Analysis of Appendiceal Neoplasms on 3544 Appendectomy Specimens for Acute Appendicitis: Retrospective Cohort Study of a Single Institution

Abstract

BackgroundAppendiceal neoplasms are rare and generally determined in appendectomy specimens for acute appendicitis. Depending on a tumor’s histopathology and size, appendectomy or right hemicolectomy are the surgical treatment options. Adenocarcinomas, mucinous neoplasms, goblet cell carcinoids and neuroendocrine tumors are the types of the primary appendiceal neoplasm histopathology. In this study, we aimed to determine the incidence of appendiceal neoplasms in an acute appendicitis cohort. Also, histopathological distributions, demographic data, preoperative radiological diagnosis, and intraoperative findings were revealed for analysis, retrospectively.Material/MethodsBetween October 2011 and September 2017, 3554 appendectomies were performed for acute appendicitis in Bezmialem University Hospital, Istanbul Turkey. The medical records of these consecutive 3554 patients were evaluated retrospectively. After the histopathological analysis of the appendectomy specimens, a total of 28 patients were detected as having appendiceal neoplasm including appendiceal adenocarcinoma, low grade mucinous neoplasia, and appendiceal neuroendocrine tumors.ResultsAppendiceal neoplasms were determined in 28 out of 3554 acute appendicitis patients with an incidence of 0.78%. According to the histopathological types, 3 of the cases (10.7%) were appendiceal adenocarcinoma, 8 of the cases (28.5%) were low grade mucinous neoplasia, and 17 of the cases (60.8%) were neuroendocrine tumors. The overall incidence of the appendiceal neuroendocrine tumors was 0.48%.ConclusionsThe information obtained from our study suggests that pathological examination of the specimen may not be necessary if there is no doubt according to preoperative radiological diagnosis and/or intraoperative findings of the surgeon.

An Unusual Case of Acute Appendicitis due to Metastatic Prostatic Adenocarcinoma

“…Malignancy is an important, albeit rare, cause of acute appendicitis in older adults [ 10 , 11 ]. Studies have found neoplasms in up to 2.5% appendectomy specimens [ 12 , 13 ], with only about 0.1% being metastatic [ 14 , 15 ]. Neuroendocrine tumors are the most common primary appendiceal neoplasms associated with acute appendicitis [ 11 , 12 , 14 ].…”

“…Studies have found neoplasms in up to 2.5% appendectomy specimens [ 12 , 13 ], with only about 0.1% being metastatic [ 14 , 15 ]. Neuroendocrine tumors are the most common primary appendiceal neoplasms associated with acute appendicitis [ 11 , 12 , 14 ]. Other primary appendiceal neoplasms identified in the causation of acute appendicitis include adenomas (sessile serrated adenoma, tubular adenoma, and villous adenoma), adenocarcinoma, and low-grade and high-grade appendiceal mucinous neoplasms [ 11 , 12 , 15 ].…”

National trends in the presentation of surgically resected appendiceal adenocarcinoma over a decade

“…Among appendiceal neoplasms, appendiceal adenocarcinoma portends a worse overall prognosis and represents a clinical challenge, particularly in the setting of perforated appendicitis. Patients are often diagnosed with appendiceal adenocarcinoma due to nonspecific tumor‐related symptoms, including abdominal bloating and appendicitis 3‐9 …”

“…While the current reported incidence of appendiceal adenocarcinoma in all appendectomy pathology specimens is low, ranging 0.08%–2%, the incidence of appendiceal adenocarcinoma has increased over the previous decade by 54% across all histologic subtypes, stages, and ages 3‐9 . Prior studies have shown that, among those presenting with appendicitis, appendiceal adenocarcinoma is more common among older patients, specifically those greater than 50 years of age, patients with greater comorbidities based on American Society of Anesthesiologists (ASA) classification, patients who have absence of traditional symptomatology (i.e., migratory right lower quadrant abdominal pain), and patients who present with phlegmonous findings on imaging; the sensitivity and specificity of these prognostic factors though has not been consistently reported 7‐12 …”

Neuroendocrine tumor of the appendix—a case report and review of the literature

“…Current guidelines suggest that simple appendectomy is adequate treatment for ANETs if they are <1 cm, and right hemicolectomy is recommended for those bigger than 2 cm. However, ideal treatment of 1–2 cm tumors is still controversial [5, 6].…”