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Winicki NM, Radomski SN, Ciftci Y, Sabit AH, Johnston FM, Greer JB. Mortality risk prediction for primary appendiceal cancer. Surgery 2024; 175:1489-1495. [PMID: 38494390 DOI: 10.1016/j.surg.2024.02.014] [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: 10/01/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Accurately predicting survival in patients with cancer is crucial for both clinical decision-making and patient counseling. The primary aim of this study was to generate the first machine-learning algorithm to predict the risk of mortality following the diagnosis of an appendiceal neoplasm. METHODS Patients with primary appendiceal cancer in the Surveillance, Epidemiology, and End Results database from 2000 to 2019 were included. Patient demographics, tumor characteristics, and survival data were extracted from the Surveillance, Epidemiology, and End Results database. Extreme gradient boost, random forest, neural network, and logistic regression machine learning models were employed to predict 1-, 5-, and 10-year mortality. After algorithm validation, the best-performance model was used to develop a patient-specific web-based risk prediction model. RESULTS A total of 16,579 patients were included in the study, with 13,262 in the training group (80%) and 3,317 in the validation group (20%). Extreme gradient boost exhibited the highest prediction accuracy for 1-, 5-, and 10-year mortality, with the 10-year model exhibiting the maximum area under the curve (0.909 [±0.006]) after 10-fold cross-validation. Variables that significantly influenced the predictive ability of the model were disease grade, malignant carcinoid histology, incidence of positive regional lymph nodes, number of nodes harvested, and presence of distant disease. CONCLUSION Here, we report the development and validation of a novel prognostic prediction model for patients with appendiceal neoplasms of numerous histologic subtypes that incorporate a vast array of patient, surgical, and pathologic variables. By using machine learning, we achieved an excellent predictive accuracy that was superior to that of previous nomograms.
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Affiliation(s)
- Nolan M Winicki
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shannon N Radomski
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yusuf Ciftci
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ahmed H Sabit
- Department of Biostatistics, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fabian M Johnston
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jonathan B Greer
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
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Ayala-de Miguel C, Jiménez-Castro J, Sánchez-Vegas A, Díaz-López S, Chaves-Conde M. Neoplastic appendiceal mucinous lesions: a narrative review of the literature from an oncologist's perspective. Clin Transl Oncol 2024; 26:1287-1299. [PMID: 38070049 DOI: 10.1007/s12094-023-03356-6] [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: 08/19/2023] [Accepted: 11/14/2023] [Indexed: 05/22/2024]
Abstract
Appendiceal mucinous lesions' classification and nomenclature has been modified several times along the last decades, reflecting their great heterogeneity and making difficult to compare results and draw conclusions. Despite its nearby origin, appendiceal mucinous lesions have a distinctive behaviour compared to colorectal cancer, including their molecular and genetic markers. Due to their low frequency, their management is not well standardised. However, surgery is considered the cornerstone of treatment. Their indolent behaviour has encouraged surgeons to apply more aggressive treatments, such as cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), that may extend overall survival. Chemotherapy is reserved for unresectable and/or disseminated disease and could play a role in the adjuvant and neoadjuvant setting. Pressurised intraperitoneal aerosol chemotherapy (PIPAC) is recently emerging as a possible alternative for treatment in advanced disease although its results in long-term survival are lacking Hereby, we review the available evidence in the management of appendiceal mucinous lesions, including localised and disseminated disease, with a special emphasis on the oncological perspective, focusing on the lights and shadows of the systemic treatments.
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Affiliation(s)
- Carlos Ayala-de Miguel
- Servicio Oncología Médica, Hospital Universitario Valme, Ctra. de Cádiz Km 548,9, C.P.: 41014, Seville, Spain
| | - Jerónimo Jiménez-Castro
- Servicio Oncología Médica, Hospital Universitario Valme, Ctra. de Cádiz Km 548,9, C.P.: 41014, Seville, Spain.
| | - Adrián Sánchez-Vegas
- Servicio Oncología Médica, Hospital Universitario Valme, Ctra. de Cádiz Km 548,9, C.P.: 41014, Seville, Spain
| | - Sebastián Díaz-López
- Servicio Oncología Médica, Hospital Universitario Valme, Ctra. de Cádiz Km 548,9, C.P.: 41014, Seville, Spain
| | - Manuel Chaves-Conde
- Servicio Oncología Médica, Hospital Universitario Valme, Ctra. de Cádiz Km 548,9, C.P.: 41014, Seville, Spain
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Lopez-Ramirez F, Sardi A, King MC, Nikiforchin A, Falla-Zuniga LF, Barakat P, Nieroda C, Gushchin V. Sufficient Regional Lymph Node Examination for Staging Adenocarcinoma of the Appendix. Ann Surg Oncol 2024; 31:1773-1782. [PMID: 38153641 DOI: 10.1245/s10434-023-14683-x] [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: 06/19/2023] [Accepted: 11/12/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND The presence of lymph node (LN) metastasis is a known negative prognostic factor in appendix cancer (AC) patients. However, currently the minimum number of LNs required to adequately determine LN negativity is extrapolated from colorectal studies and data specific to AC is lacking. We aimed to define the lowest number of LNs required to adequately stage AC and assess its impact on oncologic outcomes. METHODS Patients with stage II-III AC from the National Cancer Database (NCDB 2004-2019) undergoing surgical resection with complete information about LN examination were included. Multivariable logistic regression assessed the odds of LN positive (LNP) disease for different numbers of LNs examined. Multivariable Cox regressions were performed by LN status subgroups, adjusted by prognostic factors, including grade, histologic subtype, surgical approach, and documented adjuvant systemic chemotherapy. RESULTS Overall, 3,602 patients were included, from which 1,026 (28.5%) were LNP. Harvesting ten LNs was the minimum number required without decreased odds of LNP compared with the reference category (≥ 20 LNs). Total LNs examined were < 10 in 466 (12.9%) patients. Median follow-up from diagnosis was 75.4 months. Failing to evaluate at least ten LNs was an independent negative prognostic factor for overall survival (adjusted hazard ratio 1.39, p < 0.01). CONCLUSIONS In appendix adenocarcinoma, examining a minimum of ten LNs was necessary to minimize the risk of missing LNP disease and was associated with improved overall survival rates. To mitigate the risk of misclassification, an adequate number of regional LNs must be assessed to determine LN status.
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Affiliation(s)
- Felipe Lopez-Ramirez
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA
| | - Armando Sardi
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA.
| | - Mary Caitlin King
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA
| | - Andrei Nikiforchin
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA
| | - Luis Felipe Falla-Zuniga
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA
| | - Philipp Barakat
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA
| | - Carol Nieroda
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, Mercy Medical Center, The Institute for Cancer Care, Baltimore, MD, USA
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4
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Han Z, Liu X, Tian Y, Shen S, Wang H, Hu S, Wu X, Yan Z, Lu C, Wang P, Bai Y, Kong Y, Wang L, Cao S, Li Z, Zhong H, Meng C, Zhou Y. Long term survival outcomes of surgery combined with hyperthermic intraperitoneal chemotherapy for perforated low-grade appendiceal mucinous neoplasms: A multicenter retrospective study. World J Surg 2024; 48:86-96. [PMID: 38686746 DOI: 10.1002/wjs.12018] [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: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 05/02/2024]
Abstract
BACKGROUND Low-grade appendiceal mucinous neoplasms (LAMN) are very rare, accounting for approximately 0.2%-0.5% of gastrointestinal tumors. We conducted a multicenter retrospective study to explore the impact of different surgical procedures combined with HIPEC on the short-term outcomes and long-term survival of patients. METHODS We retrospectively analyzed the clinicopathological data of 91 LAMN perforation patients from 9 teaching hospitals over a 10-year period, and divided them into HIPEC group and non-HIPEC group based on whether or not underwent HIPEC. RESULTS Of the 91 patients with LAMN, 52 were in the HIPEC group and 39 in the non-HIPEC group. The Kaplan-Meier method predicted that 52 patients in the HIPEC group had 5- and 10-year overall survival rates of 82.7% and 76.9%, respectively, compared with predicted survival rates of 51.3% and 46.2% for the 39 patients in the non-HIPEC group, with a statistically significant difference between the two groups (χ2 = 10.622, p = 0.001; χ2 = 10.995, p = 0.001). Compared to the 5-year and 10-year relapse-free survival rates of 75.0% and 65.4% in the HIPEC group, respectively, the 5-year and 10-year relapse-free survival rates of 48.7% and 46.2% in the non-HIPEC group were significant different between the two outcomes (χ2 = 8.063, p = 0.005; χ2 = 6.775, p = 0.009). The incidence of postoperative electrolyte disturbances and hypoalbuminemia was significantly higher in the HIPEC group than in the non-HIPEC group (p = 0.023; p = 0.044). CONCLUSIONS This study shows that surgery combined with HIPEC can significantly improve 5-year and 10-year overall survival rates and relapse-free survival rates of LAMN perforation patients, without affecting their short-term clinical outcomes.
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Affiliation(s)
- Zhenlong Han
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Xiaodong Liu
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yulong Tian
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shuai Shen
- Department of Colorectal Surgery, Weifang People's Hospital, Weifang, Shandong, China
| | - Hongbo Wang
- Department of Gastrointestinal Surgery, The People's Hospital of Jimo Qingdao, Qingdao, Shandong, China
| | - Shuiqing Hu
- Department of Gastrointestinal Surgery, The People's Hospital of Jimo Qingdao, Qingdao, Shandong, China
| | - Xudong Wu
- Department of Gastrointestinal Surgery, The People's Hospital of Dongying Shandong, Dongying, Shandong, China
| | - Zhao Yan
- Department of Gastrointestinal Surgery, The People's Hospital of Dongying Shandong, Dongying, Shandong, China
| | - Cunlong Lu
- Department of Gastrointestinal Surgery, Juxian People's Hospital, Rizhao, Shandong, China
| | - Peixin Wang
- General Surgery Department, Qingdao Hospital University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong, China
| | - Yingcheng Bai
- General Surgery Department, 971st Naval Hospital, Qingdao, Shandong, China
| | - Ying Kong
- General Surgery Department, Jining No 1 People's Hospital, Jining, Shandong, China
| | - Liankai Wang
- Department of Gastrointestinal Surgery, Weifang Yidu Central Hospital, Weifang, Shandong, China
| | - Shougen Cao
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zequn Li
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Hao Zhong
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Cheng Meng
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yanbing Zhou
- Department of Gastrointestinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Vierra M, Bansal VV, Morgan RB, Witmer HDD, Reddy B, Dhiman A, Godley FA, Ong CT, Belmont E, Polite B, Shergill A, Turaga KK, Eng OS. Fragmentation of Care in Patients with Peritoneal Metastases Undergoing Cytoreductive Surgery. Ann Surg Oncol 2024; 31:645-654. [PMID: 37737968 DOI: 10.1245/s10434-023-14318-1] [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: 05/10/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The delivery of multimodal treatment at a high-volume center is known to optimize the outcomes of gastrointestinal malignancies. However, patients undergoing cytoreductive surgery (CRS) for peritoneal metastases often must 'fragment' their surgical and systemic therapeutic care between different institutions. We hypothesized that this adversely affects outcomes. PATIENTS AND METHODS Adults undergoing CRS for colorectal or appendiceal adenocarcinoma at our institution between 2016 and 2022 were identified retrospectively and grouped by care network: 'coordinated care' patients received exclusively in-network systemic therapy, while 'fragmented care' patients received some systemic therapy from outside-network providers. Factors associated with fragmented care were also ascertained. Overall survival (OS) from CRS and systemic therapy-related serious adverse events (SAEs) were compared across the groups. RESULTS Among 85 (80%) patients, 47 (55%) had colorectal primaries and 51 (60%) received fragmented care. Greater travel distance [OR 1.01 (CI 1.00-1.02), p = 0.02] and educational status [OR 1.04 (CI 1.01-1.07), p = 0.01] were associated with receiving fragmented care. OS was comparable between patients who received fragmented and coordinated care in the colorectal [32.5 months versus 40.8 months, HR 0.95 (CI 0.43-2.10), p = 0.89] and appendiceal [31.0 months versus 27.4 months, HR 1.17 (CI 0.37-3.74), p = 0.55] subgroups. The frequency of SAEs (7.8% versus 17.6%, p = 0.19) was also similar. CONCLUSIONS There were no significant differences in survival or SAEs based on the networks of systemic therapy delivery. This suggests that patients undergoing CRS at a high-volume center may safely receive systemic therapy at outside-network facilities with comparable outcomes.
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Affiliation(s)
- Mason Vierra
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Varun V Bansal
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Ryan B Morgan
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Hunter D D Witmer
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Biren Reddy
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Ankit Dhiman
- Department of Surgery, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Frederick A Godley
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Cecilia T Ong
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Erika Belmont
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - Blasé Polite
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - Ardaman Shergill
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - Kiran K Turaga
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Oliver S Eng
- Department of Surgery, University of California, Irvine, Orange, CA, USA.
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Marks VA, Kerekes D, Butensky S, Ahuja N, Johnson C, Turaga K, Khan SA. Role of colectomy in the management of appendiceal tumors: a retrospective cohort study. BMC Gastroenterol 2023; 23:398. [PMID: 37978348 PMCID: PMC10655451 DOI: 10.1186/s12876-023-03019-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/29/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Appendiceal tumors represent a range of histologies that vary in behavior. Recommendations for treatment with appendectomy versus right hemicolectomy (RHC) for different tumor types are evolving and sometimes conflicting. This study sought to characterize variation in the United States around surgical treatment of major appendiceal tumor types over time and describe differences in outcomes based on procedure. METHODS Patients diagnosed with appendiceal goblet cell adenocarcinoma (GCA), mucinous adenocarcinoma, neuroendocrine neoplasm (NEN), or non-mucinous adenocarcinoma from 2004-2017 were identified in the National Cancer Database. Trends in RHC over time and predictors of RHC were identified. Surgical outcomes for each histologic type and stage were compared. RESULTS Of 18,216 patients, 11% had GCAs, 34% mucinous adenocarcinoma, 31% NENs, and 24% non-mucinous adenocarcinoma. Rate of RHC for NEN decreased from 68% in 2004 to 40% in 2017 (p = 0.008) but remained constant around 60-75% for other tumor types. Higher stage was associated with increased odds of RHC for all tumor types. RHC was associated with higher rate of unplanned readmission (5% vs. 3%, p < 0.001) and longer postoperative hospital stay (median 5 days vs. 3 days, p < 0.001). On risk-adjusted analysis, RHC was significantly associated with increased survival versus appendectomy for stage 2 disease of all tumor types (HRs 0.43 to 0.63) and for stage 1 non-mucinous adenocarcinoma (HR = 0.56). CONCLUSIONS Most patients with appendiceal tumors undergo RHC, which is associated with increased readmission, longer length of stay, and improved survival for stage 2 disease of all types. RHC should be offered selectively for appendiceal tumors.
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Affiliation(s)
- Victoria A Marks
- Department of Surgical Oncology, Yale School of Medicine, Yale University School of Medicine, 330 Cedar Street, FMB130, New Haven, CT, 06520, USA
| | - Daniel Kerekes
- Department of Surgical Oncology, Yale School of Medicine, Yale University School of Medicine, 330 Cedar Street, FMB130, New Haven, CT, 06520, USA
| | - Samuel Butensky
- Department of Surgical Oncology, Yale School of Medicine, Yale University School of Medicine, 330 Cedar Street, FMB130, New Haven, CT, 06520, USA
| | - Nita Ahuja
- Department of Surgical Oncology, Yale School of Medicine, Yale University School of Medicine, 330 Cedar Street, FMB130, New Haven, CT, 06520, USA
| | - Caroline Johnson
- Yale School of Public Health, 60 College St, New Haven, CT, 06510, USA
| | - Kiran Turaga
- Department of Surgical Oncology, Yale School of Medicine, Yale University School of Medicine, 330 Cedar Street, FMB130, New Haven, CT, 06520, USA
| | - Sajid A Khan
- Department of Surgical Oncology, Yale School of Medicine, Yale University School of Medicine, 330 Cedar Street, FMB130, New Haven, CT, 06520, USA.
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Galaviz VD, Nguyen AD, Sticco PL, Downing KT. Appendectomy in endometriosis: an update on surgical indications and management of uncommon diseases. Curr Opin Obstet Gynecol 2023; 35:377-382. [PMID: 37144569 DOI: 10.1097/gco.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE OF REVIEW Abnormal appendiceal disease is commonly encountered following an appendectomy when performed in patients with endometriosis. Appendiceal endometriosis is the most notable finding and can affect up to 39% of patients with endometriosis. Despite this knowledge, guidelines for performing an appendectomy have not been formally established. In this article, we review the surgical indications for an appendectomy at the time of endometriosis surgery and discuss the management of other diseases that may be encountered following the histopathologic evaluation of an excised appendix. RECENT FINDINGS Removal of the appendix in patients with endometriosis contributes to optimal surgical management. Relying on abnormal appendiceal appearance for removal may leave endometriosis-affected appendices. For this reason, utilizing risk factors to guide surgical management is essential. Common appendiceal diseases are sufficiently managed with appendectomy. Uncommon diseases may require further surveillance. SUMMARY Emerging data in our field support the performance of an appendectomy at the time of endometriosis surgery. Guidelines for performing a concurrent appendectomy should be formalized to encourage preoperative counselling and management for patients with risk factors for appendiceal endometriosis. Abnormal diseases is frequently encountered after appendectomy in the setting of endometriosis surgery and further management is based on the histopathology of the specimen.
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Constantin M, Petrescu L, Mătanie C, Vrancianu CO, Niculescu AG, Andronic O, Bolocan A. The Vermiform Appendix and Its Pathologies. Cancers (Basel) 2023; 15:3872. [PMID: 37568688 PMCID: PMC10417615 DOI: 10.3390/cancers15153872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The vermiform appendix is a muscular cylindrical structure originating near the junction of the cecum and ileum, averaging 9 cm (5-35 cm) in size. As the most mobile viscera, it can adopt several positions, the most common being the retrocecal position. Perceived as an atavistic organ lacking physiological relevance, the vermiform appendix appears to be involved in immune function, serving in the maturation of B lymphocytes and the production of immunoglobulin A, in endocrine function, excreting amines and hormones in the 2-3 mL of mucus secreted daily, and in digestive function, by storing beneficial bacteria from where they can recolonize the colon. With a lumen of about 6 mm, the vermiform appendix has a reduced storage capacity, so any blockage of the appendix with fecoliths (fecaliths), seeds derailed from the colon, or enlarged lymph nodes prevents drainage and intraluminal accumulation of secreted mucus. Unable to relax, the appendix wall severely limits its intraluminal volume, so mucus accumulation leads to inflammation of the appendix, known generically as appendicitis. In addition, the vermiform appendix may be the site of the development of neoplastic processes, which may or may not involve mucus production, some of which can significantly affect the standard of living and ultimately lead to death. In general, mucinous tumors may have a better prognosis than non-mucinous tumors. This review takes a comprehensive path, starting by describing the anatomy and embryology of the vermiform appendix and further detailing its inflammatory pathologies, pathologies related to congenital anomalies, and appendix tumors, thus creating an up-to-date framework for better understanding, diagnosis, and treatment of these health problems.
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Affiliation(s)
- Marian Constantin
- Institute of Biology of Romanian Academy, 060031 Bucharest, Romania;
- The Research Institute of the University of Bucharest, ICUB, 050095 Bucharest, Romania;
| | - Livia Petrescu
- Department of Anatomy, Animal Physiology and Biophysics, DAFAB, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania; (L.P.); (C.M.)
| | - Cristina Mătanie
- Department of Anatomy, Animal Physiology and Biophysics, DAFAB, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania; (L.P.); (C.M.)
| | - Corneliu Ovidiu Vrancianu
- The Research Institute of the University of Bucharest, ICUB, 050095 Bucharest, Romania;
- Microbiology—Immunology Department, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania
- National Institute of Research and Development for Biological Sciences, 296 Splaiul Independentei, District 6, 060031 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- The Research Institute of the University of Bucharest, ICUB, 050095 Bucharest, Romania;
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
| | - Octavian Andronic
- University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (O.A.); (A.B.)
| | - Alexandra Bolocan
- University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (O.A.); (A.B.)
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Andjelkovic B, Stojanovic B, Stojanovic MD, Milosevic B, Cvetkovic A, Spasic M, Jakovljevic S, Cvetkovic D, Stojanovic BS, Milosev D, Mitrovic M, Stankovic V. Appendiceal Signet Ring Cell Carcinoma: An Atypical Cause of Acute Appendicitis-A Case Study and Review of Current Knowledge. Diagnostics (Basel) 2023; 13:2359. [PMID: 37510102 PMCID: PMC10378069 DOI: 10.3390/diagnostics13142359] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Appendiceal signet ring cell carcinoma (ASRCC) is a rare and aggressive form of appendiceal cancer, often presenting with nonspecific symptoms that overlap with acute appendicitis. Early diagnosis and appropriate management are crucial for improving patient outcomes in these rare malignancies. This case report and literature review aims to raise awareness among clinicians about ASRCC of the appendix as a cause of acute appendicitis and highlight the importance of considering this diagnosis in patients with atypical presentations or unexpected histopathological findings. We present a 65-year-old female patient with ASRCC who underwent successful surgical treatment and remains disease-free at the one-year follow-up. It also highlights the necessity of early detection and appropriate treatment in order to improve patient outcomes. In addition, a comprehensive literature review is provided, discussing the clinical presentation, histopathological characteristics, potential pathogenesis, treatment options, and prognosis of ASRCC.
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Affiliation(s)
- Branko Andjelkovic
- Department of General Surgery, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Bojan Stojanovic
- Department of General Surgery, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | | | - Bojan Milosevic
- Department of General Surgery, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Aleksandar Cvetkovic
- Department of General Surgery, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Marko Spasic
- Department of General Surgery, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Stefan Jakovljevic
- Department of General Surgery, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Danijela Cvetkovic
- Department of Genetics, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Bojana S Stojanovic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Danijela Milosev
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Minja Mitrovic
- Department of Neurology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
| | - Vesna Stankovic
- Department of Pathology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
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Liapis SC, Perivoliotis K, Psarianos K, Chatzinikolaou C, Moula AI, Skoufogiannis P, Balogiannis I, Lytras D. A giant low-grade appendiceal mucinous neoplasm (LAMN) presenting as ileocecal intussusception: a case report. J Surg Case Rep 2023; 2023:rjad273. [PMID: 37251252 PMCID: PMC10224788 DOI: 10.1093/jscr/rjad273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/25/2023] [Indexed: 05/31/2023] Open
Abstract
We report the rare case of a giant low-grade appendiceal mucinous neoplasm (LAMN), presenting as ileocecal intussusception. An 80-year-old woman presented in the emergency department of our institution with progressively worsening diffuse abdominal pain during the last 24 h. A CT scan revealed a giant abdominal mass (98.7 × 127.3 × 107.6 mm) with air-fluid level and imaging characteristics of ileocecal intussusception. An emergency exploratory laparotomy was performed, and a well-circumscribed cystic mass deriving from the appendix was found. A right hemicolectomy was performed, and the histopathological examination confirmed the diagnosis of LAMN. This report aims to raise awareness among surgeons and radiologists, about LAMNs as a differential diagnosis of right iliac fossa masses presenting as acute abdomen.
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Affiliation(s)
- Stavros C Liapis
- Correspondence address. Department of Surgery, General Hospital of Volos, Magnesia, Polymeri 134, Thessaly, Greece. Tel: +302421351403; E-mail:
| | | | | | | | - Amalia I Moula
- Department of Surgery, General Hospital of Volos, Magnesia, Greece
| | | | - Ioannis Balogiannis
- Department of Surgery, General University Hospital of Larissa, Thessaly, Greece
| | - Dimitrios Lytras
- Department of Surgery, General Hospital of Volos, Magnesia, Greece
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Muacevic A, Adler JR, Pansuriya AM, Mahmood A, Haseeb ul Rasool M, Bhatti Z. Rare Mucinous Adenocarcinoma of the Appendix Undergoing Multiple Recurrent Surgical Interventions. Cureus 2023; 15:e33294. [PMID: 36741631 PMCID: PMC9894632 DOI: 10.7759/cureus.33294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/04/2023] Open
Abstract
Primary appendiceal carcinomas are rare and often found incidentally when the appendix is surgically removed. Adenocarcinoma predominates the histological types of malignancies, with mucinous adenocarcinoma being the most prevalent of the various subtypes. Pseudomyxoma peritonei (PMP), a complication seen in mucinous adenocarcinoma of the appendix (MAA), is the collection of mucinous ascites in the intra-abdominal cavity and the thickening of the surrounding viscera by mucin-producing tumor cells. PMP initially presents with increased abdominal discomfort and girth and, in later stages, presents with obstructive abdomen symptoms. These symptoms are nonspecific and can be a challenge to pinpoint. Such was the case for our patient, in this case report, who initially presented with dyspepsia and later demonstrated compressive symptoms and weight loss, raising concern for malignancy. An appendiceal pathology was of concern when his right lower quadrant pain acutely worsened during an abdominal ultrasound, and imaging and biopsy confirmed MAA with PMP. The aim of this report is to shed light on the management of recurrent MAA. Our patient's recurrent MAA was managed with debulking procedures and three rounds of hyperthermic intraperitoneal chemotherapy (HIPEC) and was managed postoperatively with folinic acid, fluorouracil, and irinotecan (FOLFIRI) and bevacizumab, which in its totality helped achieve a progression-free survival of more than two years. We believe that cytoreduction and intraoperative chemotherapy prolong survival in patients with recurrent disease, as was the case with our patients. Our patient also demonstrated benefit as his disease stabilized after starting bevacizumab; however, more studies need to be performed at a larger scale to show a consistent relationship.
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Guerrero-Macías S, Briceño-Morales C, González F, Paola Puerto A, Burgos R, Millán-Matta C, García-Mora M. Neoplasias apendiculares incidentales. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Las neoplasias apendiculares se presentan hasta en el 50 % de los casos como un episodio de apendicitis aguda. Existen características demográficas, clínicas y radiológicas que aumentan las posibilidades de un tumor apendicular subyacente, sin embargo, en la mayoría de los casos, son los hallazgos intraoperatorios los que alertan al cirujano. A pesar de que el tipo histológico determina la radicalidad del manejo quirúrgico de estos pacientes, algunas características macroscópicas pueden orientar a las patologías específicas y a una conducta adecuada. En general, los objetivos del manejo quirúrgico inicial se cumplen con una resección limitada al apéndice cecal, asociada a la citología de mucina y biopsia de los implantes peritoneales si están presentes, reservando las resecciones extendidas, como hemicolectomía derecha oncológica, para los pacientes con compromiso extenso de la base o del mesenterio apendicular ante la sospecha de neoplasias neuroendocrinas o adenocarcinoma del apéndice cecal.
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