 2 in mesenteric LNs, and 1 in the surgical incision. CONCLUSION Stages 1-3 invasive AA and GCC behave similarly in terms of clinical presentation and outcome. Perforated appendix and T4 tumor stage were common but not associated with recurrence. Although uncommon, LN metastasis strongly predicted recurrence.
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Affiliation(s)
- Garrett M Nash
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - James D Smith
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura Tang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Larissa K Temple
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eileen O'Reilly
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Leonard B Saltz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - José G Guillem
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip B Paty
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Terada T. Primary signet-ring cell carcinoma of vermiform appendix clinically and pathologically presenting as acute appendicitis. HUMAN PATHOLOGY: CASE REPORTS 2014. [DOI: 10.1016/j.ehpc.2014.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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34
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QUIZ. J Taibah Univ Med Sci 2013. [DOI: 10.1016/j.jtumed.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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35
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Yilmaz M, Akbulut S, Kutluturk K, Sahin N, Arabaci E, Ara C, Yilmaz S. Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. World J Gastroenterol 2013; 19:4015-4022. [PMID: 23840147 PMCID: PMC3703189 DOI: 10.3748/wjg.v19.i25.4015] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis.
METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gangrenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out.
RESULTS: A total of 912 males and 709 females, from 16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell non-hodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy.
CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases.
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Crenitte MRF, de Campos FPF, de Lima PP, Martines BMR, Borba MR. Mucinous adenocarcinona of the appendix. AUTOPSY AND CASE REPORTS 2013; 3:39-44. [PMID: 31528606 PMCID: PMC6673683 DOI: 10.4322/acr.2013.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 05/25/2013] [Indexed: 11/28/2022] Open
Abstract
Diagnosis of malignancy in the vermiform appendix is quite rare. The most common histological malignant neoplasia found in this tiny portion of the gastrointestinal tract is represented by the mucinous adenocarcinoma. This entity predominates in males around 50 years of age, and clinical presentation usually mimics or occurs along with an acute appendicitis. Early diagnosis is outside the rule since most cases at this stage are symptomless. The authors present the case of a 59-year-old female patient who looked for medical attention complaining of abdominal pain. Physical examination and laboratory workup were poor in diagnostic findings. The computed tomography images were compatible with the diagnosis of appendicitis and/or appendiceal neoplasia. The patient underwent a laparotomy and right hemicolectomy. The histological examination disclosed a moderately differentiated mucinous adenocarcinoma of the appendix stage T4a, N0, M0. The patient outcome was uneventful and was referred to an oncological center.
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Affiliation(s)
- Milton Roberto Furst Crenitte
- Department of Internal Medicine - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | | | | | - Marcelo Rodrigues Borba
- Department of Surgery - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
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Matsushita Y, Takeshita M. Paediatric T-cell lymphoma of the appendix: a case report. Diagn Pathol 2013; 8:2. [PMID: 23302373 PMCID: PMC3546902 DOI: 10.1186/1746-1596-8-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 12/13/2012] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED A 7-year-old boy with no history of malnutrition or diarrhoea complained of acute abdominal pain, was diagnosed with acute appendicitis, and underwent appendectomy. Histologically, a diffuse infiltrate of large atypical lymphoid cells was found in the entire appendiceal wall. Immunohistochemical examination revealed that the tumour cells expressed T-cell receptor (TCR)-βF1, CD3, CD4, CD25, cytotoxic-related protein TIA1 and granzyme-B, but were negative for CD8, Foxp3, CD20, CD30 and CD56. Polymerase chain reaction (PCR) revealed clonal bands of TCR-γ gene products in the tumour tissue. No anti-cytomegalovirus antibody-positive cells were detected. In situ hybridization revealed no nuclear signals of Epstein-Barr virus (EBV)-encoded RNA. Helicobacter pylori infection was detected in tumour tissue by anti-East Asian cytotoxin-associated gene (Cag) A antibody and PCR using its specific primers. The patient received chemotherapy and has remained in remission for 2 years. To the best of our knowledge, only two cases of appendiceal T-cell non-Hodgkin lymphoma (NHL) have been reported, both in elderly patients. We believe that this is the first reported case of childhood CD4- and TIA1-positive cytotoxic T (Th1)-cell NHL in the appendix or gastrointestinal tract. Helicobacter pylori infection might be an initiator of atypical cytotoxic T-cell proliferation. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1302380563830412.
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Affiliation(s)
- Yoshifumi Matsushita
- Laboratory of Pathology, Chidoribashi Hospital, 5-18-1 Chiyo, Fukuoka 812-8633, Japan
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Köksal AŞ, Kalkan IH, Yildiz H, Ökten RS, Neşşar G, Saşmaz N. Direct visualization of an extremely rare malignancy: adenocarcinoma of the appendix. Am J Gastroenterol 2013; 108:149-50. [PMID: 23287952 DOI: 10.1038/ajg.2012.339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Grozinsky-Glasberg S, Alexandraki KI, Barak D, Doviner V, Reissman P, Kaltsas GA, Gross DJ. Current size criteria for the management of neuroendocrine tumors of the appendix: are they valid? Clinical experience and review of the literature. Neuroendocrinology 2013; 98:31-7. [PMID: 23051855 DOI: 10.1159/000343801] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 09/27/2012] [Indexed: 12/13/2022]
Abstract
We evaluated the latest pathological criteria for completion right hemicolectomy (RHC) in patients with appendiceal neuroendocrine tumors (ANETs) with emphasis on the size of the primary tumor. Data of 28 consecutive patients who underwent RHC for ANETs in three tertiary hospitals were reviewed retrospectively to assess the indications for completion RHC. 10/28 patients were found to have residual disease (36%). In 8/28 patients (29%), the tumor diameter was <1 cm (mean 0.7 ± 0.2 cm, range 0.5-0.9 cm); the indications for RHC included: tumor presence in surgical margins (1 patient), extensive mesoappendiceal invasion (EMI) (1 patient), vascular invasion (VI) (3 patients), Ki-67 ≥2% (3 patients); residual disease was present in 1 patient (3.5%). In 13/28 patients (46%), the tumor diameter was ≥1 and <2 cm (mean 1.30 ± 0.2 cm, range 1.0-1.8 cm); the indications for RHC were: EMI (2 patients), VI (2 patients), Ki-67 ≥2% (2 patients); residual disease was present in 5 patients (18%). In 7/28 patients (25%), the tumor diameter was ≥2 cm (mean 2.5 ± 0.7 cm, range 2.0-4.0 cm). In this final subgroup, RHC was an accepted practice irrespective of other pathologic findings: the tumor was present in surgical margins in 2 patients, in 5 patients VI was demonstrated, and Ki-67 ≥2% was found in 5 patients; residual disease was present in 4 patients (14%). Using the latest European Neuroendocrine Tumor Society criteria for RHC, residual disease may be missed in 18% of ANET patients.
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Affiliation(s)
- S Grozinsky-Glasberg
- Neuroendocrine Tumor Unit, Endocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Abstract
AIM Primary appendiceal neoplasms are rare, with carcinoid being more common than carcinoma. Preoperative diagnosis is infrequent. We report a series of 24 primary appendiceal neoplasms treated over a 5-year period. METHOD All primary appendiceal neoplasms diagnosed in a university teaching hospital between April 2003 and June 2008 were identified from the prospective histopathology database. Patient records were reviewed for clinical, operative and pathological data. RESULTS Fourteen carcinomas and 10 carcinoids were identified in the 5-year period. The former presented at median age 55.8 years with median symptom duration of 35 days, compared with 48 years and 3 days, respectively, for carcinoids. An abdominal mass was commoner in carcinomas (8/14 vs 1/10). Six patients with carcinoma underwent appendicectomy followed by completion right-hemicolectomy, two of whom had residual disease; seven underwent primary right-hemicolectomy and one had abscess drainage. Five patients with appendiceal carcinoma died of the disease during a median follow-up of 633 (256-1158) days. Six patients underwent appendicectomy for acute appendicitis, one had a primary right-hemicolectomy for a caecal mass. Three had a subsequent right-hemicolectomy for a high-risk carcinoid. An appendiceal carcinoid was an incidental finding in three right-hemicolectomy specimens removed for other indications. No metastases or deaths were recorded at median follow-up 451 (51-975) days. CONCLUSION Appendiceal carcinomas follow a more protracted clinical course than carcinoids, which usually present as acute appendicitis. Caution is needed when diagnosing simple appendicitis in older patients with longer symptom duration, particularly if a mass is present. Patients with appendiceal carcinoma should be offered completion right-hemicolectomy. Carcinoma has a poor prognosis.
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Affiliation(s)
- C G Whitfield
- Department of Colorectal Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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Tsuchihashi K, Takayoshi K, Uchino K, Shirakawa T, Kumagai H, Tamura S, Komoda M, Isobe T, Takaishi S, Kusaba H, Aishima S, Akashi K, Baba E. Systemic chemotherapy for metastatic non-mucinous appendiceal adenocarcinoma: a case report and literature review. Int Cancer Conf J 2012. [DOI: 10.1007/s13691-012-0060-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Natalia C, Koh CE, Lee PJ. Giant appendiceal leiomyosarcoma: a rare and unusual tumour. Case Rep Surg 2011; 2011:384762. [PMID: 22606577 PMCID: PMC3350297 DOI: 10.1155/2011/384762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 07/10/2011] [Indexed: 12/01/2022] Open
Abstract
Appendiceal tumours are uncommon but may be present in 0.9-1.4% of all appendicectomy specimens. While carcinoid tumours and adenocarcinomas comprise the majority of appendiceal tumours, rarely, lymphomas or sarcomas may also present in the appendix. Appendiceal leiomyosarcomas are rare, and to date, only a handful of cases have been reported. The current paper presents a case of giant appendiceal leiomyosarcoma followed by a review of the literature.
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Affiliation(s)
- Christine Natalia
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Cherry E. Koh
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- Surgical Outcomes Research (SOuRCe), Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
| | - Peter J. Lee
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- Royal Prince Alfred Hospital Medical Centre, Suite 415/ 100 Carillon Avenue, Newtown, NSW 2042, Australia
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Mahta A, Kim RY, Fanta PT, Lawson JD, Kesari S. Leptomeningeal Metastasis from Appendiceal Adenocarcinoma: Case Report and Literature Review. J Gastrointest Cancer 2011; 43 Suppl 1:108-10. [PMID: 21826409 DOI: 10.1007/s12029-011-9312-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Ali Mahta
- Department of Neurosciences, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Ryan Y Kim
- Department of Neurosciences, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Paul T Fanta
- Department of Medicine, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Joshua D Lawson
- Department of Radiation Oncology, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, USA
| | - Santosh Kesari
- Department of Neurosciences, Moores UCSD Cancer Center, University of California San Diego, La Jolla, CA, USA.
- Moores UCSD Cancer Center, 3855 Health Sciences Drive, Rm 3336, La Jolla, CA, 92093-0819, USA.
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Komm M, Kronawitter-Fesl M, Kremer M, Lutz L, Holinski-Feder E, Kopp R. Primary mucinous adenocarcinoma of the vermiform appendix with high grade microsatellite instability. J Cancer 2011; 2:302-6. [PMID: 21716905 PMCID: PMC3119391 DOI: 10.7150/jca.2.302] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Accepted: 05/13/2011] [Indexed: 12/16/2022] Open
Abstract
Primary adenocarcinoma of the vermiform appendix is a rare entity and is frequently discovered by the pathologist following appendectomy for suspected appendicitis.We present a 42-year-old male with primary mucinous adenocarcinoma of the appendix initially presenting symptoms of acute appendicitis. Histological investigation of the appendectomy specimen showed a mucinous adenocarcinoma and the patient was treated by secondary right hemicolectomy giving the final histopathological classification of an UICC IIIC tumor. Since the patient fulfills the revised Bethesda criteria analysis of immunoreactivity of DNA mismatch repair proteins was performed showing loss of MLH1 and MSH2 expression associated with high microsatellite instability (MSI-H), not yet reported for primary mucinous appendiceal carcinoma. Further genetic analysis for DNA mismatch repair gene mutations were negative. The patient received intensified adjuvant chemotherapy according to the FOLFOX-4-scheme, since MSI-H colorectal carcinomas might show lower response rates following standard 5-FU-based adjuvant chemotherapy.
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Affiliation(s)
- Moritz Komm
- 1. Department of General Surgery, Klinikum München-Harlaching, Munich, Germany
| | | | - Marcus Kremer
- 2. Department of Pathology, Klinikum München-Harlaching, Munich, Germany
| | - Ludwig Lutz
- 3. Department of Haematology and Oncology, Klinikum München-Harlaching, Munich, Germany
| | | | - Reinhard Kopp
- 1. Department of General Surgery, Klinikum München-Harlaching, Munich, Germany
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A retrospective clinicopathological analysis of appendiceal tumors from 3,744 appendectomies: a single-institution study. Int J Colorectal Dis 2011; 26:617-21. [PMID: 21234578 DOI: 10.1007/s00384-010-1124-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2010] [Indexed: 02/04/2023]
Abstract
PURPOSE This study was conducted to describe the clinicopathological characteristics of appendiceal tumors and to evaluate their appropriate management. METHODS Between September 2000 and September 2005, 28 appendiceal tumors were identified by a retrospective review of 3,744 appendectomies. RESULTS Twenty-eight patients were found to have appendiceal tumors (incidence, 0.7%).The largest single group of tumors were benign mucinous cystadenomas (50%); carcinoids (32.1%) were next, and they were followed by malignant tumors (17.9%). Four out of five patients who had malignant appendiceal tumors presented with periappendiceal abscess. None of the patients was correctly diagnosed preoperatively. One-stage curative resection was possible in more than 76% of the patients, and the rate of making the correct preoperative diagnosis was 35%. CONCLUSION Most appendiceal tumors presented with appendicitis and periappendiceal abscess. Appendiceal tumors should be included in the differential diagnosis when an unexpected appendiceal mass is encountered during appendectomy.
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Guraya SY, Almaramhy HH. Clinicopathological features and the outcome of surgical management for adenocarcinoma of the appendix. World J Gastrointest Surg 2011; 3:7-12. [PMID: 21286219 PMCID: PMC3030740 DOI: 10.4240/wjgs.v3.i1.7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Revised: 01/02/2011] [Accepted: 01/09/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To present a comprehensive analysis of incidence, clinicopathological features, appropriateness of surgical procedures, and survival for adenocarcinoma of the appendix.
METHODS: A retrospective case analysis was conducted for the 10-year period 1998-2008. All patients diagnosed with adenocarcinoma of the appendix were analyzed for their demographics details, clinical features, tumor incidence and characteristics, tumor stage, surgical procedures performed, and their survival.
RESULTS: Nine thousand three hundred and twenty-three patients underwent appendectomies during the study period, and of these, 10 (0.1%: 8 men and 2 women with a mean age of 53.1 years, age range 21-83 years) were found to have primary adenocarcinoma of the appendix. Appendicular neoplasia was not suspected pre-operatively in any of the patients. Six (60%) patients underwent secondary right hemicolectomy. Four (40%) cases had appendectomy alone, and two of them died, whereas all those who underwent right hemicolectomy are alive and disease free. Five (50%) were reported to have grade 1 disease, three (30%) grade 2, and two (20%) grade 3 with mean survival of 34, 48, and 22 mo, respectively. Six (60%) patients presented with advanced disease (Duke’s C and D). At the end of follow up (mean period: 37.9 mo), eight patients are alive and disease free at the end of follow up. Overall mean survival was 36.3 mo (confidence interval; 16%-56%) with 41.3 and 16 mo for men and women, respectively. Mean survival for those with and without lymph node involvement was 33.6 and 40.2 mo, respectively. Right hemicolectomy gave better results than appendectomy alone, although the difference was not statistically significant due to the small number of cases.
CONCLUSION: Adenocarcinoma of the appendix is extremely rare neoplasm with varied presentations, and is usually advanced when diagnosed. Right hemicolectomy is the treatment of choice for such tumors.
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Affiliation(s)
- Salman Yousuf Guraya
- Salman Yousuf Guraya, Hamdi Hameed Almaramhy, Department of Surgery, College of Medicine, Taibah University, PO Box 30054, Al Madina Al Munawara 41477, Saudi Arabia
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Behera PK, Rath PK, Panda R, Satpathi S, Behera R. Primary appendiceal mucinous adenocarcinoma. Indian J Surg 2010; 73:146-8. [PMID: 22468066 DOI: 10.1007/s12262-010-0201-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 01/18/2009] [Indexed: 01/17/2023] Open
Abstract
Primary Adenocarcinomas of the appendix are extremely rare tumor. We report a case of primary mucinous adenocarcinoma in a 40 year old lady misdiagnosed as having acute appendicitis. All the routine investigations were within normal limit. USG of abdomen showed dilated appendix with little fluid collection adjacent to it and no other abnormality was seen which suggested acute appendicitis. Appendicectomy was done and excised appendix was sent for histopathological examination. Mucinous Adenocarcinoma of the appendix was confirmed after histopathological examination. Right hemicolectomy was done as a second stage procedure. As some cases are incidentally discovered, this case emphasizes that histological examination of all appendicectomy specimens is mandatory.
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A case of signet ring carcinoma of the appendix: dilemmas in differential diagnosis and management. J Gastrointest Cancer 2010; 41:141-4. [PMID: 20058100 DOI: 10.1007/s12029-009-9123-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Signet ring carcinoma (SRC) of the appendix consists one of the most biologically virulent cancers. We present the case of a patient with primary SRC complicated by the development of acute inflammation of the appendix. CASE REPORT A 78-year-old man was admitted due to a 5-day history of increasing colicky abdominal pain and vomiting. Clinical examination revealed a firm, tender mass in the right ileac fossa. Laparotomy confirmed a tumor mass which appeared to originate from the appendix. The affected part of the bowel was resected and a right hemicolectomy with an end-to-side ileotransverse anastomosis was performed. The appendix was notably thickened with an ulcerated wall containing sinus tracts, chronic inflammation, and scarring. Moreover, a focus of SRC was detected. CONCLUSIONS Appendiceal SRC is a rare entity, which may sometimes be confused with other pathologies providing difficulties in differential diagnosis, having an impact on therapeutic decisions and affecting prognosis.
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Ko YH, Park SH, Jung CK, Won HS, Hong SH, Park JC, Roh SY, Woo IS, Kang JH, Hong YS, Byun JH. Clinical characteristics and prognostic factors for primary appendiceal carcinoma. Asia Pac J Clin Oncol 2010; 6:19-27. [PMID: 20398034 DOI: 10.1111/j.1743-7563.2010.01276.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Primary adenocarcinoma of the appendix is a rare malignancy. This study assessed prognostic factors affecting the clinical outcome in patients with appendiceal neoplasms. METHODS We performed a retrospective analysis of patients who had appendectomies between 1991 and 2007 at five centers in South Korea. RESULTS Overall 55 patients (19 men, 36 women, median age 61 years) were identified. Of these, 37 (67.3%) were mucinous adenocarcinomas, 14 (25.5%) were intestinal-type adenocarcinomas, and four (7.3%) were signet ring cell carcinomas. The distribution of stages was: 26 (47.3%) with localized disease, five (9.1%) with regional disease, and 24 (43.6%) with distant metastatic disease. The overall 3- and 5-year survival rates among all patients were 72.2% and 64.0%, respectively, with 20 deaths during the follow-up period. In a multivariate analysis, high histological grade (hazard ratio [HR]vs low grade 15.7; P = 0.001) and pathological stage (distant vs loco-regional, HR 6.2; P = 0.021) were independent predictors of overall survival. Of the 34 patients who underwent curative resections of primary appendiceal carcinomas, the 3- and 5-year disease-free survival rates were 66.4% and 53.3%, respectively. The recurrence rate was higher in patients with regional lymph node metastasis (HR vs node negative disease 23.4; P = 0.005) and high-grade tumors (HR vs low grade 6.3; P = 0.029). Additionally, a right hemicolectomy reduced the risk of recurrence (HR vs lesser procedures 0.05; P = 0.005). CONCLUSION High tumor grade and advanced stage were significantly predictive of poor survival outcome in patients with primary appendiceal carcinomas.
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Affiliation(s)
- Yoon Ho Ko
- Division of Oncology, Department of Internal Medicine, Catholic University, Seoul, Korea
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