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Yalçın B, Karnak İ, Orhan D, Oğuz B, Aydın B, Kurucu N, Varan A, Kutluk T. Paediatric appendiceal neuroendocrine tumours: a review of 33 cases from a single center. ANZ J Surg 2021; 92:742-746. [PMID: 34664383 DOI: 10.1111/ans.17284] [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: 09/12/2021] [Accepted: 10/01/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Appendiceal neurendocrine tumours (NETs) are rare neoplasms and diagnosis is commonly incidental following appendectomy. We aimed to review our experience with appendiceal NETs. METHODS Records of children with appendiceal NETs were reviewed and data concerning demographic characteristics, clinical findings, surgical procedures, histopathological findings, management and outcomes were recorded. RESULTS Between 1985 and 2021, 33 cases with appendiceal NETs (median age 11.8 years, range 7.8-16; male/female = 10/23) were identified. All but one patients presented with abdominal pain, six had vomiting, four had fever and they underwent appendectomies with presumed diagnosis of acute appendicitis. Abscess drainage and appendectomy was performed in a 16-year-old girl for suspected right ovarian mass, and tumour was positive in the omentum. Histopathological diagnosis was classical carcinoid tumour (NET) in all cases. Median tumour size was 0.9 cm (n = 26, range, 0.1-3.5 cm); tumours were ≤1 cm in 19 cases, 2 cm in one, 3.5 cm in another case. Tumours were located in the tip (n = 11), body (n = 6) and base of appendix (n = 1) (in others data unavailable). In 28 patients with data, tumour extended to submucosa in five, to tunica muscularis in seven, to subserosa in six, to serosa in six, to mesoappendix in three, to periappendiceal fat in one. Three cases were lost to follow-up, 31 cases were alive (median follow-up 53 months). CONCLUSIONS Paediatric appendiceal NETs do not behave aggressively and appendectomy alone is sufficient for tumours ≤2 cm regardless of local invasion. The need for further extensive surgery in tumours >2 cm also remains controversial.
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Affiliation(s)
- Bilgehan Yalçın
- Department of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - İbrahim Karnak
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Diclehan Orhan
- Department of Pathology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Berna Oğuz
- Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burça Aydın
- Department of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nilgün Kurucu
- Department of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Varan
- Department of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Tezer Kutluk
- Department of Pediatric Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Zvizdic Z, Milisic E, Ibisevic N, Pasic IS, Vranic S. Appendiceal carcinoid in a pediatric patient with Peutz-Jeghers syndrome: A case report and comprehensive literature review. Medicine (Baltimore) 2021; 100:e27389. [PMID: 34596162 PMCID: PMC8483869 DOI: 10.1097/md.0000000000027389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Peutz-Jeghers syndrome (PJS), a rare autosomal dominant disorder, is characterized by mucocutaneous pigmentations, hamartomatous polyps in the gastrointestinal tract, and a high risk of developing various malignancies. To the best of our knowledge, only 1 case of appendiceal carcinoid associated with PJS has been previously reported in the pediatric population. PATIENT CONCERNS We report a 7-year-old girl who was admitted for severe, intermittent abdominal pain and cramps, nausea, and vomiting. Multiple brown melanotic macules on the lips, buccal mucosa, and the tongue were noted. DIAGNOSIS A plain abdominal X-ray in a standing position revealed dilated intestinal loops with multiple air-fluid levels. A computed tomography scan of the abdomen showing a "coffee bean" appearance of the jejunal loop with a transition point to the duodenal loop. Axial-contrast-enhanced computed tomography scan of the abdomen showing dilated jejunum loops, filled with fluid with the swirled appearance of mesentery typical for volvulus. The diagnosis of PJS was based on clinical findings along with the histopathologic confirmation of the hamartomatous polyps. INTERVENTIONS An emergency laparotomy was performed, revealing a jejunojejunal intussusception starting 40 cm from the duodenojejunal flexure. Jejunotomy revealed that a lead-point intussusception was a necrotic hamartomatous polyp. After resecting the involved jejunal necrotic segment, including the polyp, end-to-end jejuno-jejunal anastomosis was performed. Further exploration revealed the presence of a jejunal mass 80 cm from the duodenojejunal flexure identified as another hamartomatous pedunculated polyp. The polyp was resected, and the enterotomy was then closed transversely. The grossly normal appendix was also removed. OUTCOMES Clinical findings along with the histopathologically confirmed hamartomatous polyps were consistent with PJS. An appendiceal carcinoid (well-differentiated neuroendocrine tumor, European Neuroendocrine Tumor Society stage pT2) was incidentally detected during histological examination of the appendix. The patient and parents were counseled accordingly, focusing on active surveillance and control of symptoms. Two additional hamartomatous polyps (gastric and jejunal) were detected endoscopically and resected in the fourth postoperative week. A regular, 1-year follow-up and surveillance revealed no complications or recurrences. LESSONS Unusual neoplasms can occasionally be encountered in well-defined syndromes such as PJS. Therefore, active follow-up and surveillance are mandatory for all patients with PJS.
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Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Emir Milisic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nermina Ibisevic
- Department of Pathology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Irmina Sefic Pasic
- Department of Radiology, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- Biomedical and Pharmaceutical Research Unit, QU Health, Qatar University, Doha, Qatar
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Panek M, Szymczak M, Stepaniuk M, Górecki W, Gawłowska-Marciniak A, Wolak P, Zbyrad D, Rybkiewicz M, Chrobak K, Noparlik R, Niedzielski J, Janik P, Nowak J, Miaśkiewicz W, Kamiński A, Fischer W, Dembowska-Bagińska B, Kaliciński P. Radical surgical treatment of neuroendocrine tumors of the appendix in children - a Polish multicenter study. Arch Med Sci 2021; 17:1128-1131. [PMID: 34336042 PMCID: PMC8314412 DOI: 10.5114/aoms/135706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 04/11/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of the study was to examine management of pediatric appendiceal neuroendocrine tumors (ANETs) in Poland. METHODS Records of 27 patients with ANET diagnosed incidentally after appendectomy in the last decade. RESULTS Well-differentiated NET G1/G2 was diagnosed in 25 and well-differentiated neuroendocrine carcinoma G3 in 2 patients. Extended surgery was performed primarily in one instance and secondarily in 10 patients (right hemicolectomy in 9, ileocecal resection in 1) without adjuvant chemotherapy. Follow-up range was 1-121 months. Recurrence after secondary surgery was observed in 1 (3.7%) patient. CONCLUSIONS Applying ENETS guidelines resulted in 100% overall survival of patients with NET.
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Affiliation(s)
- Małgorzata Panek
- Department of Pediatric Surgery and Organ Transplantation, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Marek Szymczak
- Department of Pediatric Surgery and Organ Transplantation, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Maria Stepaniuk
- Department of Pathology, The Children’s Memorial Health Institute, Warsaw, Poland
| | - Wojciech Górecki
- Department of Pediatric Surgery, Jagiellonian University Medical College, Krakow, Poland
| | | | - Przemysław Wolak
- Department of Pediatric Surgery, Urology and Traumatology, Wladyslaw Buszkowski Children’s Hospital, Kielce, Poland
| | - Dariusz Zbyrad
- Department of Pediatric Surgery and Traumatology, Provincial Hospital, Tarnobrzeg, Poland
| | - Marek Rybkiewicz
- Department of Pediatric and Oncological Surgery, Urology and Hand Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Kamila Chrobak
- Department of Children’s Developmental Defects Surgery and Traumatology, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Ryszard Noparlik
- Department of Pediatric Surgery, University Clinical Hospital, Opole, Poland
| | - Jerzy Niedzielski
- Department of Pediatric Surgery and Urology, Medical University of Lodz, Lodz, Poland
| | - Przemysław Janik
- Department of Urology and Pediatric Surgery, The Ludwik Rydygier Provincial Polyclinic Hospital, Torun, Poland
| | - Jan Nowak
- Department of Pediatric Surgery and Urology, Karol Marcinkowski University Hospital, Zielona Gora, Poland
| | - Witold Miaśkiewicz
- Department of Pediatric Surgery and Traumatology, ZZOZ, Ostrow Wielkopolski, Poland
| | - Andrzej Kamiński
- Department of Pediatric Surgery and Urology, The Autonomous Public Children’s Clinic Hospital of the Medical University of Warsaw, Warsaw, Poland
| | - Wojciech Fischer
- Department of Pediatric Surgery, Hospital Municipal St. John Paul II, Elblag, Poland
| | | | - Piotr Kaliciński
- Department of Pediatric Surgery and Organ Transplantation, The Children’s Memorial Health Institute, Warsaw, Poland
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Gaiani F, de’Angelis N, Minelli R, Kayali S, Carra MC, de’Angelis GL. Pediatric gastroenteropancreatic neuroendocrine tumor: A case report and review of the literature. Medicine (Baltimore) 2019; 98:e17154. [PMID: 31517859 PMCID: PMC6750332 DOI: 10.1097/md.0000000000017154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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
INTRODUCTION Gastroenteropancreatic neuroendocrine tumors (GEP-NETs) are a heterogeneous group of epithelial neoplasms originating from the diffuse neuroendocrine cell system of the gastrointestinal tract and pancreas. They are very rare, especially in pediatric age, and vary widely in terms of clinical presentation, malignant potential, and prognosis. PATIENT CONCERNS A 9 years' old, white female child presented with abdominal pain and diarrhea mixed with bright red blood lasting 2 days followed by hematemesis. DIAGNOSIS Routine laboratory tests revealed microcytic anemia. Upper endoscopy showed a 20-mm polypoid lesion in the posterior wall of the duodenal bulb. Biopsy specimens were taken and histologic analysis showed a well-differentiated neuroendocrine tumor G1, with a ki-67 index <2%, an expression of chromogranine A (CgA), synaptophysin and somatostatin receptor type 2A (SSTR2A). Endoscopic ultrasound showed a 21-mm hypoechoic, hypervascular lesion involving the mucosal, submucosal, and muscular layers and a 15-mm hypoechoic round periduodenal lymph node. Gallium-68-somatostatin receptor positron emission tomography (PET with Ga-DOTATOC) showed one area of tracer uptake in the duodenum and other one near the duodenum compatible with the primary tumor site and a lymph node respectively. All the tests confirmed the diagnosis of a GEP-NET of the duodenal bulb, with a single lymph-node metastasis. INTERVENTIONS The patient underwent an open duodenal wedge resection. OUTCOMES The follow-up at 6, 24, and 36 months and then yearly after surgery for a total of 42 months showed no evidence of recurrence. CONCLUSION Duodenal neuroendocrine tumors represent 1% to 3% of all GEP-NETs. They are rare in adults and extremely rare in children. Therefore, the diagnostic and therapeutic approach should be multidisciplinary, including laboratory, endoscopic, and specific imaging tests and strictly follows guidelines, to avoid misdiagnosis and inadequate treatments. Although the prognosis is benign in most cases, they can present with metastases. Therefore, a careful follow-up is extremely important.
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Affiliation(s)
- Federica Gaiani
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Nicola de’Angelis
- Department of Digestive, Hepatobiliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Créteil
| | - Roberta Minelli
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Stefano Kayali
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | | | - Gian Luigi de’Angelis
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
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Akova F, Aydin E, Nur Eray Y, Toksoy N, Yalcin S, Altinay S, Tetikkurt US. Long-term outcomes in pediatric appendiceal carcinoids: Turkey experience. Eur J Pediatr 2018; 177:1845-1850. [PMID: 30255450 DOI: 10.1007/s00431-018-3258-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/17/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
Abstract
The tendency of non-operative management of appendicitis let us explore the natural history of appendiceal carcinoids, compare them with appendicitis patients, and determine the possibility of deciding the extent of the surgery and post-operative follow-up on behalf of the intraoperative findings. A retrospective review was performed of patients with appendicitis between 2009 and 2017. Of 2781 patients, 10 (0.36%) were diagnosed with appendiceal carcinoids. Sixty percent were female with an average age of 13.10 ± 1.73. The mean tumor size was 0.97 ± 0.34 cm with 70% located at the tip. Majority had an insular pattern (n = 9), six had subserosal fat tissue invasion, one had extension to mesoappendix, one had vascular invasion, and two had lymphatic invasion. The average mitotic index was 3.20 ± 1.40/50HPF, and Ki 67 activity was 3 ± 1.7%. The mean follow-up period was 66.40 ± 25.92 months. Patients were further evaluated with ultrasonography (n = 10), CT (n = 3), and MRI (n = 10). Serum markers including chromogranin (n = 9), NSE (n = 6), and 5-HIAA (n = 6) were normal. None required further treatment and had any symptoms of carcinoid syndromes or recurrences post-operatively.Conclusion: Other than appendectomy, no additional surgery or follow-up is required in appendiceal carcinoids less than 1.5 cm in size, regardless of the lymphoid or vascular invasion. What is Known: • The treatment of patients with a 1-2-cm tumor is not clear in both the pediatric and adult populations, and additional resection is needed. • Patients are monitored post-operatively with radiological and/or biochemical testing. What is New: • Appendectomy is curative for tumors less than 2 cm. • No additional surgery or follow-up is required in appendiceal carcinoids less than 1.5 cm in size regardless of the lymphoid or vascular invasion.
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Affiliation(s)
- Fatih Akova
- Pediatric Surgery Department, Biruni University, Istanbul, Turkey
| | - Emrah Aydin
- Pediatric Surgery Department, Bahcelievler State Hospital, Istanbul, Turkey. .,Pediatric Surgery Department, Bagcilar Training & Research Hospital, Istanbul, Turkey. .,Pediatric Surgery Department, School of Medicine, Koc University, Istanbul, Turkey.
| | - Y Nur Eray
- Pediatric Surgery Department, Bagcilar Training & Research Hospital, Istanbul, Turkey
| | - Nurseli Toksoy
- Pediatric Surgery Department, Bagcilar Training & Research Hospital, Istanbul, Turkey
| | - Senay Yalcin
- Department of Pathology, Bagcilar Training & Research Hospital, Istanbul, Turkey
| | - Serdar Altinay
- Department of Pathology, Selcuk University, Konya, Turkey
| | - Umit Seza Tetikkurt
- Department of Pathology, Bagcilar Training & Research Hospital, Istanbul, Turkey
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Degnan AJ, Tocchio S, Kurtom W, Tadros SS. Pediatric neuroendocrine carcinoid tumors: Management, pathology, and imaging findings in a pediatric referral center. Pediatr Blood Cancer 2017; 64. [PMID: 28205418 DOI: 10.1002/pbc.26477] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 12/20/2016] [Accepted: 01/10/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND While neuroendocrine (carcinoid) tumors are increasingly recognized in the adult population, they are often not suspected in children. PROCEDURE Retrospective review of all well-differentiated neuroendocrine (carcinoid) tumors was performed based on pathology reports from a quaternary pediatric medical center between January 2003 and June 2016. Clinical presentations, treatment approaches, imaging findings, and outcomes were reviewed and analyzed. RESULTS A total of 45 cases of pathology-proven carcinoid tumor were reported with an average age of 14.1 years (range: 7-21 years, SD: 2.8 years). Of these cases, 80% (36) were appendiceal, 11% (5) bronchial, 2% (1) colonic, 2% (1) gastric, 2% (1) enteric, and 2% (1) testicular. Metastases were observed in one (3%) appendiceal, one (100%) enteric, and two (40%) bronchial cases. No recurrence was demonstrated in any appendiceal carcinoid cases. Recurrence was seen in one of three extra-appendiceal gastrointestinal tumors. Tumor site and size significantly correlated with metastases and recurrence. CONCLUSIONS Contrary to recent epidemiological investigations in adults, appendiceal carcinoid tumors remain the most common site for pediatric carcinoid tumors. Appendiceal carcinoid tumors exhibited benign clinical courses without recurrence during short-term follow-up. Extra-appendiceal gastrointestinal carcinoid tumors exhibited much more aggressive behavior with greater metastases and recurrence. Bronchial carcinoid tumors demonstrated good clinical response to resection even in cases with mediastinal lymph node involvement. While increased use of urine 5-HIAA levels and somatostatin receptor-specific imaging might improve detection and guide management of extra-appendiceal carcinoid tumors, longer-term follow-up is needed.
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Affiliation(s)
- Andrew J Degnan
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.,Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Shannon Tocchio
- Department of Pediatric Radiology, University of Virginia, Charlottesville, Virginia
| | - Waleed Kurtom
- Division of Neonatology, Department of Pediatrics, University of Miami, Miami, Florida
| | - Sameh S Tadros
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Pediatric Radiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania.,Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Lobeck IN, Jeste N, Geller J, Pressey J, von Allmen D. Surgical management and surveillance of pediatric appendiceal carcinoid tumor. J Pediatr Surg 2017; 52:925-927. [PMID: 28363472 DOI: 10.1016/j.jpedsurg.2017.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 03/09/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Appendiceal carcinoid tumors are rare neuroendocrine neoplasms. The aim of this study was to determine if postoperative oncologic follow-up was necessary for this tumor. METHODS A retrospective review was performed of patients with appendiceal carcinoid 2000-2015. RESULTS 8382 patients underwent appendectomy 2000-2015. 30 (0.3%) had appendiceal carcinoid. 70% were female (n=21) with an average age of 13.5±2.8 years (range 8-18). Most presented with abdominal pain (n=29, 97%). 20% (n=6) had appendiceal perforation. Mean tumor size was 5.4±4mm (range microscopic - 15mm) with most at the appendiceal tip (n=18, 60%). No node infiltration was found, although 10% (n=3) had perineural and 3% (n=1) had lymphovascular invasion. Five were transmural (17%). Most patients were referred to oncology (n=19, 63%) for staging and surveillance including ultrasonography (n=11, 65%), MRI (n=7, 41%), and CT (n=6, 35%). The majority (79%, n=15) underwent serial 5-HIAA testing. All surveillance was found to be normal, and no patients required further treatment. Mean follow-up was 36±34 months, with 58% (n=11) continuing surveillance. Medical charges ranged $8500-$44,000. No recurrences have been identified. CONCLUSION Appendectomy is an adequate treatment for pediatric appendiceal carcinoid <16 mm despite presence of histological risk factors. More aggressive surgery and extensive oncologic follow up are of limited value. LEVEL OF EVIDENCE III. TYPE OF STUDY Retrospective comparative study.
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Affiliation(s)
- Inna N Lobeck
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Neelum Jeste
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - James Geller
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Joseph Pressey
- Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Daniel von Allmen
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
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de Lambert G, Lardy H, Martelli H, Orbach D, Gauthier F, Guérin F. Surgical Management of Neuroendocrine Tumors of the Appendix in Children and Adolescents: A Retrospective French Multicenter Study of 114 Cases. Pediatr Blood Cancer 2016; 63:598-603. [PMID: 26663900 DOI: 10.1002/pbc.25823] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Right hemicolectomy (RHC) in patients with neuroendocrine tumors (NET) of the appendix has been advocated for tumors more than 2 cm, or with mesoappendix/vessel invasion, or with raised mitotic activity. No study demonstrated prolonged survival with RHC over appendectomy alone. The aim of this study was to contribute to define guidelines for secondary surgery in children or adolescents with NET of the appendix. PROCEDURE We contacted all French pediatric surgeons and oncologists by mail, and reviewed the records of patients under 18 with NET of the appendix from 1988 until 2012. RESULTS A total of 114 patients were recorded with a female/male ratio of 1.6. Median age at presentation was 12 years (range: 5-17 years). Ten patients had a tumor more than 2 cm. Twenty patients had evidence of extension into the mesoappendix, including five with blood or lymph vessels' invasion. Solely, one patient had a tumor with a high proliferative index. Incomplete resection was observed in three cases. Eighty-five patients had no criterion for secondary surgery. Twenty-nine patients had criteria for RHC but only 10 underwent surgery. None of the resected specimens showed carcinoid tumor. Three patients had positive lymph nodes. At the last follow-up, all patients were alive and disease free. CONCLUSION Appendectomy alone seems to be curative of these tumors with no influence on life expectancy. Follow-up is not only unnecessary, but its means, whether clinical, radiological or biological, are ineffective.
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Affiliation(s)
- Guénolée de Lambert
- Department of Pediatric Surgery, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Hubert Lardy
- Department of Pediatric Surgery, CHRU de Tours, Hôpital Clocheville, Tours, France
| | - Hélène Martelli
- Department of Pediatric Surgery, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Daniel Orbach
- Department of Pediatric and Adolescent Oncology, Institut Curie, Paris, France
| | - Frédéric Gauthier
- Department of Pediatric Surgery, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
| | - Florent Guérin
- Department of Pediatric Surgery, Hôpital Bicêtre, Hôpitaux Universitaires Paris Sud, Le Kremlin-Bicêtre, France
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Alexandraki KI, Kaltsas GA, Grozinsky-Glasberg S, Chatzellis E, Grossman AB. Appendiceal neuroendocrine neoplasms: diagnosis and management. Endocr Relat Cancer 2016; 23:R27-41. [PMID: 26483424 DOI: 10.1530/erc-15-0310] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2015] [Indexed: 12/13/2022]
Abstract
Gastrointestinal neuroendocrine neoplasms (GI-NENs) are increasingly being recognised, while appendiceal NENs (aNENs) currently constitute the third most common GI-NEN. Appendiceal NENs are generally considered to follow an indolent course with the majority being localised at diagnosis. Thus, the initial surgical approach is not that of a planned oncological resection. Due to the localised nature of the disease in the majority of cases, subsequent biochemical and radiological assessment are not routinely recommended. Histopathological criteria (size, mesoappendiceal invasion, Ki-67 proliferation index, neuro- and angio-invasion) are mainly used to identify those patients who are also candidates for a right hemicolectomy. Goblet cell carcinoids are a distinct entity and should be treated as adenocarcinomas. Despite the absence of any substantial prospective data regarding optimal management and follow-up, recent consensus statements and guidelines have been published. The purpose of this review is to overview the published studies on the diagnosis and management of appendiceal NENs and to suggest a possible management protocol.
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Affiliation(s)
- Krystallenia I Alexandraki
- Department of PathophysiologyNational University of Athens, GreeceNeuroendocrine Tumor UnitEndocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Hospital, Jerusalem, IsraelOxford Centre for DiabetesEndocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK
| | - Gregory A Kaltsas
- Department of PathophysiologyNational University of Athens, GreeceNeuroendocrine Tumor UnitEndocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Hospital, Jerusalem, IsraelOxford Centre for DiabetesEndocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK
| | - Simona Grozinsky-Glasberg
- Department of PathophysiologyNational University of Athens, GreeceNeuroendocrine Tumor UnitEndocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Hospital, Jerusalem, IsraelOxford Centre for DiabetesEndocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK
| | - Eleftherios Chatzellis
- Department of PathophysiologyNational University of Athens, GreeceNeuroendocrine Tumor UnitEndocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Hospital, Jerusalem, IsraelOxford Centre for DiabetesEndocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK
| | - Ashley B Grossman
- Department of PathophysiologyNational University of Athens, GreeceNeuroendocrine Tumor UnitEndocrinology and Metabolism Service, Department of Medicine, Hadassah-Hebrew University Hospital, Jerusalem, IsraelOxford Centre for DiabetesEndocrinology and Metabolism, Churchill Hospital, University of Oxford, Oxford, UK
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10
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Carcinoid tumours of the appendix in children having appendicectomies at Princess Margaret Hospital since 1995. J Pediatr Surg 2015; 50:1595-9. [PMID: 26259557 DOI: 10.1016/j.jpedsurg.2015.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 06/01/2015] [Accepted: 06/01/2015] [Indexed: 01/28/2023]
Abstract
AIM The diagnosis of carcinoid tumour is a relatively rare one. Our surgical approach has changed over the last two decades from predominantly open to predominately laparoscopic with a tendency to leave the mesoappendix in situ. The aim of this audit was to identify how many cases we had at PMH and to see whether the shift in surgical approach allowed us to make prognostic decisions in keeping with current best practice and whether this made any difference in further surgery requirements or outcome for patients. METHODS A retrospective review of all cases of carcinoid identified in our search of all appendicectomy histopathology results was conducted. Results were compared to those found in other studies. Duration of follow up and further investigations was reviewed, as was whether or not there was any recurrence. RESULTS Our incidence of carcinoid tumours in patients undergoing appendicectomy since 1995 was 0.35%, similar to that in other centres. None of our patients had surgery beyond an appendicectomy and our active follow up varied from none to 6 months. There were no recurrences in this time. CONCLUSIONS The literature review carried out suggests further meta-analysis is needed including data on long term follow up before definitive guidelines regarding extent of surgical treatment and follow up based on histopathology are created. The condition is rare and the studies small, resulting in no clear consensus on the best practice for tumours measuring between 1 and 1.5 cm in diameter. Our surgical approach to appendicectomies has changed; it is unclear whether this has resulted in a change in outcome.
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Fallon SC, Hicks MJ, Carpenter JL, Vasudevan SA, Nuchtern JG, Cass DL. Management of appendiceal carcinoid tumors in children. J Surg Res 2015; 198:384-7. [PMID: 25891670 DOI: 10.1016/j.jss.2015.03.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/11/2015] [Accepted: 03/19/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Appendiceal carcinoid tumors, also know as well-differentiated neuroendocrine neoplasms, are rare lesions detected incidentally after appendectomy in children. There are limited data about the natural history of these tumors, and guidelines regarding family counseling and need for additional surgery or follow-up imaging are not established in the pediatric age group. The purpose of this study was to review our institutional experience with appendiceal carcinoid tumors to provide data that might improve management. METHODS After institutional review board approval, the charts of all patients treated at our institution for an appendiceal carcinoid tumor between 2002 and 2014 were reviewed. Data collected included patient demographics, pathologic details, postoperative management, and follow-up information. Descriptive analyses were performed. RESULTS Twenty-eight patients were identified, which represents an incidence of 0.2% of children undergoing appendectomy during that time interval. The mean age at surgery was 13.8 ± 2.1 y; 54% were females. Two patients had symptoms suspicious for carcinoid syndrome at presentation, though none had evidence of metastatic disease. The mean tumor size was 0.73 ± 0.4 cm. Five patients (18%) underwent subsequent ileocecectomy or right hemicolectomy because of pathologic findings of invasion of the mesoappendix (n = 4) or lymphovascular invasion and subserosal extension (n = 1), two of whom had residual disease in the resected specimen (one in a lymph node). No recurrences have been detected at mean follow-up of 1.8 y. CONCLUSIONS Appendiceal carcinoid tumors are discovered incidentally in about 0.2% of children undergoing appendectomy. Based on findings from a large contemporary series, we can conclude that these tumors are generally small and demonstrate lymphovascular invasion or mesenteric extension in fewer than 20% of cases. Prospective, multicenter studies are necessary to better define the indication for ileocecectomy and follow-up imaging protocols.
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Affiliation(s)
- Sara C Fallon
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - M John Hicks
- Department of Pathology, Texas Children's Hospital, Houston, Texas
| | - Jennifer L Carpenter
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Sanjeev A Vasudevan
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jed G Nuchtern
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Darrell L Cass
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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Liu FH, Wang C, Xing YL, Wu JH, Tang Y. Clinical characteristics and prognosis of primary pancreatic carcinoid tumors: A report of 13 cases from a single institution. Oncol Lett 2014; 9:780-784. [PMID: 25621051 PMCID: PMC4301509 DOI: 10.3892/ol.2014.2776] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 10/15/2014] [Indexed: 11/30/2022] Open
Abstract
The present study aimed to analyze the diagnosis and treatment of 13 cases of pancreatic carcinoid tumors during a 56-year period at the Tianjin Medical University Cancer Institute and Hospital (Tianjin, China). The data from 13 cases, consisting of 5 males and 8 females (mean age, 50 years), were collected and analyzed. Hematoxylin-eosin and immunohistochemistry staining were performed to investigate the expression of neuron-specific enolase (NSE), cytokeratin (CK), chromogranin A (CgA) and synaptophysin (Syn) in the tumors. The affected patients suffered abdominal and/or back pain without typical carcinoid syndrome. Radical resection was performed in 10 cases and regional resection in one case. The remaining two patients exhbited remote metastasis, and so were treated with single and double bypass surgery (choledochojejunostomy and gastrojejunostomy/choledochojejunostomy, respectively). The expression of CK, Syn, CgA and NSE was positive in nine (69.23%), 10 (76.92%), five (38.46%) and eight (61.54%) cases, respectively. The median survival time was 26.6 months. In conclusion, in patients with pancreatic carcinoid tumors that exhibit no typical carcinoid syndrome, such as those in the present study, the diagnosis can be confirmed by pathological examination and surgery is the most effective treatment.
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Affiliation(s)
- Feng-Hua Liu
- Department of Gynecological Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
| | - Chong Wang
- Department of General Surgery, Tianjin First Central Hospital, Tianjin 300190, P.R. China
| | - Ya-Ling Xing
- Department of Pancreatic Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
| | - Jiang-Hua Wu
- Department of Pathology, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
| | - Yong Tang
- Department of Pancreatic Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, P.R. China
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Malkan AD, Sandoval JA. Controversial tumors in pediatric surgical oncology. Curr Probl Surg 2014; 51:478-520. [PMID: 25524425 DOI: 10.1067/j.cpsurg.2014.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/17/2014] [Indexed: 12/13/2022]
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Henderson L, Fehily C, Folaranmi S, Kelsey A, McPartland J, Jawaid WB, Craigie R, Losty PD. Management and outcome of neuroendocrine tumours of the appendix-a two centre UK experience. J Pediatr Surg 2014; 49:1513-7. [PMID: 25280658 DOI: 10.1016/j.jpedsurg.2014.05.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 05/07/2014] [Accepted: 05/16/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Neuroendocrine tumours (NET) of the appendix are rare histopathological neoplasms detected following operation for appendicitis in childhood. The role (if any) for radical surgery notably right hemicolectomy (RHC) has often reflected the 'expert opinion' of adult general surgeons with wider experience of managing NET lesions of the gastrointestinal tract. Critical decisions have focused on (a) tumour size, (b) histology, (c) tumour location/invasion and (d) positive lymph nodes. Against this background we report the clinical outcome of children with 'incidental' appendix carcinoid tumours managed at two regional UK paediatric surgery centres. A critical review of the literature is additionally provided in an effort to define contemporary patterns of care in paediatric surgical practice. METHODS Hospital records and pathology database(s) identified 27 patients at two UK centres with a confirmed histological diagnosis of appendix NET lesions during January 1997-January 2013. A PUBMED and EMBASE search strategy-(English language publications only), 1975-present, was performed to gather information on all patients younger than 20years at primary diagnosis with NET appendix tumours to review their management and outcomes. RESULTS All 27 patients treated at the two institutions had acute appendicitis including 3 cases presenting with an appendix mass. Twenty-five underwent appendicectomy with two having interval operations. Tumours had a maximum diameter of 2-18mm (median 9mm) with 73% of lesions located at the appendix tip. Fourteen (52%) had tumour invading the mesoappendix. All patients underwent appendicectomy only with no single case having RHC or additional surgery. Surveillance studies (5HIAA, chromogranin-A) and imaging including ultrasound or CT were deployed in a minority of patients revealing no abnormality. All 27 cases are alive and well-(mean follow up 5years; range: 9months-16years). The literature highlights varied management strategies and no recorded fatalities with radical surgery in children largely evolving from adult surgical practice. CONCLUSIONS This study confirms that paediatric patients with 'incidental' NET tumours of the appendix have an excellent prognosis. Consensus guidelines should ideally be developed by paediatric oncology surgeons to avoid unnecessary radical surgery in many otherwise healthy children.
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Affiliation(s)
- Lucy Henderson
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Claere Fehily
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Semiu Folaranmi
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust and The University of Liverpool, UK
| | - Anna Kelsey
- Department of Paediatric Histopathology, Royal Manchester Children's Hospital, Manchester, UK
| | - Jo McPartland
- Department of Paediatric Histopathology, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Wajid B Jawaid
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Ross Craigie
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK
| | - Paul D Losty
- Department of Paediatric Surgery, Alder Hey Children's Hospital NHS Foundation Trust and The University of Liverpool, UK.
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Malkan AD, Wahid FN, Fernandez-Pineda I, Sandoval JA. Appendiceal carcinoid tumor in children: implications for less radical surgery? Clin Transl Oncol 2014; 17:197-200. [DOI: 10.1007/s12094-014-1196-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/14/2014] [Indexed: 02/08/2023]
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16
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Kim SS, Kays DW, Larson SD, Islam S. Appendiceal carcinoids in children--management and outcomes. J Surg Res 2014; 192:250-3. [PMID: 25039014 DOI: 10.1016/j.jss.2014.06.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/09/2014] [Accepted: 06/18/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Appendiceal carcinoid tumors are very rare in children, and management has been guided by adult presentations and outcomes. Here, we present our experience with pediatric appendiceal carcinoid tumors. METHODS We undertook a retrospective review of all cases of appendiceal carcinoids in children over a 20-y period. Data regarding clinical presentation, diagnosis, pathology, follow-up, and outcomes were collected and analyzed. RESULTS We identified 13 cases of appendiceal carcinoids. All cases were diagnosed after appendectomy for presumed appendicitis (nine acute and four interval;), with no patient having carcinoid syndrome. Mean age at diagnosis was 13.7 y, and all but one case was female. Tumor size ranged from microscopic foci of tumor cells to 2.1 cm (mean, 0.93 cm). Seven cases had invasion of the mesoappendix, three of which underwent a subsequent right hemicolectomy. The patient with the largest tumor (2.1 cm) had evidence of lymphatic invasion with three nodes positive for tumor after right colectomy. No patient had elevation of 5-hydroxyindoleacetic acid or serum chromogranin A, and surveillance computed tomographic scans did not reveal any liver metastases. CONCLUSIONS This is a relatively large series of carcinoids of the appendix in children. We found no evidence of carcinoid syndrome or metastatic disease in these cases other than lymphatic. The need for a secondary colectomy is perhaps questionable.
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Affiliation(s)
- Sara S Kim
- Department of Surgery, College of Medicine, University of Florida, Gainesville, Florida
| | - David W Kays
- Department of Surgery, College of Medicine, University of Florida, Gainesville, Florida
| | - Shawn D Larson
- Department of Surgery, College of Medicine, University of Florida, Gainesville, Florida
| | - Saleem Islam
- Department of Surgery, College of Medicine, University of Florida, Gainesville, Florida.
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Abstract
BACKGROUND Neuroendocrine tumours (NETs) of the appendix are slow-growing tumours and, although rare, they are the most common gastrointestinal epithelial tumours in childhood and adolescence. The treatment and the follow-up screenings have not been standardised. In addition to this, although tumour size is considered the main prognostic variable to define the aggressiveness of approach, a precise cutoff needs to be established. METHODS A total of 113 patients younger than 18 years with a diagnosis of appendiceal NETs were registered as of January 1, 2000, until May 30, 2013, within the Rare Tumors in Pediatric Age (TREP) project, an Italian multi-institutional network dedicated to rare tumours in children and adolescents. The recommendations of the Rare Tumors in Pediatric Age study included imaging and laboratory investigations. The treatment after appendectomy was decided on the basis of histology, tumour size, and imaging; primary reexcision (PRE) was not recommended in completely excised tumours, regardless of tumour size and invasiveness. RESULTS A total of 113 of 113 patients had a diagnosis of well-differentiated NETs; in 108 of 113 the tumour was smaller than 2 cm and in 5, larger than 2 cm. Excision margins were free in 111 of 113 patients. In 3 of 113 a PRE was performed, and in 1 residual tumour was detected. All 113 of 113 patients are alive in complete remission (median follow-up of 41 months). CONCLUSIONS Reported data and our experience showed that no relapse or death occurred in children and adolescents affected by appendiceal NETs. Appendectomy alone should be considered curative for most patients, and a more aggressive surgical approach is warranted in the cases with incompletely excised tumours.
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Katić V, Đinđić B, Mojsilović M, Mladenović P, Bojanić V, Stamenković I, Ignjatović N. OSVRT NA NOVA SAZNANJA O KARCINOIDNIM TUMORIMA APENDIKSA. ACTA MEDICA MEDIANAE 2013. [DOI: 10.5633/amm.2012.0104s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Katić V, Đinđić B, Mojsilović M, Mladenović P, Bojanić V, Stamenković I, Ignjatović N. NEW CLASSIFICATION AND DIAGNOSIS OF APPENDICEAL CARCINOID TUMORS. ACTA MEDICA MEDIANAE 2012. [DOI: 10.5633/amm.2012.0104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Lee SH, Lee WA, Park EW, Cheong YS. Four Cases of Carcinoid Tumor in Asymptomatic Thirties. Korean J Fam Med 2011. [DOI: 10.4082/kjfm.2011.32.2.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Seung Hwa Lee
- Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Won Ae Lee
- Department of Pathology, Dankook University College of Medicine, Cheonan, Korea
| | - Eal Whan Park
- Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Yoo Seock Cheong
- Department of Family Medicine, Dankook University College of Medicine, Cheonan, Korea
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