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AlAli MN, Zubaidi A, Traiki TAB, Alkhayal K, Sbaih M, Aldeghaither SK, Almugrin FF, Alshammari SA, Alswayyed M, Abdullah M. Appendiceal neoplasms in Saudi Arabia: prevalence and clinicopathological profile. Ann Saudi Med 2024; 44:255-263. [PMID: 39127899 DOI: 10.5144/0256-4947.2024.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND The appendix is a small organ with no particular known function. Primary appendiceal neoplasms (ANs) are rare. While the prevalence is increasing worldwide over the past two decades, no apparent increase in the prevalence of ANs has been reported in the Arabian Gulf States. Recently, a significant decline in the age at diagnosis of some types of ANs has been reported worldwide, with a female predominance. OBJECTIVES Evaluate the prevalence and clinicopathological characteristics of ANs within our institution in Saudi Arabia and compare them to limited existing studies from different regions as well as the Arabian Gulf States. DESIGN Retrospective cohort. SETTING Tertiary care center in Riyadh. PATIENTS AND METHODS All patients who underwent appendectomy and had the appendix submitted for histopathological evaluation between May 2015 and June 2020 were included to allow for a follow-up of 5 years or more at the time of data collection. MAIN OUTCOME MEASURES Demographics, clinical presentations, surgical interventions, histopathological findings, complications, and recurrence rates. SAMPLE SIZE 25 AN patients. RESULTS Of 1110 patients, 25 had ANs (13 female and 12 male participants) with a mean (standard deviation) age of 54.6 (14.1) years. Only 40% presented with acute appendicitis, 64% had comorbidities, and less than 50% underwent laparoscopic appendectomy. Histopathologically, 72% were low-grade appendiceal mucinous neoplasms (LAMNs). Complications were minimal grades (Clavien-Dindo classification), with 80% experiencing none. The mean hospital stay was 9.96 days. Local recurrence occurred in 8% of cases, and distant metastasis was documented in one adenocarcinoma case. However, the 5-year overall and disease-free survival rates were 88% and 80%, respectively. CONCLUSIONS The incidence of ANs is increasing in Saudi Arabia with the higher prevalence of LAMNs. The pathological examination of the resected appendix played a pivotal role in the diagnosis of ANs. LIMITATIONS Data collected retrospectively, a single institution, and a small population.
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Affiliation(s)
- Mohammed Nabil AlAli
- From the Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
- From the Department of Surgery, Prince Mohammed bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Ahmad Zubaidi
- From the Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Thamer A Bin Traiki
- From the Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Khayal Alkhayal
- From the Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Sbaih
- From the Department of Surgery, Prince Mohammed bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Saud Khalid Aldeghaither
- From the Department of Surgery, Prince Mohammed bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia
| | - Farah F Almugrin
- From the College of Medicine, Imam Mohammad ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Sulaiman Abdullah Alshammari
- From the Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Alswayyed
- From the Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Maha Abdullah
- From the Colorectal Research Chair, Department of Surgery, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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Herzberg J, Acs M, Guraya SY, Schlitt HJ, Honarpisheh H, Strate T, Piso P. Anastomotic leakage following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal cancer: A clinical cohort study. Surg Oncol 2024; 54:102080. [PMID: 38663060 DOI: 10.1016/j.suronc.2024.102080] [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] [Received: 12/30/2023] [Revised: 03/13/2024] [Accepted: 04/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Extended oncological resections for colorectal cancer surgery are associated with a high rate of complications, especially anastomotic leakage (AL). This study determines the incidence of risk factors for postoperative complications following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal cancer (CRC). METHODS In this cohort study, the clinical data of all patients with CRC, treated with CRS and HIPEC, from 2011 to 2021 was analyzed. We considered patients' characteristics, tumor-specific features, postoperative complications, and hospital stay using Chi-Square-test or Fisher's exact test. The Mann-Whitney-U-test was used to measure the probability of differences between two sets of data. RESULTS Of 1089 HIPEC procedures performed in the study center, 185 patients with CRC and peritoneal metastasis were treated with CRS and HIPEC after formation of at least one anastomosis and therefore included in this study. This included synchronous and metachronous peritoneal metastasis with a mean peritoneal cancer index of 8.67 ± 5.22. In this cohort, AL occurred in 12 (6.5 %) patients. There was no correlation between the number of anastomoses and the occurrence of an AL (p = 0.401). CONCLUSION This study reports a low risk of AL after CRS with HIPEC for CRC, comparable to other published data. If a complete cytoreduction seems possible, the risk of anastomotic leakage should not negatively influence the decision to resect. Further studies on this subject are essential to validate our findings.
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Affiliation(s)
- Jonas Herzberg
- Department of Surgery - Hospital Reinbek St. Adolf-Stift, Hamburger Strasse 41, 21465, Reinbek, Germany.
| | - Miklos Acs
- Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, D-93049, Germany; Department of Surgery, University Hospital, Regensburg, D-93049, Germany
| | - Salman Yousuf Guraya
- Clinical Sciences Department, College of Medicine, University of Sharjah, P. O. Box 27272, Sharjah, United Arab Emirates
| | | | - Human Honarpisheh
- Department of Surgery - Hospital Reinbek St. Adolf-Stift, Hamburger Strasse 41, 21465, Reinbek, Germany
| | - Tim Strate
- Department of Surgery - Hospital Reinbek St. Adolf-Stift, Hamburger Strasse 41, 21465, Reinbek, Germany
| | - Pompiliu Piso
- Department of General and Visceral Surgery, Hospital Barmherzige Brüder, Regensburg, D-93049, Germany
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Aloysius M, Nikumbh T, Singh A, Shah N, Wang Y, Aswath G, John S, Cheryala M, Goyal H. Cancer-specific survival in non-mucinous appendiceal adenocarcinomas after local resection versus right hemicolectomy: A Surveillance, Epidemiology, and End Results database study. Surgery 2023; 174:759-765. [PMID: 37453862 DOI: 10.1016/j.surg.2023.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 04/30/2023] [Accepted: 05/24/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Adenocarcinomas of the appendix are rare cancers for which no National Comprehensive Cancer Network guidelines exist, and for patients who undergo resection with curative intent, there is a paucity of data on prognostic factors affecting long-term cancer-specific survival. We aimed to compare the cancer-specific survival outcomes in adult patients with appendiceal non-mucinous adenocarcinoma undergoing either local resection versus right hemicolectomy. METHODS This was a retrospective study from the National Cancer Institute Surveillance, Epidemiology, and End Results of patients who underwent curative resection over a 15-year period (2004-2019) for primary appendiceal adenocarcinoma. Out of 16,699 patients, 14,945 were excluded (exclusion criteria were non-adenocarcinoma histological types and patients with regional or distant metastasis as per National Cancer Institute Surveillance, Epidemiology, and End Results stage). Effects of factors (age, race, tumor biology [mucinous versus non-mucinous tumors], the extent of resection of the primary lesion, and lymph nodes) on cancer-specific long-term survival were studied. Survival analysis was performed using the Kaplan-Meier method. Survival outcomes were reported as mean survival (months). RESULTS Of 1,754 patients, 827 (47.1%) were women, and 927 (52.1%) were men. The mean age in years (± standard deviation) was 62.43 ± 14.3. The racial distribution was as follows: Black 237 (13.5%), White 1,398 (79.7%), and Other 119 (6.8%). A total of 771 (44.6%) underwent local resection (appendectomy or segmental resection of colon without lymph node resection), and 983 (55.4%) underwent hemicolectomy with lymph node resection. Favorable survival prognosticators were age <50 years, White race, and well-differentiated histology. Patients with mucinous tumors experienced better survival. Patients who underwent right hemicolectomy with lymph node resection experienced better survival compared with those who had an appendectomy or segmental colonic resection for non-mucinous tumors rather than mucinous tumors. CONCLUSION We report novel demographic, tumor-related, and operative prognostic factors impacting long-term cancer-specific survival in patients who undergo resection for appendiceal adenocarcinoma. The extent of resection of the primary lesion with draining lymph nodes determines long-term cancer-specific survival in non-mucinous appendiceal adenocarcinomas.
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Affiliation(s)
- Mark Aloysius
- Department of Medicine, The Wright Center for Graduate Medical Education, Scranton, PA
| | - Tejas Nikumbh
- Department of Medicine, The Wright Center for Graduate Medical Education, Scranton, PA.
| | - Amninder Singh
- Department of Medicine, The Wright Center for Graduate Medical Education, Scranton, PA. https://twitter.com/dramnindersingh
| | - Niraj Shah
- Department of Medicine, Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, MS
| | - Yichen Wang
- Mercy Medical Center, Trinity Health of New England, Springfield, MA. https://twitter.com/DrYichenWang
| | - Ganesh Aswath
- Division of Gastroenterology, Upstate University Hospital, Syracuse, NY
| | - Savio John
- Division of Gastroenterology, Upstate University Hospital, Syracuse, NY
| | - Mahesh Cheryala
- Division of Gastroenterology, Riverside Gastroenterology Specialists, VA. https://twitter.com/CheryalaMahesh
| | - Hemant Goyal
- Department of Medicine, The Wright Center for Graduate Medical Education, Scranton, PA. https://twitter.com/HemantGoyalMD
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Ano-Edward G, Aworinde-Olufemi K, Agbakwuru E, Lasisi M, Famoroti BM. Adenocarcinoma of the appendix. HAMDAN MEDICAL JOURNAL 2022. [DOI: 10.4103/hmj.hmj_9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Omar M, Kogler W, Sanders K, Richardson A. Cardiac tamponade from appendiceal adenocarcinoma. BMJ Case Rep 2020; 13:13/8/e235878. [PMID: 32816884 DOI: 10.1136/bcr-2020-235878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Michael Omar
- Internal Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - William Kogler
- Internal Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Kimberly Sanders
- Internal Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Aaron Richardson
- Cardiology, University of Florida Health Science Center Jacksonville, Jacksonville, Florida, USA
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Chandradevan R, Rutkofsky IH, Campana MCE, Kaur H, Kitchen FL, Odum CC, Devereaux RS, Colquitt JD, Hamler SE, Williams Iv JT. A diagnostic dilemma of appendicular mass in an elderly patient: a case report and literature review. J Surg Case Rep 2019; 2019:rjz059. [PMID: 30891173 PMCID: PMC6416824 DOI: 10.1093/jscr/rjz059] [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: 01/30/2019] [Accepted: 02/26/2019] [Indexed: 12/04/2022] Open
Abstract
Primary appendicular adenocarcinoma is a rare tumor, mucinous variety, being most common. The case presentation highlights the unusual appearance and diagnostic dilemma of an appendicular adenocarcinoma. Our elderly patient presented with an ill-defined tender lump which later was diagnosed as a perforated appendicular adenocarcinoma, responsive to single-staged surgery and adjunct chemotherapy. We considered the single-staged surgery since the appendix was perforated and right colectomy would not aid the prognosis. High index of clinical suspicion for malignancy should be kept in mind for elderly patients presenting with an appendicular lump. Every effort should be made during the elective surgery to remove the mass during the single-staged surgery.
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Affiliation(s)
- Raguraj Chandradevan
- HCA-Coliseum Medical Centers, Macon, GA, USA.,School of Medicine-Mercer University, Macon, GA, USA
| | - Ian H Rutkofsky
- HCA-Coliseum Medical Centers, Macon, GA, USA.,School of Medicine-Mercer University, Macon, GA, USA
| | - Mary Charmaine E Campana
- HCA-Coliseum Medical Centers, Macon, GA, USA.,School of Medicine-Mercer University, Macon, GA, USA
| | - Harkirat Kaur
- HCA-Coliseum Medical Centers, Macon, GA, USA.,School of Medicine-Mercer University, Macon, GA, USA
| | - Felisha L Kitchen
- HCA-Coliseum Medical Centers, Macon, GA, USA.,School of Medicine-Mercer University, Macon, GA, USA
| | - Craig C Odum
- HCA-Coliseum Medical Centers, Macon, GA, USA.,HCA-Research Institute, Nashville, TN, USA
| | - Randolph S Devereaux
- HCA-Coliseum Medical Centers, Macon, GA, USA.,School of Medicine-Mercer University, Macon, GA, USA
| | - James D Colquitt
- HCA-Coliseum Medical Centers, Macon, GA, USA.,School of Medicine-Mercer University, Macon, GA, USA
| | - Sarah E Hamler
- HCA-Coliseum Medical Centers, Macon, GA, USA.,School of Medicine-Mercer University, Macon, GA, USA
| | - John T Williams Iv
- HCA-Coliseum Medical Centers, Macon, GA, USA.,School of Medicine-Mercer University, Macon, GA, USA
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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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8
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Lima AP, Vieira FJ, Oliveira GPDEM, Ramos PDS, Avelino ME, Prado FG, Salomão G, Silva FC, Rodrigues JVL. Clinical-epidemiological profile of acute appendicitis: retrospective analysis of 638 cases. Rev Col Bras Cir 2017; 43:248-53. [PMID: 27679944 DOI: 10.1590/0100-69912016004009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 06/21/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE to describe the clinical and epidemiological profile of acute appendicitis (AA) of the patients treated at a referral center in the Juiz de Fora macro-region, Minas Gerais State, Brazil. METHODS we conducted a retrospective, observational study in the Dr. Mozart Geraldo TeixeiraEmergency Hospital. We selected 638 patients diagnosed with AA, and analyzed the variables gender, age, evolutionary phase, length of hospital stay, pathological diagnosis, use of antibiotics, use of drains, complications and mortality. RESULTS AA was more prevalent in young adults (19-44 years) and males (65.20%). The mean hospital stay was seven days and phase II was the most prevalent. We found the histopathological diagnosis of primary tumor of the appendix in six patients (0.94%), adenocarcinoma being the most common histologic type (66.7%). Regarding the use of antibiotics, 196 patients underwent antibiotic prophylaxis and 306 received antibiotic therapy. Eighty-one patients used some kind of drain, for an average of 4.8 days. Seventeen patients died (2.67%), predominantly males (70.59%), with mean age of 38.47 years. CONCLUSION AA has a higher prevalence in males and young adults. The length of stay is directly associated with the evolutionary phase. The most common complication is infection of the surgical site. Mortality in our service is still high when compared with developed centers. OBJETIVO avaliar a epidemiologia e os resultados do tratamento cirúrgico de doentes portadores de graus III e IV, mais avançados, da Síndrome de Mirizzi (SM) de acordo com a classificação de Csendes. MÉTODOS estudo retrospectivo, de corte transversal através da revisão de prontuários de 13 pacientes portadores de graus III e IV da SM operados de dezembro de 2001 a setembro de 2013, entre 3691 colecistectomias realizadas neste período. RESULTADOS a incidência da SM foi 0,6% (23 casos) e os graus III e IV perfizeram 0,35% deste número. Houve um predomínio de tipo IV (12 casos). O diagnóstico pré-operatório foi possível em 53,8% dos casos. A conduta preferencial foi derivação biliodigestiva (10 casos) e foi optado por drenagem com tubo "T" e sutura da via biliar em três ocasiões especiais. Três pacientes apresentaram fístula biliar resolvida com conduta expectante e um caso de coleperitônio necessitou reoperação. No seguimento ambulatorial dos pacientes que realizaram a anastomose biliodigestiva (oito), 50% estão assintomáticos, 25% apresentaram estenose da anastomose e 25% perderam seguimento. O tempo médio de acompanhamento foi 41,8 meses. CONCLUSÃO de incidência baixa e de diagnóstico pré-operatório em apenas metade dos casos, a SM em graus avançados tem na anastomose biliodigestiva sua melhor conduta, porém não isenta de morbimortalidade.
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Affiliation(s)
- Amanda Pereira Lima
- - Faculty of Medical Sciences and Health, Juiz de Fora (SUPREME), Juiz de Fora, MG, Brazil
| | - Felipe José Vieira
- - Dr. Mozart Geraldo Teixeira Emergency Hospital, Juiz de Fora, MG, Brazil.,- Faculty of Medical Sciences and Health, Juiz de Fora (SUPREME), Juiz de Fora, MG, Brazil
| | | | | | - Marielle Elisa Avelino
- - Faculty of Medical Sciences and Health, Juiz de Fora (SUPREME), Juiz de Fora, MG, Brazil
| | - Felipe Garcia Prado
- - Faculty of Medical Sciences and Health, Juiz de Fora (SUPREME), Juiz de Fora, MG, Brazil
| | - Gilson Salomão
- - Dr. Mozart Geraldo Teixeira Emergency Hospital, Juiz de Fora, MG, Brazil
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Leonards LM, Pahwa A, Patel MK, Petersen J, Nguyen MJ, Jude CM. Neoplasms of the Appendix: Pictorial Review with Clinical and Pathologic Correlation. Radiographics 2017; 37:1059-1083. [PMID: 28598731 DOI: 10.1148/rg.2017160150] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Appendiceal neoplasms are uncommon tumors of the gastrointestinal tract that may manifest with symptoms of appendicitis, right lower quadrant pain, or palpable mass, leading to imaging or surgical intervention. The majority of appendiceal masses consist of primary epithelial neoplasms and neuroendocrine tumors (NETs). Epithelial neoplasms-mucinous and nonmucinous types-are more often detected at imaging than NETs due to their larger size and propensity for peritoneal spread and metastatic disease. Epithelial mucinous neoplasms are defined by the presence of mucin, detected at radiologic and pathologic examination. A mucocele or pseudomyxoma peritonei from epithelial mucinous tumors are the two most common cross-sectional imaging findings of appendiceal mucinous neoplasms. Nonmucinous epithelial tumors are less common and manifest as masses similar to colonic-type malignancies. NETs are often discovered incidentally at appendectomy due to their small size and nonaggressive behavior. Imaging findings of primary appendiceal tumors may overlap with those of acute appendicitis. Additionally, an appendiceal mass may cause acute appendicitis, obscuring the underlying mass. Other neoplasms including lymphoma, sarcoma, mesenchymal and nerve sheath tumors, or secondary malignant involvement of the appendix are rare. Treatment depends on the histologic subtype and extent of disease. Detailed description of organ, nodal, and peritoneal involvement informs surgical management with the goal of complete cytoreduction. Novel treatments such as hyperthermic intraperitoneal chemotherapy have increased survival for patients with mucinous tumors. ©RSNA, 2017.
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Affiliation(s)
- Laura M Leonards
- From the Departments of Radiology (L.M.L., M.K.P.) and Pathology (J.P.), Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095; and Department of Radiology, Olive View-UCLA Medical Center, Sylmar, Calif (L.M.L., A.P., M.K.P., M.J.N., C.M.J.)
| | - Anokh Pahwa
- From the Departments of Radiology (L.M.L., M.K.P.) and Pathology (J.P.), Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095; and Department of Radiology, Olive View-UCLA Medical Center, Sylmar, Calif (L.M.L., A.P., M.K.P., M.J.N., C.M.J.)
| | - Maitraya K Patel
- From the Departments of Radiology (L.M.L., M.K.P.) and Pathology (J.P.), Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095; and Department of Radiology, Olive View-UCLA Medical Center, Sylmar, Calif (L.M.L., A.P., M.K.P., M.J.N., C.M.J.)
| | - Jeffrey Petersen
- From the Departments of Radiology (L.M.L., M.K.P.) and Pathology (J.P.), Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095; and Department of Radiology, Olive View-UCLA Medical Center, Sylmar, Calif (L.M.L., A.P., M.K.P., M.J.N., C.M.J.)
| | - Michael J Nguyen
- From the Departments of Radiology (L.M.L., M.K.P.) and Pathology (J.P.), Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095; and Department of Radiology, Olive View-UCLA Medical Center, Sylmar, Calif (L.M.L., A.P., M.K.P., M.J.N., C.M.J.)
| | - Cecilia M Jude
- From the Departments of Radiology (L.M.L., M.K.P.) and Pathology (J.P.), Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095; and Department of Radiology, Olive View-UCLA Medical Center, Sylmar, Calif (L.M.L., A.P., M.K.P., M.J.N., C.M.J.)
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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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Clinical Significance of Metastatic Lymph Nodes in the Gut of Patients with Pure and Mixed Primary Appendiceal Carcinoids. Dis Colon Rectum 2016; 59:508-12. [PMID: 27145307 DOI: 10.1097/dcr.0000000000000574] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Right hemicolectomy is indicated for primary appendiceal carcinoids with diameters greater than 2 cm because of an increased risk of metastasis to the lymph nodes of the gut. However, the natural history of positive nodes remains unknown. OBJECTIVE The aim of this study was to investigate the impact of metastatic lymph nodes on survival among patients with pure or mixed primary appendiceal carcinoids, while controlling for potential confounders such as age, sex, tumor size, surgical intervention, and lymph node rate (number of positive lymph nodes/lymph node yield). DESIGN This is a retrospective comparative study.. SETTINGS Data were retrieved from the Surveillance, Epidemiology and End Results database. PATIENTS Patients undergoing colectomy for appendiceal carcinoids between 1998 and 2009 were selected. MAIN OUTCOME MEASURES The survival curves for the 2 groups were compared to evaluate differences in prognosis. Univariate and multivariate analyses were performed. RESULTS Lymph node rates did not significantly differ between the pure and mixed carcinoid groups (p = 0.768), although overall survival was poorer among patients with mixed carcinoids (p = 0.004; HR, 0.498; 95% CI, 0.310-0.800). For pure carcinoids, surgical intervention (p = 0.029; HR, 0.241; 95% CI, 0.067-0.867), age (p < 0.001; HR, 1.083; 95% CI, 1.051-1.116), and lymph node rate (p = 0.039; HR, 5.295; 95% CI, 1.089-25.754) were independent predictors of overall survival. For mixed carcinoids, surgical intervention (p = 0.019; HR, 1.675; 95% CI, 1.088-2.578), tumor size (p < 0.001; HR, 0.442; 95% CI, 0.286-0.683), age (p < 0.001; HR, 1.041; 95% CI, 1.026-1.056), and lymph node rate (p < 0.001; HR, 17.471; 95% CI, 10.047-0.382) were significant prognostic factors. LIMITATIONS The study is limited by its retrospective nature and by the shortcomings of the Surveillance, Epidemiology and End Results database related to the availability and quality of data. CONCLUSION Based on the data retrieved from the Surveillance, Epidemiology and End Results database and adjusted for potential confounding factors, the lymph node rate of metastasis strongly impacts overall survival among patients with pure or mixed carcinoids. Nodal metastasis thus appears to be a reliable clinical hallmark of tumor aggressiveness.
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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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Guraya SY. Malignant Duodeno-Colic Fistula: A Rare Complication of Colorectal Cancer. J Clin Diagn Res 2015; 9:PL01. [PMID: 26673482 DOI: 10.7860/jcdr/2015/16429.6800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 10/15/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Salman Yousuf Guraya
- Professor, Department of Surgery and Consultant Colorectal Surgeon, College of Medicine, Taibah University , Almadinah, Almunawwarah, Saudi Arabia
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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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Guraya SY. Association of type 2 diabetes mellitus and the risk of colorectal cancer: A meta-analysis and systematic review. World J Gastroenterol 2015; 21:6026-6031. [PMID: 26019469 PMCID: PMC4438039 DOI: 10.3748/wjg.v21.i19.6026] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 11/26/2014] [Accepted: 12/16/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To provide a quantitative assessment of the association between type 2 diabetes mellitus (T2DM) and the risk of colorectal cancer (CRC).
METHODS: Systematic review was conducted thorough MEDLINE, EMBASE, Cochrane Library, and ISI Web of knowledge databases till 31st January 2014. This meta-analysis included the cohort studies that illustrated relative risk (RR) or odds ratio estimates with 95%CI for the predictive risk of CRC by T2DM. Summary relative risks with 95%CI were analyzed by using an effects summary ratio model. Heterogeneity among studies was assessed by the Cochran’s Q and I2 statistics.
RESULTS: The meta analysis of 8 finally selected studies showed a positive correlation of T2DM with the risk of CRC as depicted by effects summary RR of 1.21 (95%CI: 1.02-1.42). Diabetic women showed greater risk of developing CRC as their effect summary RR of 1.22 (95%CI: 1.01-49) with significant overall Z test at 5% level of significance was higher than the effect summary RR of 1.17 (95%CI: 1.00-1.37) of men showing insignificant Z test. The effect summary RR of 1.19 with 95%CI of 1.07-1.33 indicate a positive relationship between DM and increased risk of CRC with significant heterogeneity (I2 = 92% and P-value < 0.05).
CONCLUSION: Results from this systematic review and meta-analysis report that diabetic people have an increased risk of CRC as compared to non-diabetics.
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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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