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Wang L, Dong Y, Chen YH, Wang YN, Sun L. Accidental discovery of appendiceal carcinoma during gynecological surgery: A case report. World J Clin Cases 2022; 10:8040-8044. [PMID: 36158468 PMCID: PMC9372845 DOI: 10.12998/wjcc.v10.i22.8040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/28/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Malignant tumors of the appendix are extremely rare, constituting about 1% of all gastrointestinal tumors. Generally, pathology identifies these tumors during or after appendectomy because they are difficult to detect at the preoperative stage. This case report aims to introduce the definitive diagnosis and treatment of mucinous adenocarcinoma of the appendix.
CASE SUMMARY A 49-year-old female patient came to our hospital with right lower abdominal pain, nausea, and vomiting for three days. There was no change in the menstrual cycle. Gynecological ultrasound showed a cystic, solid mass in the right adnexa. Abdominal enhanced computed tomography showed a thick appendix. Cancer was found on exploration of the appendix during gynecological surgery. The right colon was removed. After surgery, the patient received chemotherapy and is recovering well.
CONCLUSION Appendiceal carcinoma is frequently found during or after surgery, and both preoperative examination and early evaluation of clinical manifestations are extremely important.
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Affiliation(s)
- Lin Wang
- Department of Clinical Medicine, Jining Medical University, Jining 272000, Shandong Province, China
| | - Yan Dong
- Department of Clinical Medicine, Jining Medical University, Jining 272000, Shandong Province, China
| | - Ya-Hui Chen
- Department of Clinical Medicine, Jining Medical University, Jining 272000, Shandong Province, China
| | - Ya-Nan Wang
- Department of Clinical Medicine, Jining Medical University, Jining 272000, Shandong Province, China
| | - Lin Sun
- Department of Obstetrics and Gynecology, The Affiliated Hospital of Jining Medical University, Jining 272000, Shandong Province, China
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Cordeiro PJD, Muzi CD. Cirurgia Citorredutora com Quimioterapia Intraperitoneal Hipertérmica em Pacientes com Adenocarcinoma Mucinoso de Apêndice: Série de 43 Casos. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n1.1696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Introdução: O carcinoma primário de apêndice é uma condição rara. Muitas revisões retrospectivas internacionais delineiam a experiência de diferentes centros em neoplasias apendiculares. Por sua vez, o tratamento do câncer nessa localização é complexo e depende do subtipo histológico e da extensão da doença. Um dos tratamentos mais promissores é a cirurgia citorredutora (CCR) associada à quimioterapia intraperitoneal hipertérmica (HIPEC). No Brasil, não há descrição de séries de casos que tiveram essa abordagem terapêutica. O objetivo desta série de casos é analisar as características sociodemográficas e o tipo de intervenção terapêutica em pacientes com doenças malignas de apêndice em um Centro de Assistência de Alta Complexidade em Oncologia III (Cacon III). Relato dos casos: Foram incluídos 43 casos de tumores primários de apêndice. O adenocarcinoma do apêndice do tipo mucinoso de baixo grau foi a neoplasia mais diagnosticada. O principal protocolo utilizado foi de uma a duas cirurgias e aplicação de mitomicina C em temperatura média de 40 graus. Os casos apresentaram grande heterogeneidade quanto ao uso do protocolo. Conclusão: O presente relato de 43 casos é importante por se tratar de um tumor raro nessa localização. A modalidade terapêutica descrita é promissora, mas não há protocolo definido para essa finalidade. É necessário atualizar as diretrizes terapêuticas para normatizar a conduta internamente, especialmente em se tratando de uma unidade de referência nacional.
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Phan DH, Teo JY, Nalliah S. Closed loop large bowel obstruction due to appendiceal signet cell carcinoma. J Surg Case Rep 2021; 2021:rjab452. [PMID: 34729168 PMCID: PMC8557668 DOI: 10.1093/jscr/rjab452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/20/2021] [Indexed: 11/14/2022] Open
Abstract
Signet cell carcinoma of the appendix is the rarest and the most aggressive subtype of appendiceal malignancy, typically presenting with non-specific symptoms. We describe a case of a 62-year-old male with large bowel obstruction, with computed tomography demonstrating dilated large bowels from caecum to proximal sigmoid colon and pneumoperitoneum. Intraoperatively, closed loop obstruction caused by dense adherence of sigmoid colon to caecum was noted, which had resulted in caecal perforation. Histopathology study indicated primary appendiceal malignancy of signet cell morphology with intraperitoneal spread to sigmoid colon. Large bowel obstruction from appendiceal malignancy has rarely been reported and similar presentations have not been described in the existing literature. When left-sided large bowel obstruction is suspected to be caused by a malignant stricture, it is essential to consider transperitoneal spread of appendiceal malignancy as potential aetiology, particularly in the elderly.
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Affiliation(s)
- Du H Phan
- Department of General Surgery, Hervey Bay Hospital, Queensland, Australia
| | - Joshua Y Teo
- Department of General Surgery, Hervey Bay Hospital, Queensland, Australia
| | - Sasikaran Nalliah
- Department of General Surgery, Hervey Bay Hospital, Queensland, Australia
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McDonald SJ, Lee F, Dean N, Ridley LJ, Stewart P. Fistulae involving the appendix: a systematic review of the literature. ANZ J Surg 2021; 90:1878-1887. [PMID: 33710738 DOI: 10.1111/ans.15805] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/19/2020] [Accepted: 02/23/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND The appendix has a unique place in surgical history. Although the first ever appendicectomy involved a fistula to the skin, fistulae involving the appendix remain uncommon and can lead to unique surgical considerations. METHODS A systematic review of the literature was performed for case reports of appendiceal fistulae. We excluded cases in which the patient had a history of appendicectomy. Cases were categorized by site and aetiology, with information regarding relative frequency and demographics obtained. RESULTS A total of 301 case reports of fistula involving the appendix were found. The most common sites of these fistulae were to the bladder (148 cases), skin (40 cases), vasculature (19 cases), umbilicus (16 cases) and to the gastrointestinal tract. The most common aetiology in sub-analysis was appendicitis alone (150 cases), with less common causes including appendiceal adenocarcinoma (32 cases) and congenital abnormalities (18 cases). There were significantly more appendiceal fistulae in males than in females, with a ratio of 1.7:1. In patients with appendiceal adenocarcinoma as a cause for fistula, there were significantly more females than males with a ratio of 2.3:1. CONCLUSION In conducting a systematic review of case reports of fistulae involving the appendix, we identified 301 unique case reports, with a range of different sites and aetiologies.
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Affiliation(s)
- Stephen J McDonald
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Felix Lee
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
| | - Nicholas Dean
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Lloyd J Ridley
- Department of Radiology, Concord Repatriation General Hospital, Sydney, New South Wales, Australia.,Discipline of Medical Imaging, The University of Sydney, Sydney, New South Wales, Australia
| | - Peter Stewart
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Division of Colorectal Surgery, Department of Surgery, Concord Hospital, Sydney, New South Wales, Australia
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Skendelas JP, Alemany VS, Au V, Rao D, McNelis J, Kim PK. Appendiceal adenocarcinoma found by surgery for acute appendicitis is associated with older age. BMC Surg 2021; 21:228. [PMID: 33934697 PMCID: PMC8088755 DOI: 10.1186/s12893-021-01224-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/21/2021] [Indexed: 02/20/2023] Open
Abstract
Background Appendectomy for acute appendicitis is the most common procedure performed emergently by general surgeons in the United States. The current management of acute appendicitis is increasingly controversial as non-operative management gains favor. Although rare, appendiceal neoplasms are often found as an incidental finding in the setting of appendectomy. Criteria and screening for appendiceal neoplasms are not standardized among surgical societies. Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for all patients who underwent appendectomy over a 9-year period (2010–2018). Over the same time period, patients who underwent appendectomy in two municipal hospitals in The Bronx, New York City, USA were reviewed. Results We found a 1.7% incidence of appendiceal neoplasms locally and a 0.53% incidence of appendiceal tumors in a national population sample. Both groups demonstrated an increased incidence of appendiceal carcinoma by age. This finding was most pronounced after the age of 40 in both local and national populations. In our study, the incidence of appendiceal tumors increased with each decade interval up to the age of 80 and peaked at 2.1% in patients between 70 and 79 years. Conclusions Appendiceal adenocarcinomas were identified in patients with acute appendicitis that seem to be associated with increasing age. The presence of an appendiceal malignancy should be considered in the management of older patients with acute appendicitis before a decision to embark on non-operative therapy.
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Affiliation(s)
- John P Skendelas
- Jacobi Medical Center, Bronx, NY, USA.,North Central Bronx Hospital, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Vincent Au
- Jacobi Medical Center, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA
| | - Devika Rao
- Jacobi Medical Center, Bronx, NY, USA.,North Central Bronx Hospital, Bronx, NY, USA.,Montefiore Medical Center, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | - John McNelis
- Jacobi Medical Center, Bronx, NY, USA.,North Central Bronx Hospital, Bronx, NY, USA.,Albert Einstein College of Medicine, Bronx, NY, USA
| | - Peter K Kim
- Jacobi Medical Center, Bronx, NY, USA. .,North Central Bronx Hospital, Bronx, NY, USA. .,Albert Einstein College of Medicine, Bronx, NY, USA. .,Jacobi Medical Center, 1400 Pelham Parkway, Building 1, Room 510, Bronx, NY, 10461, USA.
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Roma K, Baldwin M, Sedmak D, Silva M, Stellar W, Many G. Late stage diagnosis of mucinous adenocarcinoma of the appendix: a case report of an unusual tumor with a rare presentation. BMC Gastroenterol 2020; 20:281. [PMID: 32825826 PMCID: PMC7441642 DOI: 10.1186/s12876-020-01378-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/09/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The incidence of mucinous appendiceal adenocarcinomas (MAA) has increased over the past three decades. Advanced stage tumor diagnosis is likely attributable to non-specific findings. Here we describe advanced stage appendiceal MAA presenting as inguinal ulcers, scrotal abscesses, and other nonspecific symptoms. To our knowledge, this is the first report of MAA presenting as inguinal pain with inflamed phlegmonous tissue and scrotal abscess. CASE PRESENTATION A 67-year-old male presented to a rural facility complaining of weight-loss, fatigue, hematuria, dysuria, painful right inguinal ulceration, and right scrotal abscess drainage. Computed tomography of the abdomen and pelvis revealed a distended appendix (> 1.3 cm) and a fistula between the appendix, urinary bladder, right scrotum, and right groin. Laparoscopic appendectomy was performed and diagnosed as MAA. After a right hemicolectomy, the MAA was staged as pT3b pN0 M0 G2. CONCLUSION This case highlights a unique presentation of late stage appendiceal MAA. Due to the increased incidence of appendiceal MAAs, reports of unique clinical features are needed to facilitate early diagnosis and intervention, especially in rural settings with limited access to specialists.
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Affiliation(s)
- Katerina Roma
- Pacific Northwest University of Health Sciences, Yakima, WA 98901 USA
| | - Mark Baldwin
- Pacific Northwest University of Health Sciences, Yakima, WA 98901 USA
| | | | | | | | - Gina Many
- Community Health of Central Washington, Yakima, WA 98901 USA
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Yokode M, Ikeda E, Matsui Y, Iwamura S, Mikami S, Kobayashi H, Imai Y, Kaihara S, Yamashita Y. Fistula Formation Secondary to Mucinous Appendiceal Adenocarcinoma May Be Related to a Favorable Prognosis: A Case Report and Literature Review. Intern Med 2018; 57:2945-2949. [PMID: 29877276 PMCID: PMC6232025 DOI: 10.2169/internalmedicine.0694-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A 90-year-old man was referred to our hospital because of a positive fecal occult blood test. Colonoscopy revealed a lesion with multiple nodules covered with abundant mucus at the hepatic flexure. Computed tomography showed a dilated appendix attached distally to the hepatic flexure. Right hemicolectomy was performed, and the pathological examination revealed a mucinous appendiceal adenocarcinoma infiltrating the hepatic flexure without pseudomyxoma peritonei. The patient is doing well without recurrence 12 months postoperatively. Extraperitoneal drainage of the malignant ascites caused by the fistula may allow for an early diagnosis, while also making it possible to successfully resect the lesion, thus resulting in a favorable outcome.
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Affiliation(s)
- Masataka Yokode
- Department of Gastroenterology and Hepatology, Kobe City Medical Center West Hospital, Japan
| | - Eiji Ikeda
- Department of Gastroenterology and Hepatology, Kobe City Medical Center West Hospital, Japan
| | - Yugo Matsui
- Department of Surgery, Kobe City Medical Center West Hospital, Japan
| | - Sena Iwamura
- Department of Surgery, Kobe City Medical Center General Hospital, Japan
| | - Sakae Mikami
- Department of Gastroenterology and Hepatology, Kobe City Medical Center West Hospital, Japan
| | | | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, Japan
| | - Satoshi Kaihara
- Department of Surgery, Kobe City Medical Center General Hospital, Japan
| | - Yukimasa Yamashita
- Department of Gastroenterology and Hepatology, Kobe City Medical Center West Hospital, Japan
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Dong XF, Ma ZH, Zhao YF. Primary malignant neoplasms of the appendix: An analysis of 8 cases. Shijie Huaren Xiaohua Zazhi 2012; 20:2746-2750. [DOI: 10.11569/wcjd.v20.i28.2746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical and pathological characteristics, diagnosis, treatment and prognosis of primary malignant neoplasms of the appendix and to discuss how to reduce misdiagnosis and reoperation.
METHODS: A total of 442 patients with primary malignant neoplasms of the appendix were retrospectively analyzed, among them 8 were diagnosed at the Second Affiliated Hospital of Dalian Medical University and the other 434 were identified in Chinese medical literature databases.
RESULTS: Of 8 patients diagnosed at our hospital, 6 were male and 2 were female. Their average age at the time of presentation was 48.37 years (range 21-76 years). The duration of the disease was 10 h-8 d in 6 cases, 3 years in one case, and 20 years in one case. Postoperative pathology suggested carcinoid in 4 four cases and adenocarcinoma in other 4 cases. All of them were misdiagnosed preoperatively and intraoperatively. Six cases were followed, of whom four survived till now, one died, and one developed recurrence. Of 434 cases identified from Chinese literature, 220 were male and 214 were female. Their average age at the time of presentation was 45.14 years (mean 10-86 years). Only 2 patients were diagnosed preoperatively. Postoperative pathology suggested carcinoid in 287 cases, adenocarcinoma in 138 cases, malignant lymphoma in 6 cases, and leiomyosarcoma in 3 cases. The prognosis of appendix carcinoid was better than that of adenocarcinoma, malignant lymphoma and leiomyosarcoma.
CONCLUSION: Primary malignant neoplasms of the appendix are difficult to diagnose preoperatively, and the diagnosis relies mainly on intraoperative frozen section and postoperative pathology. Selection of reasonable surgery can improve prognosis by pathological type, neoplastic size, position of the disease, infiltration depth, and lymph node metastasis.
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Nixon M, Verwey J, Akoh JA. Caecal tumour masquerading as an appendicular mass. Clin Pract 2012; 2:e4. [PMID: 24765403 PMCID: PMC3981336 DOI: 10.4081/cp.2012.e4] [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: 11/10/2011] [Revised: 11/29/2011] [Accepted: 12/05/2011] [Indexed: 11/23/2022] Open
Abstract
Appropriate management of appendix mass is based on an accurate diagnosis of the underlying pathology. This is a report of a complex patient presenting with an appendix mass, whose surgery was deferred due to severe co-morbidities and who later died from severe metastatic disease. A 65-year-old lady presented with right iliac fossa pain and a mass. She was treated for an appendix mass initially and when the mass failed to resolve after four weeks, she was thoroughly investigated for the possibility of a tumour. Severe co-morbities had a significant impact on her management as definitive surgery was delayed. She represented 10 months after the initial admission with small bowel obstruction and died of metastatic caecal cancer. Management of appendix mass must entail a careful approach to investigating and treatment with emphasis on early intervention if the mass does not resolve promptly. This will avoid delayed diagnosis, treatment and a detrimental impact on prognosis.
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Affiliation(s)
- Martha Nixon
- Gastroenterology, Surgery & Renal Services Directorate, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, UK
| | - Jes Verwey
- Gastroenterology, Surgery & Renal Services Directorate, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, UK
| | - Jacob A Akoh
- Gastroenterology, Surgery & Renal Services Directorate, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth, UK
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Sayles M, Courtney E, Younis F, O'Donovan M, Ibrahim A, Fearnhead NS. Appendiceal mucinous adenocarcinoma presenting as an enterocutaneous fistula in an incisional hernia. BMJ Case Rep 2010; 2010:bcr.11.2009.2472. [PMID: 22789695 DOI: 10.1136/bcr.11.2009.2472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 68-year-old woman with a history of bone-graft harvesting from the right iliac crest presented with an incisional hernia and abscess at the graft donor site. Following incision and drainage of the abscess, CT demonstrated an enterocutaneous fistula between the appendix and bone-graft incision with appendicitis assumed to be the original cause of the abscess. At laparoscopy, the appendix was adherent to the hernia sac with mucinous material at the superficial orifice of the fistula site but not in the peritoneal cavity. Laparoscopic appendicectomy with fistula track excision was performed. Histological evaluation confirmed a well-to-moderately differentiated mucinous adenocarcinoma arising on a background of dysplastic villous adenoma. Tumour extended along the fistula track to involve the surface skin. A laparoscopic right hemicolectomy, lymph node dissection and wide local excision of the fistula track were carried out at a second procedure. Final histology confirmed pT4N1 tumour with clear resection margins.
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