Abstract
BACKGROUND: Appendiceal tumors are rare and often unexpectedly discovered in an acute situation, in which decision-making is difficult. To help define the most appropriate management, a retrospective analysis was undertaken to describe the clinicopathologic behavior of appendiceal tumors, and the literature was reviewed of the management of the different types of appendiceal tumors. METHOD: From a single center, a histopathologic database of 7,970 appendectomies, all appendiceal tumors, were identified and case notes reviewed. Analysis of clinical presentation, histopathology, operation, and outcome is presented. RESULTS: During a 16-year period (7,970 appendectomies), 74 patients (0.9 percent) with appendiceal tumors were identified: 42 carcinoid, 12 benign, and 20 malignant. Acute appendicitis was the most common presentation (49 percent), and 9.5 percent were incidental findings. Primary malignant tumors of the appendix were found in 0.1 percent of all appendectomies. Secondary malignant disease was identified in the appendix of 11 patients, most commonly (55 percent) from patients with primary colorectal disease. There was a high incidence of synchronous and metachronous colorectal cancer in all appendiceal tumors: carcinoids, 10 percent; benign tumors, 33 percent; secondary malignancies, 55 percent; primary malignancies, 89 percent. CONCLUSION: Appendiceal tumors are uncommon and most often present as appendicitis. Most are benign and can be managed by appendectomy, except adenocarcinomas and carcinoids larger than 2 cm, which are most appropriately managed by right hemicolectomy. A suggested management algorithm is provided. Controversy exists over the management of carcinoids 1 to 2 cm in size and adenocarcinoids. All types of appendiceal tumors have a high incidence of synchronous and metachronous colorectal cancer.
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References
Deans GT, Spence RA. Neoplastic lesions of the appendix. Br J Surg 1995;82:299–306.
Lenriot JP, Huguier M. Adenocarcinoma of the appendix. Am J Surg 1988;155:470–5.
Moertel CG, Weiland LH, Nargorney DM, Dockerty MB. Carcinoid tumor of the appendix; treatment and prognosis. N Engl J Med 1987;317:1699–701.
Moertel CG, Dockerty MB, Judd ES. Carcinoid tumors of the vermiform appendix. Cancer 1968;21:270–7.
Roggo A, Wood WC, Ottinger LW. Carcinoid tumors of the appendix. Ann Surg 1993;213:385–90.
Thirlby RC, Kasper CS, Jones RC. Metastatic carcinoid tumour of the appendix: a case report and review of the literature. Dis Colon Rectum 1984;27:42–6.
Warkel RL, Cooper PH, Helwig EB. Adenocarcinoid, a mucin-producing carcinoid tumor of the appendix: a study of 39 cases. Cancer 1978;42:2781–93.
Pettigrew RA. Carcinoma in villous appendiceal adenomata. Aust N Z J Surg 1980;50:627–9.
Higa E, Rosai J, Pizzimbono CA, Wise L. Mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma of the appendix: a re-evaluation of appendiceal “mucocele.” Cancer 1973;32:1525–41.
Wolff M, Ahmed N. Epithelial neoplasms of the vermiform appendix (exclusive of carcinoid): cystadenomas, papillary adenomas, and adenomatous polyps of the appendix. Cancer 1976;37(Part 2):2511–22.
Parkes SE, Muir KR, al Sheyyab M,et al. Carcinoid tumours of the appendix in children 1957–1986: incidence, treatment and outcome. Br J Surg 1993;80:502–4.
Moertel CL, Weiland LH, Telander RL. Carcinoid tumor of the appendix in the first two decades of life. J Pediatr Surg 1990;25:1073–5.
Bak M, Asschenfeldt P. Adenocarcinoid of the vermiform appendix: a clinicopathological study of 20 cases. Dis Colon Rectum 1988;32:605–12.
Subbuswamy SG, Gibbs NM, Ross CF, Morson BC. Goblet cell carcinoid of the appendix. Cancer 1974;34:338–44.
Isaacson P. Crypt cell carcinoma of the appendix (socalled adenocarcinoid tumor). Am J Surg Pathol 1981;5:213–24.
Park K, Blessing K, Keerr K, Chetty U, Gilmour H. Goblet cell carcinoid of the appendix. Cut 1990;31:322–4.
Skaane P, Strom EH, Corneliussen B. Adenocarcinoid (mucinous carcinoid) of the vermiform appendix. Tidsskr Nor Laegeforen 1993;113:2259–60.
Edmonds P, Merino MJ, LiVolsi VA, Duray PH. Mucinous carcinoid of the appendix. Gastroenterology 1984;86:302–9.
Nitecki SS, Wolff BG, Schlinkert R, Sarr MG. The natural history of surgically treated primary adenocarcinoma of the appendix. Ann Surg 1994;219:51–7.
Reichle FA, Brigham MP, Fleegler FJ, Rosemond GP. Adenocarcinoma of the vermiform appendix. Am Surg 1971;37:344–50.
Rutledge RH, Alexander JW. Primary appendiceal malignancies: rare but important. Surgery 1992;111:244–50.
Andesson A, Bergdahl L, Boquist L. Primary carcinoma of the appendix. Ann Surg 1976;183:53–7.
Sonnendecker EW, Margolius KA, Sonnendecker HE. Involvement of the appendix in ovarian epithelial cancer—an update. S Afr Med J 1989;76:667–8.
Dieter RA Jr. Carcinoma metastatic to the vermiform appendix: report of three cases. Dis Colon Rectum 1970;13:336–40.
Maddox PR. Acute appendicitis secondary to metastatic carcinoma of the breast. Br J Clin Pract 1990;44:376–8.
Hard M. Metastasis from adenocarcinoma of the lung producing acute appendicitis. South Med J 1985;85:319–21.
Thomas R, Barnhill D, Worsham F, Hoskins W. Krukenberg tumour of the ovary from an occult appendiceal primary: case report and literature review. Obstet Gynecol 1985;65:95S-8S.
Qizilbash AH. Hyperplastic (metasplastic) polyps of the appendix: report of 19 cases. Arch Pathol 1974;97:385–8.
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Read at the meeting of the Royal Australasian College of Surgeons, Brisbane, Australia, May 11 to 15, 1997.
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Connor, S.J., Hanna, G.B. & Frizelle, F.A. Appendiceal tumors. Dis Colon Rectum 41, 75–80 (1998). https://doi.org/10.1007/BF02236899
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DOI: https://doi.org/10.1007/BF02236899