Analysis of surgical treatment of appendix neuroendocrine neoplasms-17 years of single-center experience

Expression rate and comparison of immunohistochemistry biomarkers in appendiceal neuroendocrine and other epithelial cell neoplasms: Systematic review and meta-analysis

Background: Immunohistochemistry (IHC) provides comprehensive information for morphology and pathologic characteristics and is a valuable tool for establishing the correct cancer diagnosis in clinical diagnostic pathology and determining prognosis. Objectives: The current study analyzes and compares the expression of Immunohistochemistry biomarkers on neuroendocrine and epithelial cell types of appendiceal neoplasms. Design: This systematic review adhered to the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. We performed a meta-analysis employing a random effects model with proportions to gauge the proportion of positive cases. Method: A comprehensive systematic search in PubMed, Web of Science, and Scopus databases was conducted based on the PRISMA statement up to August 2023. Studies reporting the immunohistochemistry biomarkers expression performed in patients with primary appendiceal neuroendocrine and epithelial cell neoplasms according to the most recent World Health Organization classification of malignant tumors were included. Results: Our systematic search included 56 observational articles that meet the eligibility criteria. Meta-analysis revealed an expression rate of 93%, 91%, 87%, 71%, 94%, 99%, 32%, 76%, 25%, and 91% for non-specific enolase (NSE), chromaffin A, synaptophysin, Serotonin, SATB2, Caudal-type homeobox 2 (CDX2), β-catenin, Carcinoembryonic antigen (CEA), Cytokeratin 7, and Cytokeratin 20, respectively. CDX2 and SATB2 were the most expressed markers. The expression rate had a significant association with tumor type. NSE and synaptophysin were the highest in neuroendocrine tumors, whereas CEA was more elevated in gablet cell carcinoids. Cytokeratin 20 is suitable for identifying epithelial cell neoplasms. Conclusion: The study indicates the proportion of positive cases in patients with primary neuroendocrine and epithelial cell appendiceal neoplasms.

A Decade-Long Retrospective Clinicopathological Study of Appendiceal Neoplasms

INTRODUCTION

 Appendiceal neoplasms (ANs) are uncommon, representing less than 1% of all gastrointestinal tumors. They are most often discovered incidentally during appendectomies performed for suspected acute appendicitis. Recent studies have reported an increase in the incidence of AN. Our study aimed to analyze the spectrum of AN and determine the cases discovered incidentally.

MATERIAL AND METHODS

 This retrospective descriptive study was performed over 10 years, from March 2014 to March 2024, at Saveetha Medical College and Hospital in Chennai, India. Complete enumeration sampling was performed, and tumor registries were reviewed to identify all cases of AN received during the study period. The corresponding clinical and radiological data were obtained from the hospital database, whereas histopathology records were used to evaluate tumor characteristics. Descriptive statistical analysis was employed, and the spectrum of AN was analyzed.

RESULTS

 During the study period, 12 cases of AN were identified. Eleven cases (91.7%) were diagnosed from appendicectomy specimens, while one was from a right hemicolectomy specimen. Of these 12, nine cases (75%) were incidental findings. In our study, we found that there was a higher number of female cases, with nine out of twelve cases (75%) being female. Most patients presented with abdominal pain, and acute appendicitis was the most frequent preoperative diagnosis. Low-grade appendiceal mucinous neoplasm was the most common type encountered followed by other appendiceal tumors.

CONCLUSION

 The incidence of AN has increased in recent years, with most cases being found incidentally. Given the increasing rate of incidental AN, it is vital to maintain vigilance in specimen analysis including comprehensive examination and precise grossing to ensure malignancies are not overlooked.

Prevalence of Neuroendocrine Tumours (NET) in Patients Undergoing Appendicectomy for Acute Appendicitis: A Tertiary Care Study

Introduction Acute appendicitis is one of the common causes of acute abdomen in adults, which is managed widely with appendicectomy. Neuroendocrine tumours are the most common appendiceal tumours diagnosed incidentally on appendicectomy specimens.  Methods  Demographic data, presenting complaints, indications for appendicectomy, and the histology findings based on histopathological reports of the patients who have undergone appendicectomy for appendicitis at surgical units of Teaching Hospital, Jaffna, from 1st of January 2019 to 31st of December 2022 were retrospectively analyzed.  Results Of the 1341 histopathology reports, 0.2% (n=3) were neuroendocrine tumours (NET). The mean age of the patients with NET was 48.6, and 66.6% of them were females. All three NETs identified in appendicectomy specimens were well differentiated and smaller than 2 cm. All three had negative resection margins and were managed only with appendicectomy.  Conclusion  NETs of the appendix are the commonest appendiceal neoplasms. The majority of them are diagnosed incidentally in appendicectomy specimens. Surgical management of the tumours is either by appendicectomy or hemicolectomy, which depends mainly on tumor size. Surgical decisions should be tailor-made to the patients based on multi-disciplinary team decisions.