1
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Kearsey CC, Dritsas S, Mathur M, Wild J. 'It's just a mucocele': a case report of a massive appendiceal mucocele presenting as a left upper quadrant mass. Ann R Coll Surg Engl 2024; 106:93-95. [PMID: 36622245 PMCID: PMC10757871 DOI: 10.1308/rcsann.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2022] [Indexed: 01/10/2023] Open
Abstract
Tumours of the appendix are very rare tumours that can and often present with a mucocele. This is a case report highlighting the associated pathology of appendix tumours and the management of a large mucocele. Specifically, how a right hemicolectomy is very rarely needed in these cases regardless of size and local anatomical relationships and some important considerations for the practicing surgeon in the non-tertiary centre that encounters a case like this.
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Affiliation(s)
- CC Kearsey
- The Christie NHS Foundation Trust, UK
- Institute of Translational Medicine, University of Liverpool, UK
| | - S Dritsas
- The Christie NHS Foundation Trust, UK
| | - M Mathur
- The Christie NHS Foundation Trust, UK
| | - J Wild
- The Christie NHS Foundation Trust, UK
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2
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Salminen R, Rautio T, Nordström P, Rantanen T, Mällinen J, Grönroos J, Salminen P. Five-year follow-up of appendiceal neoplasm risk in periappendicular abscess in the Peri-Appendicitis Acuta Randomized Clinical Trial. Scand J Surg 2023; 112:265-268. [PMID: 37655682 DOI: 10.1177/14574969231192128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Affiliation(s)
- Roosa Salminen
- Department of Surgery, University of Oulu, Oulu, Finland
| | - Tero Rautio
- Department of Surgery, University of Oulu, Oulu, Finland
- Division of Operative Care, Oulu University Hospital and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Pia Nordström
- Divison of Surgery, Gastroenterology and Oncology, Tampere University Hospital, Tampere, Finland
| | - Tuomo Rantanen
- Department of Surgery, Kuopio University Hospital, Kuopio, Finland
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - Jari Mällinen
- Department of Surgery, University of Oulu, Oulu, Finland
- Division of Operative Care, Oulu University Hospital and Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Juha Grönroos
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
- Department of Surgery, University of Turku, Turku, Finland
| | - Paulina Salminen
- Paulina Salminen Division of Digestive Surgery and Urology Turku University Hospital P.O. Box 52 Turku 20520 Finland
- Department of Surgery University of Turku Turku Finland
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Kusano S, Otsubo I, Miyazaki H, Kikuchi T, Fukuda Y, Mizuta N, Ashitani H, Tsunemi K, Toyokawa A. [Goblet Cell Carcinoid of the Appendix with Complicated Appendicitis-A Case Report]. Gan To Kagaku Ryoho 2023; 50:1965-1967. [PMID: 38303266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
A 50-year-old male was referred to our hospital for the further evaluation and treatment of abdominal pain. He was diagnosed with complicated appendicitis using computed tomography. After conservative treatment, he underwent an interval appendectomy. A histopathological examination revealed a goblet cell carcinoid(GCC)of the appendix with subserosal invasion. He underwent laparoscopic ileocecal resection with D3 lymph node dissection. Histopathological findings showed neither residual tumor nor lymph node metastasis. The patients is currently followed as an outpatient without recurrence. Here we report our experience with GCC, a rare disease.
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Affiliation(s)
- Shunsuke Kusano
- Dept. of Surgery, AIJINKAI Health Care Corporation Akashi Medical Center
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4
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Hoshino H, Ota H, Yamashita S, Ikushima H, Mizuno H. [A Case of Appendiceal Metastasis from Hilar Cholangiocarcinoma with Acute Perforated Appendicitis and Cholecystitis]. Gan To Kagaku Ryoho 2023; 50:1609-1611. [PMID: 38303357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
An 88-year-old woman had been diagnosed with hilar cholangiocarcinoma for 3 years since she received metallic stents for malignant biliary obstruction, and observed without any aggressive medical treatment. She was admitted to our hospital for further investigation of her abdominal pain. Abdominal CT showed an enlarged gallbladder, fluid collection in the right paracolic gutter, and swollen appendix. Laboratory tests showed high-grade inflammation. She was diagnosed with acute perforated appendicitis with acute cholecystitis. Laparoscopic cholecystectomy and appendectomy were performed. Perforation was confirmed intraoperatively in the appendix wall and accumulation of pus was found in the right paracolic gutter. There were no macroscopic findings of metastasis and peritoneal dissemination. Microscopic examination of the resected appendix showed adenocarcinoma cells positive for CK7 and negative for CK20 and CDX2, and were predominantly infiltrated from the muscular layer to the serosa of the appendix wall, with a diagnosis of appendiceal metastasis from hilar cholangiocarcinoma. Metastatic appendiceal carcinoma is rare, and appendiceal metastasis from hilar cholangiocarcinoma is extremely rare. Herein, we report a rare case of metastatic appendiceal carcinoma from hilar bile duct cancer with acute perforated appendicitis and cholecystitis along with findings of previous literature.
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Suda M, Kiyama T, Iijima H, Kimura N. [Adult Intussusception Associated with a Low-Grade Appendiceal Mucinous Neoplasm-A Case Report]. Gan To Kagaku Ryoho 2023; 50:1420-1422. [PMID: 38303294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
A 52-year-old woman patient, who presented with lower abdominal pain, was suspected of having colonic intussusception. An enhanced CT examination indicated that the end of the small intestine or appendix tumor had invaginated into the transverse colon. The CT revealed no evidence of intestinal ischemia, the emergency operation was performed on the following day. After relieving a colonic intussusception, a mass of the appendix was found and we performed laparoscope-assisted ileocolic resection and D3 dissection because of a strong possibility of carcinoma. The patient was discharged 8 days after the surgery and showed no evidence of recurrence for 6 months after the surgery. In postoperative histopathological examination, appendix tumor was diagnosed as a low-grade appendiceal mucinous neoplasm(LAMN). Adult intussusception is a rare disease and most of the cases are caused by malignant lesions, and a treatment strategy for LAMN has not yet been established. We report this case , as there are very few reported cases of adult intussusception caused by LAMN, with a review of the relevant literature.
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Affiliation(s)
- Mutsumi Suda
- Dept. of Digestive Surgery, Musashino Tokushukai Hospital
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6
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Yang FF, Monsell SE, Davidson GH, Mogal H, Voldal EC, Fannon EEC, Lawrence SO, Krishnadasan A, Talan DA, Bizzell B, Heagerty PJ, Comstock BA, Lavallee DC, Carter DW, Skeete DA, Alam HB, Glaser J, Mandell KA, Uribe L, Neufeld M, Guiden M, Schaetzel SM, Reiter SA, Millas SG, Winchell R, Thompson CM, Self WH, Kao LS, Dodwad SJ, Salzman D, Kaji AH, DeUgarte DA, Siparsky N, Price TP, Victory J, Jones A, Kutcher M, Liang MK, Cuschieri J, Johnson J, Odom SR, Kessler LG, Flum DR. Appendiceal neoplasms in patients treated with antibiotics for acute appendicitis: secondary analysis of the CODA randomized clinical trial. Br J Surg 2023; 110:1659-1662. [PMID: 37499092 PMCID: PMC11032191 DOI: 10.1093/bjs/znad240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023]
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Xing XC, Yang JL, Xiao X. Clinical features, treatments and prognosis of appendiceal bleeding: a case series study. BMC Gastroenterol 2023; 23:377. [PMID: 37924017 PMCID: PMC10625278 DOI: 10.1186/s12876-023-03025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/01/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Appendiceal bleeding is a rare cause of lower gastrointestinal bleeding, could be overlooked and diagnosed as obscure gastrointestinal bleeding. Due to limited real-world cases, the optimized management of appendiceal bleeding is unclear. We here shared our experiences in the past 20 years. METHODS A retrospective study was conducted at West China Hospital of Sichuan University. We reviewed data of 28,175 colonoscopies from 43,095 gastrointestinal bleeding patients between June 2003 and June 2023. Six patients diagnosed as appendiceal bleeding were included. Data including symptoms, laboratory tests, imaging results, endoscopic findings, treatment and prognosis were collected and analyzed. RESULTS Appendiceal bleeding accounts for 0.014% in gastrointestinal bleeding patients. Of the six patients, five were male, with a mean age of 48.5 years. Hematochezia was the most common symptom. The etiology included appendiceal angiodysplasia, appendicitis and appendectomy associated bleeding. Hemostasis was achieved by appendectomy, endoscopic therapy or medication according to different cases. One patient did not receive any treatment because of self-limiting bleeding. CONCLUSIONS The diagnosis of appendiceal bleeding is challenging, repeated flushing during endoscopy is helpful. Appendectomy is the priority option for treatment as well as the etiology clarification, therapeutic endoscopy and medication could be considered case by case.
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Affiliation(s)
- Xiao-Cun Xing
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer, Chengdu, China
| | - Jin-Lin Yang
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer, Chengdu, China
| | - Xue Xiao
- Department of Gastroenterology and Hepatology, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
- Sichuan University-Oxford University Huaxi Gastrointestinal Cancer, Chengdu, China.
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Hale J, Scott B, Suydam C, Brockmeyer J. Endometriosis of the Appendix: When Appendicitis Is Less Than Straightforward. Mil Med 2023; 188:e3730-e3733. [PMID: 37364272 DOI: 10.1093/milmed/usad233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/16/2023] [Accepted: 06/15/2023] [Indexed: 06/28/2023] Open
Abstract
We present a case report of a 49-year-old female with a history of ulcerative colitis who originally presented to the general surgery clinic after an incidental finding on computed tomography was concerning for a dilated, fluid-filled appendix. She ultimately underwent a laparoscopic appendectomy. The pathology returned consistent with early acute appendicitis, with endometrial tissue along the outer wall of the appendix. We then performed a literature review regarding appendiceal masses and the occurrence of endometriomas and/or endometriosis of the appendix. A PubMed search was performed using the key words of appendix and appendicitis and endometrioma. Specific articles were examined mentioning the occurrence of endometriomas of the appendix and isolated endometriosis of the appendix. Between 2% and 6% of cases of appendicitis present due to an appendiceal mass, usually an inflammatory phlegmon. A variety of other causes, including primary malignancy, secondary malignancy, and combinations of pathologies, may lead to the eventual removal of the appendix. Specifically, endometriosis of the appendix is reported in less than 1% of females on post-appendectomy pathologic analysis. Although specific symptoms may guide a provider, there are few distinguishing symptoms that would point a provider toward a different etiology, to include malignancy, for appendicitis. Further information is needed to determine when a patient has an increased risk for an underlying pathology when presenting with appendicitis. This information will help drive continued treatment and lead to improved screening for appendiceal masses.
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Affiliation(s)
- Justin Hale
- General Surgery Residency Program, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA
| | - Benjamin Scott
- National Capital Consortium General Surgery Residency Program, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Camille Suydam
- General Surgery Residency Program, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA
| | - Joel Brockmeyer
- General Surgery Residency Program, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA
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9
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Tavra A, Quien D, Barcot O. Oncological aspect of incidental appendectomy with regard to histopathological findings: A retrospective cohort study. Eur J Surg Oncol 2023; 49:107013. [PMID: 37597285 DOI: 10.1016/j.ejso.2023.107013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/24/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION The aim of this retrospective cohort study was to describe the findings on histopathological examination of removed, macroscopically non-diseased, vermicular appendix during another primary surgical procedure (incidental appendectomy (IA)). Previous studies disapproved IA but were based on the possibility of complicated appendicitis. We observed the prevalence of neoplasms of the appendix in IA versus the appendectomy performed due to acute appendicitis (AA). METHODS The database of histopathology reports of the Surgery Department, University Hospital of Split was reviewed in the period from January 1, 2017, to December 31, 2021. A total of 2832 histopathology reports were reviewed. RESULTS There was no difference in gender distribution between these two groups, but AA had a statistically significantly lower median patient age compared to the group IA (40 vs. 68 years; P < 0.001). In the AA group, there were 84.5% acute appendicitis, 11.1% normal appendiceal reports, 3.2% appendiceal neoplasms, and 1.2% other pathologies. The group IA had 89.5% normal findings of the appendix, 7.2% appendiceal neoplasms, and 0.5% other pathology. The difference in neoplasm prevalence between IA and AA groups was 4.0% (95%CI: 2.2 to 5.8), P < 0.001. The number of incidental appendectomies needed to detect one neoplasm of the appendix is 25. CONCLUSION Incidental appendectomies in patients undergoing abdominal surgery revealed a relatively high prevalence of appendiceal neoplasms above the age of 60 years. Prospective studies about incidental appendectomies, their clinical consequences, and impact on prognosis should be performed to define the value of incidental appendectomy in those patients.
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Affiliation(s)
- Ante Tavra
- University of Split School of Medicine, Split, Croatia.
| | - Damir Quien
- Surgery Department, University Hospital of Split, Split, Croatia.
| | - Ognjen Barcot
- University of Split School of Medicine, Split, Croatia; Surgery Department, University Hospital of Split, Split, Croatia.
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10
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Nakamura S, Ochiai Y, Nishihara Y, Koyanagi A, Miura Y, Kikuchi D, Takazawa Y, Kuroyanagi H, Hoteya S. Advanced Appendiceal Cancer with Systematic Metastasis without Gastrointestinal Symptoms Found by Subcutaneous Tumor. Intern Med 2023; 62:2655-2660. [PMID: 36754410 PMCID: PMC10569910 DOI: 10.2169/internalmedicine.0597-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 12/14/2022] [Indexed: 02/10/2023] Open
Abstract
An 86-year-old woman with a subcutaneous nodule in her left axilla visited our hospital. She had no gastrointestinal symptoms, but contrast-enhanced computed tomography revealed a cecal mass and systemic metastasis, including cutaneous, bone, peritoneal dissemination and ascites. Colonoscopy revealed a circumferential, elevated cecal lesion. She underwent right hemicolectomy to prevent colon obstruction. The pathological diagnosis was poorly differentiated adenocarcinoma (por1>tub2>muc) arising from the appendix with a BRAFV600E mutation and microsatellite instability-high. Chemotherapy was administered, and she is currently still alive and undergoing chemotherapy. We describe a rare case of advanced appendiceal cancer without gastrointestinal symptoms diagnosed due to cutaneous metastasis.
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Affiliation(s)
| | | | - Yuki Nishihara
- Department of Gastroenterological Surgery, Toranomon Hospital, Japan
| | | | | | | | | | - Hiroya Kuroyanagi
- Department of Gastroenterological Surgery, Toranomon Hospital, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Japan
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11
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St John A, Murray R, Cooper L, Diaz J, Ghneim M. Cecal-Colon Intussusception due to Appendiceal Mucinous Adenocarcinoma. Am Surg 2023; 89:3822-3825. [PMID: 37222408 DOI: 10.1177/00031348231175489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Intussusception is a rare presentation in adults and describes when one portion of the intestine telescopes into another portion. Intussusception is associated with malignancies serving as the lead point in adults. Appendiceal mucinous neoplasms are uncommon tumors often incidentally discovered during appendectomy procedures to manage acute appendicitis. Here we present a case report of an instance of mucinous adenocarcinoma of the appendix that manifested as a large bowel obstruction with intussusception limited to the colon, underscoring the possibility of concurrent intussusception and mucinous neoplasms. The case highlights the importance of meticulous diagnostic evaluation and management, particularly without well-defined treatment protocols. Appropriate diagnostic workup and management, including surgical intervention, are critical for patient outcomes and overall prognosis. The study recommends that patients diagnosed with confirmed or suspected appendiceal neoplasms undergo upfront oncologic resection where aggressive malignancy is a concern. Colonoscopy should be performed postoperatively for all patients to identify synchronous lesions.
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Affiliation(s)
- Ace St John
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Rhaya Murray
- Department of Pathology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Laura Cooper
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
| | - Jose Diaz
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
- Department of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Mira Ghneim
- Department of Surgery, University of Maryland Medical Center, Baltimore, MD, USA
- Department of Trauma and Critical Care, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
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12
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Yurgelun MB, Papke DJ, Redston MS. Is Appendiceal Cancer a Lynch Syndrome-Associated Cancer? JAMA Oncol 2023; 9:869. [PMID: 37079292 DOI: 10.1001/jamaoncol.2023.0519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Affiliation(s)
- Matthew B Yurgelun
- Dana-Farber Cancer Institute, Boston, Massachusetts
- Brigham & Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - David J Papke
- Brigham & Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Mark S Redston
- Brigham & Women's Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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13
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Holowatyj AN, Washington MK, Horton C. Is Appendiceal Cancer a Lynch Syndrome-Associated Cancer?-Reply. JAMA Oncol 2023; 9:869-870. [PMID: 37079298 DOI: 10.1001/jamaoncol.2023.0522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Affiliation(s)
- Andreana N Holowatyj
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
- Department of Population Health Sciences, University of Utah, Salt Lake City
| | - Mary K Washington
- Vanderbilt-Ingram Cancer Center, Nashville, Tennessee
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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14
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Bathobakae L, Ozgur SS, Jariwala M, Kesrani J, Ajas S, Kumar M, Akmal A. The Cancer Diaspora: A Rare Case of Pseudomyxoma Peritonei of Appendiceal Origin. J Investig Med High Impact Case Rep 2023; 11:23247096231217822. [PMID: 38102072 PMCID: PMC10725096 DOI: 10.1177/23247096231217822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/29/2023] [Accepted: 11/12/2023] [Indexed: 12/17/2023] Open
Abstract
Pseudomyxoma peritonei (PMP) is a rare clinical entity characterized by widespread mucinous implants in the peritoneal cavity. Commonly seen in females in their 50s, PMP typically originates from ruptured appendiceal mucoceles that find refuge in the peritoneal space. Rarely, PMP may originate from the ovary, stomach, colon, or pancreas. Pseudomyxoma peritonei of colorectal origin is more malignant and has a lower survival rate. We report a case of a 59-year-old Hispanic woman with PMP who presented to the emergency room with a 3-month history of progressive abdominal distention. Pseudomyxoma peritonei was confirmed by computed tomography (CT) scan of the abdomen and pelvis and histopathology, and the patient underwent partial cytoreductive surgery. Given her Eastern Cooperative Oncology Group (ECOG) performance status of 1 despite extensive carcinomatosis, our patient may benefit from hyperthermic intraperitoneal chemotherapy (HIPEC) in the future.
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Affiliation(s)
| | | | - Mohita Jariwala
- Rowan University School of Osteopathic Medicine, Stratford, NJ, USA
| | - Jaydev Kesrani
- St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Shajla Ajas
- St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Mehandar Kumar
- St. Joseph’s University Medical Center, Paterson, NJ, USA
| | - Amer Akmal
- St. Joseph’s University Medical Center, Paterson, NJ, USA
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15
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Sugimoto T, Nagasue Y, Tanaka E, Yokomizo H. Comparison of the risk of appendiceal tumors in uncomplicated and complicated appendicitis. Surg Endosc 2022; 36:8107-8111. [PMID: 35449477 DOI: 10.1007/s00464-022-09246-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/02/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Interval appendectomy or non-operative management is commonly performed for complicated appendicitis in adult patients. However, these treatments are still controversial because the incidence rate of appendiceal tumors recognized after interval appendectomy is reportedly higher than that after emergency appendectomy. Thus, this study aimed to compare the appendiceal tumor rates between uncomplicated and complicated appendicitis. METHODS This study was a retrospective review of patients with appendicitis who underwent surgical removal at a single institution over 7.5 years. The primary objective was the comparison of the incidence rate of appendiceal tumors using propensity score matching, and the secondary objective was the same comparison among older patients, defined as patients aged ≥ 60 years. RESULTS A total of 1277 patients were included. Of these patients, 297 (23.3%) were preoperatively diagnosed with complicated appendicitis. Moreover, 22 (1.7%) patients, including 14 cases of complicated appendicitis and 8 cases of uncomplicated appendicitis, were diagnosed with appendiceal tumors based on pathological examination. No significant difference was found in the incidence rate of appendiceal tumors between the two groups after matching for patients' background, including age, sex, and history of appendicitis by propensity score matching (P = 0.073). However, among patients aged ≥ 60 years, the incidence of appendiceal tumors was significantly higher in complicated than in uncomplicated appendicitis (P = 0.006). CONCLUSIONS Although the overall risk of appendiceal tumors did not differ between complicated and uncomplicated appendicitis when analyzed by the propensity score matching, in older patients aged ≥ 60 years, the risk increased among those with complicated appendicitis. Therefore, although the incidence is low, complicated appendicitis, particularly, among older patients, should be examined carefully and be performed IA when unusual findings exist.
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Affiliation(s)
- Takuya Sugimoto
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto-city, Kumamoto, 861-8520, Japan.
| | - Yasutomo Nagasue
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto-city, Kumamoto, 861-8520, Japan
| | - Eiji Tanaka
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto-city, Kumamoto, 861-8520, Japan
| | - Hiroshi Yokomizo
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine-minami, Higashi-ku, Kumamoto-city, Kumamoto, 861-8520, Japan
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16
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Montali F, Baldinu M, Annicchiarico A, Virgilio E, Costi R. Amyand's hernia: which oncologic risk can be hidden in the sac? Acta Biomed 2022; 93:e2022273. [PMID: 36134747 PMCID: PMC10510965 DOI: 10.23750/abm.v93is1.13322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/05/2022] [Indexed: 01/27/2023]
Abstract
Amyand's hernia (AH) is a rare condition in which the appendix is found in the sac of an inguinal hernia. It occurs in only 1% of adult inguinal hernias. The herniated appendix can occasionally range varying degrees of acute inflammation up to neoplastic transformation. An appendiceal tumor can be rarely described inside the AH sac. We describe a case of gangrenous appendicitis in AH and offer a review of the literature on AH when presenting with appendicitis associated with appendiceal cancer. As of 2022, only nine cases of AH presenting with appendicitis associated with appendiceal cancer have been reported by the pertinent literature. In order of decreasing frequency, AH, AH-related appendicitis and AH-related appendicitis associated with appendiceal cancer are three rare conditions. Particular attention should be kept in each situation as diagnosis is achieved postoperatively most of the times.
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Khamzina Y, King MC, Nieroda C, Merrell DS, Sardi A, Gushchin V. The Role of Microorganisms in Appendiceal Pseudomyxoma Peritonei: A Review. Curr Oncol 2022; 29:3576-3584. [PMID: 35621679 PMCID: PMC9139876 DOI: 10.3390/curroncol29050289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 11/16/2022] Open
Abstract
Pseudomyxoma peritonei (PMP) is a rare clinical syndrome. It originates from neoplasms of the appendix and leads to the formation of peritoneal implants and the accumulation of mucinous ascites. PMP represents a spectrum of low to high-grade disease. Despite aggressive management, many PMP patients recur, leading to debilitating symptoms and few treatment options. Therefore, scientists have continued to look for ways to improve treatment and further understand disease pathogenesis. Microorganisms were previously hypothesized to play a role in PMP progression and development. Hence, antibacterial treatment was suggested by some authors, but the data were limited. In this paper, we review the current data on the role of bacteria in PMP, discuss the significance, and suggest possible solutions to the inherent challenges in these studies. Given the limitations of the discussed studies, we remain skeptical about introducing novel antibacterial treatment into clinical practice at this time; however, the available data are valuable and indicate that more research into the molecular mechanisms of PMP is needed.
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Affiliation(s)
- Yekaterina Khamzina
- Department of Surgical Oncology, The Institute for Cancer Care at Mercy, Mercy Medical Center, Baltimore, MD 21202, USA; (Y.K.); (M.C.K.); (C.N.); (A.S.)
| | - Mary Caitlin King
- Department of Surgical Oncology, The Institute for Cancer Care at Mercy, Mercy Medical Center, Baltimore, MD 21202, USA; (Y.K.); (M.C.K.); (C.N.); (A.S.)
| | - Carol Nieroda
- Department of Surgical Oncology, The Institute for Cancer Care at Mercy, Mercy Medical Center, Baltimore, MD 21202, USA; (Y.K.); (M.C.K.); (C.N.); (A.S.)
| | - D. Scott Merrell
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA;
| | - Armando Sardi
- Department of Surgical Oncology, The Institute for Cancer Care at Mercy, Mercy Medical Center, Baltimore, MD 21202, USA; (Y.K.); (M.C.K.); (C.N.); (A.S.)
| | - Vadim Gushchin
- Department of Surgical Oncology, The Institute for Cancer Care at Mercy, Mercy Medical Center, Baltimore, MD 21202, USA; (Y.K.); (M.C.K.); (C.N.); (A.S.)
- Correspondence: ; Tel.: +1-(410)-332-9294; Fax: +1-(410)-332-9731
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Ruiz Pardo J, Gras Gómez C, Estébanez Ferrero B, Sánchez Fuentes PA, Gorostiaga Altuna Í, Vidaña Márquez E, Moya P, Reina Duarte Á. Surgical indication for right hemicolectomy in goblet cell adenocarcinoma of the appendix. Rev Esp Enferm Dig 2022; 114:183-184. [PMID: 34991325 DOI: 10.17235/reed.2021.8447/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We have read with interest the article by Pérez Montiel CA et al., in which goblet cell adenocarcinoma (GCA) is described as a cause of acute appendicitis. Although the article is brilliant in terms of histopathological description of the appendiceal GCA, the surgical indication for right hemicolectomy should be analyzed in depth due to the great controversy that exists in the scientific literature.
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Affiliation(s)
- José Ruiz Pardo
- Cirugía General y del Aparato Digestivo, Hospital Universitario Torrecárdenas, España
| | - Cristina Gras Gómez
- Cirugía General y del Aparato Digestivo, Hospital Universitario Torrecárdenas, España
| | | | | | | | | | - Pedro Moya
- Cirugía General y del Aparato Digestivo, Hospital Universitario Torrecárdenas, España
| | - Ángel Reina Duarte
- Cirugía General y del Aparato Digestivo, Hospital Universitario Torrecárdenas, España
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19
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Kasetani T, Hirata H, Morita T, Furukawa H. [A Case of Appendiceal Intussusception Induced by Early Appendiceal Carcinoma]. Gan To Kagaku Ryoho 2021; 48:1728-1730. [PMID: 35046311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Appendiceal intussusception is an uncommon pathologic condition. We report herein a case of appendiceal intussusception induced by appendiceal carcinoma. A 76-year-old woman was admitted to hospital because of epigastric pain. CT scan showed multiple concentric ring sign in ascending colon and enhanced tumor in transverse colon. Colonoscopy showed invagination of polypoid lesion which was pushed back to cecum endoscopically. Laparoscopy-assisted ileocecal resection with regional lymph node dissection was performed for cecal cancer. During surgery, the appendix was found to be inverted completely into the cecum. The tumor was 70×35 mm in size in the cecal cavity, and the appendix had completely invaginated into the cecum at its base. Histopathologic examination revealed early appendiceal carcinoma. The patient is healthy without recurrence.
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20
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Cohen R, McKean K, Chetrit S. Enterocutaneous fistula resulting from the drainage of a contained appendiceal perforation secondary to a partially obstructing low-grade appendiceal mucinous neoplasm. BMJ Case Rep 2021; 14:e244546. [PMID: 34446520 PMCID: PMC8395359 DOI: 10.1136/bcr-2021-244546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/03/2022] Open
Abstract
We report a case of an enterocutaneous fistula resulting from drainage of a contained appendiceal perforation secondary to an obstructing appendiceal mucinous neoplasm. A 66-year-old otherwise healthy female patient proceeded to laparoscopic appendicectomy with resection of the fistula tract. Histopathology demonstrated a mid-appendiceal mucinous neoplasm, with a benign enterocutaneous fistula tract communicating with the distal, non-malignant portion of the appendix. We provide an overview of the literature and highlight the need to consider appendiceal mucinous neoplasm as a differential in the management of spontaneous right iliac fossa collections and fistulae.
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Affiliation(s)
- Ryan Cohen
- School of Biomedical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia
- Colorectal Surgery, St John of God Health Care Inc, Perth, Western Australia, Australia
| | - Katie McKean
- Colorectal Surgery, St John of God Health Care Inc, Perth, Western Australia, Australia
| | - Stephanie Chetrit
- Colorectal Surgery, St John of God Health Care Inc, Perth, Western Australia, Australia
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21
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Hasuike Y, Higuchi I, Ishikawa A, Mori Y, Urano N, Kitamura T, Tsuchida Y, Miyamoto M. [More than Four-Year Survival of Appendiceal Adenocarcinoma Due to Goblet Cell Carcinoid and Manifesting as an Abdominal Tumor and Hydronephrosis]. Gan To Kagaku Ryoho 2020; 47:2317-2319. [PMID: 33468946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An 89-year-old woman with complete blindness presented with a right lower abdominal tumor and weight loss. The CT scan showed a huge mass approximately 9 cm in diameter in the ileocecum, invading the right urinary tract and right iliac artery and vein. Findings of the TCS biopsy led to the suspicion of ileocecal carcinoid. Another punch biopsy specimen acquired under general anesthesia indicated mucinous cell carcinoma. When she suffered from right leg pain approximately 3 months later, we provided radiation therapy(50 Gy)because of intolerance to UFT. Consequently, pain disappeared, and the tumor size decreased significantly. We administered TS-1 but discontinued it because of intolerance. Further, 2.8 years after the first medical examination, the tumor recurred, and she developed ileus. We performed ileocolectomy, and pathological findings indicated that the adenocarcinoma in the appendix had progressed from goblet cell carcinoid(sig, si[right ovary], ly1b, v1a, n0). Four years after the first medical examination, CEA had elevated rapidly, and lung metastases were found. She died approximately 4.2 years after the first medical examination. The last measured CEA level had been 596.7 ng/mL. Starting from the lowest level at the first examination, the CEA level had slowly elevated until before the operation and rapidly elevated postoperatively. Immunopathological findings showed that the operated specimen stained diffusely for CEA, without any mucinous component. We suspected that radiation therapy modified goblet cell carcinoid to adenocarcinoma.
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22
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Awwad A, Berman Z, Krinsky M, Minocha J, Roberts A. Daily Infusion of Acetylcysteine via Percutaneous Biliary Drainage Catheter to Reduce Bile Viscosity and Prevent Recurrent Cholangitis. J Vasc Interv Radiol 2020; 32:486-487. [PMID: 33272815 DOI: 10.1016/j.jvir.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/17/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Andy Awwad
- Department of Radiology, University of California San Diego, San Diego, CA
| | - Zach Berman
- Department of Radiology, University of California San Diego, San Diego, CA
| | - Mary Krinsky
- Department of Gastroenterology, University of California San Diego, San Diego, CA
| | - Jeet Minocha
- Department of Radiology, University of California San Diego, San Diego, CA
| | - Anne Roberts
- Department of Radiology, University of California San Diego, San Diego, CA
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Kato J, Maruta A, Shirakami Y, Mizutani T, Ozawa N, Ideta T, Takada J, Kubota M, Sakai H, Ibuka T, Araki H, Shimizu M. Advanced appendiceal goblet cell carcinoids with intestinal obstruction: two case reports. Clin J Gastroenterol 2020; 13:1205-1212. [PMID: 32989687 DOI: 10.1007/s12328-020-01232-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/31/2020] [Indexed: 01/20/2023]
Abstract
A goblet cell carcinoid is quite rare and has features, wherein, a carcinoid-like image and an adenocarcinoma-like image coexist. We encountered two cases of rare goblet cell carcinoid originating in the appendix. Case 1 is that of a 48-year-old man with a chief complaint of abdominal distension and case 2 is that of a 64-year-old woman with a chief complaint of constipation. At the time of diagnosis, both cases had already metastasized to the peritoneum and other organs, and no radical surgical treatment could be administered in either case. Chemotherapies were performed according to the regimen for colon cancer, and they were effective to a certain extent. During the course of treatment, however, both cases developed intestinal obstruction, presumably due to peritoneal dissemination, which led to worse condition and death several months afterwards. Chemotherapy for goblet cell carcinoids has not yet reached a consensus, and further studies and establishment of therapeutic strategy are desired in the future.
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Affiliation(s)
- Junichi Kato
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Akinori Maruta
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Yohei Shirakami
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Taku Mizutani
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Noritaka Ozawa
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Takayasu Ideta
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Jun Takada
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masaya Kubota
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiroyasu Sakai
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Takashi Ibuka
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiroshi Araki
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masahito Shimizu
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
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24
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Affiliation(s)
| | - Jonathan C King
- Department of General Surgery, University of California, Los Angeles
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25
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Van de Moortele M, De Hertogh G, Sagaert X, Van Cutsem E. Appendiceal cancer : a review of the literature. Acta Gastroenterol Belg 2020; 83:441-448. [PMID: 33094592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Primary appendiceal cancer is rare and most commonly found incidentally on a surgical specimen after appendectomy for acute appendicitis. This small organ gives rise to different subtypes which are histological and biological distinct. Historically the classification of these tumors has been confusing because of the different nomenclature that is used. This review has broadly classified them into four subgroups: colonic-type adenocarcinoma, mucinous neoplasm, goblet cell carcinoma and neuroendocrine neoplasm. Signet ring cells is not considered as a distinct subgroup but as a histologic feature that can be present in colonic-type adenocarcinoma and mucinous neoplasms. As staging and management of appendiceal tumors depend on these subtypes, an adequate classification of them is important. This review aimed to give an overview of the epidemiology, grading and staging, management and prognosis of these neoplasms. Despite its rarety, specific staging systems and treatment guidelines exist for some subtypes. For other subtypes staging systems and management is extrapolised from colorectal cancer because of the lack of randomised, prospective trials.
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Affiliation(s)
- M Van de Moortele
- Department of Digestive Oncology and Pathology, University Hospitals Gasthuisberg/Leuven and KULeuven, Leuven, Belgium
| | - G De Hertogh
- Department of Digestive Oncology and Pathology, University Hospitals Gasthuisberg/Leuven and KULeuven, Leuven, Belgium
| | - X Sagaert
- Department of Digestive Oncology and Pathology, University Hospitals Gasthuisberg/Leuven and KULeuven, Leuven, Belgium
| | - E Van Cutsem
- Department of Digestive Oncology and Pathology, University Hospitals Gasthuisberg/Leuven and KULeuven, Leuven, Belgium
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26
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Sasaki M, Wada Y, Ishibashi N, Adachi M, Tomii C, Watanabe Y, Kamiya A, Oshima N, Goto H, Koshiishi H, Yoshimura T. [A Case of Appendiceal Neuroendocrine Tumor Diagnosed after Appendectomy]. Gan To Kagaku Ryoho 2019; 46:2161-2163. [PMID: 32156865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 25-year-old woman visited our hospital with a complaint of right lower abdominal pain. As a result of the examination, she was diagnosed as having acute appendicitis. After conservative treatment, we planned an elective surgery. At 3 months after discharge, laparoscopic appendectomy was performed. We found a mass of 10mm in diameter at the body of the appendix. Histopathological examination revealed the proliferation of heteromorphic cells with small round nuclei. It was positive for chromogranin A and synaptophysin in immunostaining, so we made a diagnosis of NET G1. Tumor cells infiltrated beyond the intrinsic muscle layer, but no vascular invasion was observed, and the margin was negative. In accordance with the guidelines, we followed up the patient with imaging examination and did not find any signs of recurrence.
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Affiliation(s)
- Megumi Sasaki
- Dept. of Surgery, Tokyo Metropolitan Ohtsuka Hospital
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27
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Cubro H, Cengic V, Burina N, Kravic Z, Beciragic E, Vranic S. Mucocele of the appendix presenting as an exacerbated chronic tubo-ovarian abscess: A case report and comprehensive review of the literature. Medicine (Baltimore) 2019; 98:e17149. [PMID: 31574819 PMCID: PMC6775329 DOI: 10.1097/md.0000000000017149] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RATIONALE Appendiceal mucocele is a rare entity of mucinous cystic dilatation of the appendix. It has no typical clinical presentation and is considered a potentially premalignant condition. PATIENT CONCERNS We present a case of accidental intraoperative finding of an appendiceal mucocele in a 54-year old woman that clinically presented with an exacerbated chronic tubo-ovarian abscess. DIAGNOSES Trans-vaginal ultrasonography showed an encapsulated, oval, unilocular mass above the uterus with a heteroechogenic structure, homogeneous fluid content, and smooth regular walls without inner proliferation. The histopathologic diagnosis was consistent with an appendiceal cystadenoma. INTERVENTIONS The patient underwent a simple appendectomy. OUTCOMES There were no clinical, biochemical or imaging signs of the disease recurrence at 6 months follow up. LESSONS To our knowledge, this is the only well-documented case of appendiceal mucocele mimicking exacerbated chronic tubo-ovarian abscess reported in the literature. Awareness of a rare entity such as an appendiceal mucocele, which is frequently misdiagnosed as a potential cause of acute abdomen, is necessary for the appropriate management strategy in order to prevent complications.
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Affiliation(s)
- Hajrunisa Cubro
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | | | | | - Zlatko Kravic
- Department of General Surgery, General Hospital “Prim.dr. Abdulah Nakas”, Sarajevo, Bosnia and Herzegovina
| | | | - Semir Vranic
- College of Medicine, Qatar University Health, Qatar University, Doha, Qatar
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28
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Fernández-Conejo G, de la Morena JM, Sola I, Jiménez-Almonacid P, Martín L, Sosa G, Llorente C. [Complicated renal cyst by fistula from acute appendicitis on an appendicular mucocele. First literature report.]. ARCH ESP UROL 2019; 72:709-712. [PMID: 31475683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We describe the first clinical case in the reviewed literature of a patient with a complicated renal cyst by fistula of an appendicular neoplasm with acute appendicitis, as well as the management performed and the therapeutic options in similar cases.
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Affiliation(s)
| | | | - Ignacio Sola
- Servicios de Urología. Hospital Universitario Fundación Alcorcón. Madrid. España
| | | | - Libertad Martín
- Cirugía General. Hospital Universitario Fundación Alcorcón. Madrid. España
| | - Grevelyn Sosa
- Anatomía Patológica. Hospital Universitario Fundación Alcorcón. Madrid. España
| | - Carlos Llorente
- Servicios de Urología. Hospital Universitario Fundación Alcorcón. Madrid. España
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29
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Khan K, Patil S, Roomi S, Shiwani MH. Appendicular Neuroendocrine Neoplasm is Associated with Acute Appendicitis - Don't Miss the Boat. Chirurgia (Bucur) 2019; 114:461-466. [PMID: 31511132 DOI: 10.21614/chirurgia.114.4.461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 10/03/2023]
Abstract
Background: Appendicular neuroendocrine neoplasms (ANEN) are rare tumours diagnosed incidentally on histology after an appendicectomy carried out for acute appendicitis. Five years survival rate of node-negative an early ANEN is over 90%. However, the growing interest, among clinicians, to treat appendicitis by antibiotics only, could potentially miss these indolent tumours. The aim of our study was to look at the incidence and management of ANEN discovered in appendicectomy specimens carried out for acute appendicitis. Methods: A retrospective review was performed for all patients undergone appendicectomy, at Barnsley hospital from 2009 to 2015, as suspected acute appendicitis, with particular focus on incidence, investigations and outcome of ANEN. Results: During 2009-2015, 1562 appendicectomies were carried out for acute appendicitis, with 11 specimens showed neuroendocrine tumours (0.70%). Mean age of patients was 31.73 years, with 81.8% female. 8 patients had laparoscopic appendicectomy (72.7%), 2 had open appendicectomy (18.2%), while one had laparoscopic converted to open appendicectomy. Tumour size was less 10 mm in 6 patients (54.5%), between 10-20 mm in 4 (36.4%). Majority were located at the body/base of appendix (54.5%). All tumours were grade 1 well differentiated tumours. 9 patients had clear resection margins, while two patients needed further surgery as an open right hemicolectomy as a curative procedure. In our series, 3 patients (27.27%) had follow up scans 2 years after surgery and showed no tumour recurrence. Conclusion: Appendicectomy is the curative procedure for the majority of ANEN. As shown in our study, if acute appendicitis is managed with conservative treatment only, there is less than 1% risk of missing the diagnosis of ANEN. Also, two of our patients had locally advanced diseases. These could definitely have a poor prognosis without ap-pendectomy.
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30
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Seawell J, Sciarretta JD, Pahlkotter M, Muertos K, Onayemi A, Davis JM. The Understated Malignancy Potential of Nonoperative Acute Appendicitis. Am Surg 2019; 85:712-716. [PMID: 31405413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Cancer of the appendix is rare and is most commonly found incidentally on pathology after an appendectomy for uncomplicated appendicitis (UA). The medical management alternative with antibiotics and observation remains an ongoing debate. The purpose of our study was to develop modern epidemiological data for adult patients completing an appendectomy for UA secondary to an appendiceal neoplasm (AN). ACS-NSQIP database was queried (2005-2016) to identify patients completing an appendectomy. Cohorts of patients who were diagnosed with UA and an AN were included in the study. Relevant perioperative clinical and outcomes data were collected. Type of AN, surgical procedure, and mortality were analyzed. A total of 239,615 UA patients were identified, of whom 2,773 (1.2%) met the inclusion criteria of AN. Patients with AN were predominantly white (79.5%), with a mean age of 54.5 ± 15.9 years, and 54.6 per cent were females. AN pathology findings included malignant neoplasm (64.5%), malignant carcinoid (17.3%), benign carcinoid (9.3%), and benign neoplasm (8.8%). The overall reported incidence was 1.2 per cent and the mortality rate was 0.7 per cent. Our study emphasizes surgical intervention in adult UA maintains a 1 per cent incidence of AN, and treatment with antibiotics alone will presumably lead to a delay in surgical treatment and progression of disease.
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31
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Lomoro P, Simonetti I, Vinci G, Fichera V, Prevedoni Gorone MS. Pancake kidney, a rare and often misdiagnosed malformation: a case report and radiological differential diagnosis. J Ultrasound 2019; 22:207-213. [PMID: 30361920 PMCID: PMC6531527 DOI: 10.1007/s40477-018-0331-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/09/2018] [Indexed: 12/13/2022] Open
Abstract
Renal ectopia and fusion anomalies are Congenital Anomalies of the Kidney and the Urinary Tract (CAKUT) that are usually incidentally detected and asymptomatic. Patients affected present a higher risk of complications like recurrent urinary tract infections or obstruction. Pancake kidney (PK) is one of the rarest types of renal anomaly with complete fusion of the superior, mild and inferior poles of both kidneys in the pelvic cavity. Each kidney has its own excretory system with two ureters that do not cross the midline. In the asymptomatic cases, a conservative approach should be performed. Surgical management may be needed when urological problems occur. PK is often associated with congenital anomalies of other organs. Ultrasound is the first line radiological examination for the diagnosis and the follow-up of kidney malformations. The main sonographic findings suggesting PK diagnosis are a large and lobulated renal mass consisting of two fused lateral lobes without an intervening septum located in the pelvic cavity. Each lobe usually has a separate pelvicalyceal system, the renal pelvis is anteriorly placed and the ureters are usually short and enter the bladder normally without crosses the midline. Ultrasonography gives useful information on the morphology and volume of the organ, and on its vascularization through the use of the Color- and Power-Doppler. Computer Tomography and Magnetic Resonance Urography are second level techniques used to confirm the diagnosis and to evaluate the presence of other abnormalities. The knowledge of the imaging findings and the anatomy of congenital renal malformations is important to avoid diagnostic pitfalls and misinterpretations. We report the case of a 14-years old female with PK who was misdiagnosed with a horseshoe kidney (HSK) during an abdominal ultrasound.
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Affiliation(s)
- P. Lomoro
- Department of Diagnostic Medicine, Institute of Radiology IRCCS San Matteo University Hospital Foundation, Pavia, Italy
| | - I. Simonetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - G. Vinci
- Department of Nephrology, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - V. Fichera
- Department of Pediatrics, Anna Meyer Children’s University Hospital, Florence, Italy
| | - M. S. Prevedoni Gorone
- Department of Diagnostic and Interventional Radiology and Neuroradiology of IRCCS, San Matteo University Hospital Foundation, Pavia, Italy
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32
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Kim WS, Lee DG. Primary mixed adenocarcinoma and small-cell carcinoma of appendix: A case report (CARE-compliant). Medicine (Baltimore) 2019; 98:e15614. [PMID: 31083256 PMCID: PMC6531065 DOI: 10.1097/md.0000000000015614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Primary extrapulmonary small-cell carcinoma (SCC) of appendix is reported very rarely. We report herein a case of mixed SCC and adenocarcinoma of appendix. PATIENT'S CONCERN A 70-year-old female was consulted to our Emergency Department with the right lower abdominal pain and low-grade fever for 2 days. DIAGNOSIS Abdominal ultrasonography revealed the perforated appendicitis with periappendiceal abscess. Postoperative histology confirmed the diagnosis of mixed SCC and adenocarcinoma. INTERVENTIONS After laparoscopic appendectomy, she underwent right hemicolectomy for radical surgery. OUTCOMES Laparoscopic appendectomy was performed and histological examination showed mixed SCC and adenocarcinoma. After confirming that there was no other organ metastasis, right hemicolectomy was performed for radical surgery. Five months after surgery, the patient expired due to multiple organ metastases. LESSONS Further studies are required for better understanding of disease entities, and clinical trials are needed to define adequate treatment strategies for extrapulmonary SCC.
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Affiliation(s)
| | - Dong Gi Lee
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Gumi, Gumi, Gyeongsangbuk-do, Republic of Korea
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Solinas L, Sagnotta A, Chessa A, Fiorini A, Battaglia B, Di Cosimo C, Notarangelo MG, Hassan R, Leone L, Mancini S. Pseudomixoma peritonei associated with appendiceal cistoadenoma rupture: case report. G Chir 2019; 40:213-216. [PMID: 31484011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Appendiceal mucocele represents specimen finding in 0.2-0.3% out of appendectomies. The rupture or perforation in peritoneal cavity might cause pseudomixoma peritonei (PMP), with multiple mucinous deposits in the abdominal cavity. We report a case of PMP caused by a perforated appendiceal cistoadeonoma.
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Ion D, Serban MB, Păduraru DN, Nica AE, Rahim AM, Andronic O. Appendiceal Mass - Dilemmas Regarding Extension of the Resection. Chirurgia (Bucur) 2019; 114:126-130. [PMID: 30830855 DOI: 10.21614/chirurgia.114.1.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 11/23/2022]
Abstract
Starting from a typical case, we try to highlight the main critical elements, both in the diagnostic algorithm and in the therapeutic one. We hereby present a 54-year old patient, known with hepatic steatosis and renal microlithiasis, which undergoes an ultrasonography in ambulatory, on the background of unsystematised abdominal discomfort; the ultrasound reveals the presence of a tumoral mass in the right iliac fossa.
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Kawai K, Murata K, Kagawa Y, Naito A, Takase K, Mori R, Nose Y, Sakamoto T, Murakami K, Katsura Y, Omura Y, Masuzawa T, Takeno A, Takeda Y. [A Case of Strangulating Intestinal Obstruction Caused by Coiling of Low-Grade Appendiceal Mucinous Neoplasm to Terminal Ileum]. Gan To Kagaku Ryoho 2019; 46:291-293. [PMID: 30914537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The patient was a 67-year-old female without a history of surgery. She presented with an abdominal pain and vomiting, and was rushed to our hospital. The abdominal pain was severe, but no peritoneal irritation sign was observed. Abdominal CT scan revealed a strangulating intestinal obstruction and accumulation of ascitic fluid. Emergency surgery was performed for diagnosis and treatment. The intraoperative finding showed serous ascitic fluid and strangulating intestinal obstruction caused by appendiceal tumor coiling around the terminal ileum, which had become ischemic with thinning of its wall. Ileocecal resection with removal of lymph nodes(D3)was performed. The postoperative course was uneventful, and the patient was discharged 13 days after the surgery. Pathological examination of the appendiceal tumor revealed a low-grade appendiceal mucinous neoplasm(LAMN)with no metastasis to the lymph nodes. We had a rare case of strangulating intestinal obstruction caused by coiling of LAMN to the terminal ileum.
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Říha I, Třeška V, Nosek J, Šmíd D, Slunečko R. Rare causes of acute appendicitis. Rozhl Chir 2019; 98:189-193. [PMID: 31159539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION A clinical diagnosis of acute appendicitis does not necessarily imply only inflammatory changes found upon histopathological examination. Even though appendiceal tumors are very rare, accounting for less than 4% of all gastrointestinal tumors‚ they need to be taken into account and require the right choices regarding subsequent onco-surgical management. METHODS 1036 appendectomies were performed and 38 (3.7%) rare appendiceal tumor cases were identified at the department of Surgery in Pilsen from 1 January 2008 to 1 October 2018. The following text presents the difficult nature of the initial diagnosis, current therapy and principles of follow-up care in this relatively rare group of patients. CONCLUSION Appendiceal tumors are very rare. Depending on the histopathological type of tumor, it is necessary to choose adequate therapy and also provide proper follow up care.
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Kato Y, Okazaki Y, Fukui Y, Kushitani Y, Kametani N, Yoshii M, Ako E, Yamamoto A, Yamada N, Nishimura S, Taenaka N, Mastunaga Y, Fujita S. [A Case of Appendiceal Adenocarcinoma with Vesico-Appendiceal Fistula Treated by Additional Laparoscopic Excision]. Gan To Kagaku Ryoho 2018; 45:1848-1850. [PMID: 30692374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 40-year-old woman was admitted to our hospital with the chief complaint of miction pain. MRI showed fundal wall thickening of the bladder in contact with the appendix. Under cystoscopy, redness of the mucous membrane was found in the posterior wall of the bladder. Therefore, laparo-appendectomy with partial cystectomy was performed. Microscopically, adenocarcinoma cells were observed in the lumen of the appendix, invading the wall of the urinary bladder at the fundus of the appendix. We performed laparo-ileocecal resection for a regional lymphadenectomy. Thus, the patient was diagnosed with adenocarcinoma of the appendix[V, type 3, 16×7 mm, tub2, pT4b(SI, urinary bladder), int, INF b, ly0, v0, pN0, cM0, pStage Ⅱ]. The patient has been receiving adjuvant chemotherapy using capecitabine for 6 months. There was no evidence of recurrence after 9 months of follow-up.
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Tsujio G, Nagahara H, Shibutani M, Fukuoka T, Matsutani S, Kusunoki C, Yamazoe S, Kimura K, Toyokawa T, Amano R, Tanaka H, Muguruma K, Yashiro M, Hirakawa K, Ohira M. [A Case of Appendiceal Cancer Wherein the Abdominal Abscess Ruptured into the Urinary Bladder Owing to Obstructive Appendicitis]. Gan To Kagaku Ryoho 2018; 45:2458-2460. [PMID: 30692497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A 73-year-old woman presented to her doctor because of lower abdominal pain and distension. A neoplastic lesion in the lower abdomen was revealed, and she was referred to our department. Enhanced CT showed wall thickening in the urinary bladder and a 6 cm mass that extended to the appendix. An appendiceal tumor invading the urinary bladder or a urinary bladder tumor invading the appendix was suspected, and we planned surgical treatment. One month later, we repeated enhanced CT scanning on admission. The mass had shrunk, but the thickening of the urinary bladder wall remained, and an enhanced appendiceal tumor was visible. Surgery was performed and we found a 1 cm appendiceal tumor. Intraoperative pathological examination revealed appendiceal cancer. Therefore, we performed ileocecal resection, D2 lymph node dissection, and partial cystectomy. Final histopathological examination revealed appendiceal cancer with pT2N0M0, pStage Ⅰ. Taking into account the patient's clinical course, we diagnosed obstructive appendicitis with an abscess due to appendiceal cancer rupture into the urinary bladder.
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Affiliation(s)
- Gen Tsujio
- Dept. of Surgical Oncology, Osaka City University Graduate School of Medicine
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Van Hooser A, Williams TR, Myers DT. Mucinous appendiceal neoplasms: pathologic classification, clinical implications, imaging spectrum and mimics. Abdom Radiol (NY) 2018; 43:2913-2922. [PMID: 29564494 DOI: 10.1007/s00261-018-1561-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mucinous appendiceal neoplasms are uncommon, but important to recognize with imaging due to malignant potential. Peritoneal seeding and pseudomyxoma peritonei can occur with both frankly malignant as well as low-grade appendiceal neoplasms. Prospective imaging identification of potential appendiceal neoplasm is paramount to clinical/surgical management. When a mucinous appendiceal neoplasm is suspected, a right hemicolectomy with lymph node dissection is the preferred surgical management. Unfortunately, accurate preoperative diagnosis can be challenging due to a wide range of clinical presentations and overlapping imaging appearances of appendiceal neoplasms with benign entities. Using the 2010 World Health Organization (WHO) pathologic classification as a framework, we provide a comprehensive multi-modality pictorial essay detailing the broad array of imaging findings of mucinous appendiceal neoplasms and common imaging mimics.
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Affiliation(s)
| | - Todd R Williams
- Radiology Department, Henry Ford Hospital, Detroit, MI, 48202, USA.
| | - Daniel T Myers
- Radiology Department, Henry Ford Hospital, Detroit, MI, 48202, USA
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Yokode M, Ikeda E, Matsui Y, Iwamura S, Mikami S, Kobayashi H, Imai Y, Kaihara S, Yamashita Y. Fistula Formation Secondary to Mucinous Appendiceal Adenocarcinoma May Be Related to a Favorable Prognosis: A Case Report and Literature Review. Intern Med 2018; 57:2945-2949. [PMID: 29877276 PMCID: PMC6232025 DOI: 10.2169/internalmedicine.0694-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
A 90-year-old man was referred to our hospital because of a positive fecal occult blood test. Colonoscopy revealed a lesion with multiple nodules covered with abundant mucus at the hepatic flexure. Computed tomography showed a dilated appendix attached distally to the hepatic flexure. Right hemicolectomy was performed, and the pathological examination revealed a mucinous appendiceal adenocarcinoma infiltrating the hepatic flexure without pseudomyxoma peritonei. The patient is doing well without recurrence 12 months postoperatively. Extraperitoneal drainage of the malignant ascites caused by the fistula may allow for an early diagnosis, while also making it possible to successfully resect the lesion, thus resulting in a favorable outcome.
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Affiliation(s)
- Masataka Yokode
- Department of Gastroenterology and Hepatology, Kobe City Medical Center West Hospital, Japan
| | - Eiji Ikeda
- Department of Gastroenterology and Hepatology, Kobe City Medical Center West Hospital, Japan
| | - Yugo Matsui
- Department of Surgery, Kobe City Medical Center West Hospital, Japan
| | - Sena Iwamura
- Department of Surgery, Kobe City Medical Center General Hospital, Japan
| | - Sakae Mikami
- Department of Gastroenterology and Hepatology, Kobe City Medical Center West Hospital, Japan
| | | | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, Japan
| | - Satoshi Kaihara
- Department of Surgery, Kobe City Medical Center General Hospital, Japan
| | - Yukimasa Yamashita
- Department of Gastroenterology and Hepatology, Kobe City Medical Center West Hospital, Japan
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Pahlkotter M, Melmer PD, Holmes S, Davis JM, Sciarretta JD. Appendiceal Carcinoids and the Reality of Nonoperative Acute Appendicitis: Analysis of the American College of Surgeons National Surgical Quality Improvement Program Database. Am Surg 2018; 84:e234-e236. [PMID: 30454332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Zegarac M, Nikolic S, Kolarevic D, Kocic M, Djurisic I, Inic Z, Buta M, Cvetkovic A, Markovic I. Goblet cell carcinoid of the appendix. Review of the literature a propos of a rare case of endometrial metastases. J BUON 2018; 23:867-871. [PMID: 30358187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Carcinoid tumors are rare tumors most commonly found in the gastrointestinal tract. They represent the most common malignancies of the appendix. As a distinct entity from both adenocarcinomas and carcinoids, Goblet cell carcinoid (GCC) was initially described in the literature in 1969. The GCC is almost exclusive to the appendix, but rarely can be found in rectum, ileum and colon. More than 50% of the patients at the time of diagnosis already have advancedstage disease. The most common metastatic sites are the peritoneal surfaces of the pelvis and abdominal cavity, and ovaries in women. Surgery is the main form of treatment in patients with GCC. CASE PRESENTATION A 49-year-old woman was treated at the Institute of Oncology and Radiology of Serbia with histopathological findings of GCC. In a 8-year period the patient was treated with initial appendectomy and three more operations because of locoregional disease progression. The last operation was performed in March 2016 because of endometrial metastases. Since then the patient is on regular follow up without disease progression. CONCLUSION GCC is a very rare entity. Multidisciplinary approach is necessary for adequate patient treatment.
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Affiliation(s)
- Milan Zegarac
- Department of Surgical Oncology, Institute of Oncology and Radiology of Serbia, Belgrade, Serbia
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Mao W, Lyu Y, Pu N, Li J, Xin B, Chen W, Jin D, Lou W, Xu X. [Prognostic analysis and clinicopathological features of 20 patients with appendiceal neuroendocrine neoplasms]. Zhonghua Wei Chang Wai Ke Za Zhi 2018; 21:564-568. [PMID: 29774940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate clinicopathological features and prognostic factors of appendiceal neuroendocrine neoplasms(a-NEN). METHODS Clinical data of 20 patients diagnosed with a-NEN at Zhongshan Hospital of Fudan University between January 2000 and December 2016 were retrospectively analyzed. Pathological diagnosis was based on the WHO classification criteria of digestive system tumors (2010 edition). Based on the mitotic count and Ki-67 index, a-NENs were divided into grade 1 neuroendocrine tumor (NET G1), grade 2(G2) NET G2) and grade 3 (neuroendocrine carcinoma, NEC). Some special types of a-NEN (e.g. goblet cell carcinoid) and mixed adenoneuroendocrine neoplasms were classified as mixed adenoneuroendocrine carcinoma (MANEC). Follow-up was conducted by telephone or return visits. Univariate analysis was carried out using the Kaplan-Meier method, and the log-rank test was used to draw survival curves. RESULTS Of 20 patients, 14 were male and 6 were female with median age of 54 years. Seventeen cases presented acute right lower quadrant abdominal pain, 1 chronic right lower quadrant abdominal pain, 1 persistent abdominal discomfort with outburst whole abdominal pain and 1 was found during body check without symptoms. Twenty cases comprised 8 G1 patients, 4 G2 patients, 3 G3 patients, and 5 MANEC patients. When diagnosed, there was 1 patient with liver metastasis, 1 patient with abdominal and pelvic metastases, and 2 patients with postoperative pathological findings of lymph node metastasis. Six patients underwent appendectomy, 12 underwent right hemicolectomy, 1 underwent right hemicolectomy plus small intestine resection, and 1 underwent partial hepatectomy plus right hemicolectomy. The follow-up time was 7-187 months(average, 36 months). The total 1- and 3-year survival rates were 94.7% and 60.2%, respectively. Univariate analysis showed that age >50 years (χ2=7.036, P=0.008), pathology grade as MANEC (χ2=5.297, P=0.021), and metastasis (χ2=6.558, P=0.010) indicated lower 5-year survival rate. CONCLUSIONS Most a-NEN patients have no typical symptoms, and the main complaint at consultation is acute right lower quadrant abdominal pain. Prognosis is poor for patients with age >50 years, MANEC pathology grade and metastasis.
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Affiliation(s)
- Weilin Mao
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Yang Lyu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ning Pu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jian'ang Li
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Baobao Xin
- Department of General Surgery,Jinshan Hospital, Fudan University, Shanghai 201508, China
| | - Wenqi Chen
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Dayong Jin
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wenhui Lou
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xuefeng Xu
- Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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Angulo JC, Lopez JI, Lopez-Arregui E, Flores N. Urinoma Formation Secondary to Ureteral Obstruction by Metastatic Squamous Cell Carcinoma of the Appendix. Case Report. Tumori 2018; 79:447-9. [PMID: 8171749 DOI: 10.1177/030089169307900616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a case of secondary squamous cell carcinoma of the appendix causing spontaneous extravasation of urine and urinoma formation. On the basis of clinical findings, we interpret this rare lesion as metastatic from a cervical carcinoma surgically resected 8 years earlier. Ureteral continuity was restored by retrograde catheterization and the urinoma was drained percutaneously. The final diagnosis was made at laparotomy.
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Affiliation(s)
- J C Angulo
- Department of Urology, Hospital de Basurto Bilbao, Spain
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Abstract
Cancer of the appendix was found in a 69-year-old female patient affected by long-standing ulcerative colitis (UC). On histological examination the cancer was a typical cystadenocarcinoma of the appendix. The appendiceal mucosa not invaded by the neoplastic process was normal. Histological examination of the colorectal mucosa did not show dysplasia or cancer. These findings suggest that appendiceal cancer and UC may be unrelated diseases. A surveillance program for early detection of cancer of the appendix in patients with longstanding UC does not seem mandatory.
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Affiliation(s)
- U Zannoni
- Istituto di Ematologia e Oncologia Medica L. e A. Seragnoli, Bologna, Italy
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Kijima T, Hayashi H, Chijimatsu H, Yoshimoto Y, Morita K, Sakata K, Setoguchi M. [A Case Report of Appendiceal Cancer Complicated Appendicitis Treated with Single-Incision Laparoscopic Ileocecal Resection]. Gan To Kagaku Ryoho 2018; 45:652-654. [PMID: 29650824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We report a case of appendicitis with an abscess that was treated with single-incision laparoscopic ileocecal resection with D2 lymphadenectomy because of intraoperative suspicion of appendiceal cancer. A 73-year-old woman was admitted to the hospital because of right lower abdominal pain. She was diagnosed with appendicitis with an abscess. Although single-incision laparoscopic appendectomy was planned, appendiceal cancer was suspected from intraoperative findings. Therefore, we performed single-incision laparoscopic ileocecal resection with D2 lymphadenectomy. The pathological result was moderately differentiated adenocarcinoma in the appendix. Because of the high risk of fStage II appendiceal cancer, adjuvant chemotherapy was administered. Neither recurrence nor metastasis have been detected 7 months after surgery.
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Affiliation(s)
- Taiki Kijima
- Dept. of Surgery, JCHO Shimonoseki Medical Center
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Oosterwijk AJM, van den Berg JW, van Rossem CC. [A man with abdominal pain, diarrhoea and rectal bleeding]. Ned Tijdschr Geneeskd 2018; 162:D2050. [PMID: 29676706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 49-year-old man came to the emergency room with abdominal pain, vomiting, diarrhoea and rectal bleeding. Both colonoscopy and CT of the abdomen showed cecocolic intussusception caused by an appendiceal mucocele. An ileocecal resection was performed via a laparoscopic approach and microscopy of the tissue showed a low-grade mucinous neoplasm.
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Pallas N, Karamveri C, Kyziridis D, Hristakis C, Kyriakopoulos V, Kalakonas A, Vaikos D, Tentes AAK. Cytoreductive surgery and hyperthermic intraperitenoal chemotherapy (HIPEC) for colorectal and appendiceal carcinomas with peritoneal carcinomatosis. J BUON 2017; 22:1547-1553. [PMID: 29332351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Cytoreductive surgery combined with intraperitoneal chemotherapy has been established as the standard treatment for selected patients with peritoneal malignancy. The purpose of the study was the presentation of the 10- year experience with cytoreductive surgery and intraperitoneal chemotherapy in patients with peritoneal carcinomatosis of colorectal and appendiceal origin. METHODS Clinical and histopathological variables were retrospectively reviewed in a prospectively maintained database. All patients underwent cytoreductive surgery with the purpose of complete or near-complete cytoreduction. The variables were correlated to survival, and recurrences. Morbidity and hospital mortality were recorded. RESULTS From 2006-2016 100 patients underwent cytoreductive surgery for colorectal and appendiceal carcinomas with peritoneal carcinomatosis. The hospital mortality and morbidity were 2% and 43% respectively. Completeness of cytoreduction (CC) 0 surgery was possible in 51% of the patients. The median and 10-year survival were 13 months and 23% respectively. The completeness of cytoreduction, performance status and the lymph node status were identified as prognostic indicators of survival. The recurrence rate was 55%. The completeness of cytoreduction, the lymph node status, and the use of postoperative adjuvant systemic chemotherapy were identified as prognostic variables of recurrence. CONCLUSION Nearly half of the patients with peritoneal carcinomatosis of colorectal and appendiceal origin may undergo complete cytoreduction and nearly half of them may enjoy long-term survival.
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Affiliation(s)
- Nicolaos Pallas
- Department of Surgical Oncology, Peritoneal Surface Malignancy Program, Metropolitan Hospital, New Faliro, Greece
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Khan MK, Talukder RH, Uddin MJ. Mucinous Adenocarcinoma of the Appendix: A Case Report. Mymensingh Med J 2017; 26:448-450. [PMID: 28588185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Primary tumors of the appendix are unusual and most of them are carcinoids. Their main presentation is that of an acute appendicitis or as a palpable mass, mainly in the right lower quadrant. A 40 years old male patient presented in Dhaka Community Medical College Hospital, Dhaka, Bangladesh on 31st October 2013 with mucous adenocarcinoma of the appendix, which primarily presented as heaviness in right lower abdomen and atypical abdominal pain. Diagnosis of the disease was made after right hemicolectomy and histopathological analysis of the specimen. Mucin producing adenocarcinomas of the appendix are a category of rare cancers of the gastrointestinal tract. Although at present they are a well studied pathological entity, the crucial issue of their preoperative diagnosis remains unsolved.
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Affiliation(s)
- M K Khan
- Professor Md Kamruzzaman Khan, Professor, Department of Surgery, Dhaka Community Medical College and Hospital, Bangladesh
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Agrusa A, Romano G, Galia M, Cucinella G, Sorce V, Di Buono G, Agnello F, Amato G, Gulotta G. Appendiceal mucinous neoplasms: an uncertain nosological entity. Report of a case. G Chir 2017; 37:86-9. [PMID: 27381696 DOI: 10.11138/gchir/2016.37.2.086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Appendiceal mucocele is a relatively rare condition characterized by progressive dilation of the appendix caused by intraluminal accumulation of mucoid substance. Its incidence is 0.07 - 0,63% of all appendectomies performed. CASE REPORT We report the case of a 70-year-old man who came to our observation with gravative pain in right lower abdominal region. A computed tomography abdominal scan revealed a cystic/tubular structure like an appendicular mass with wall enhancement but without calcifications suggestive of a mucocele. Into peritoneal cavity we found profuse mucinous material with a 1,5 cm size parietal nodule. We also identified a free perforation of the cecum with consensual spillage of gelatinous material mimicking a pseudomyxoma peritonei. We decided to perform a right hemicolectomy with excision of peritoneal lesion. DISCUSSION The controversy in the pathologic terminology can give rise to a clinical dilemma in terms of the management and follow-up plans. For mucosal hyperplasia and cystadenoma simple appendectomy is curative. Only in case of large base of implantation it may be necessary the resection of the ileum and caecum or right hemicolectomy. In case of mucinous cystoadenocarcinoma authors perform a right hemicolectomy. CONCLUSION Appendiceal mucinous neoplasms are different pathological entities. The correct surgical management depends on size and location of lesion. A preoperative diagnosis is obviously needed in order to perform the correct treatment. CT abdominal scan is the better diagnostic tool, but different authors show their inability to reach a preoperative diagnosis in the larger majority of cases.
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