Progression to pseudomyxoma peritonei in patients with low grade appendiceal mucinous neoplasms discovered at time of appendectomy

Reiter, Shelby; Rog, Colin J.; Alassas, Mohammed; Ong, Evan

doi:10.1016/j.amjsurg.2021.12.003

Cited by 13 publications

(5 citation statements)

References 21 publications

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“…This conclusion is in accordance with a study by Reiter et al. [ 27 ], which showed that 20 % of their patients who were followed up after LAMN diagnosis on surgical specimens progressed to PMP in an average of 12.4 months. In our case series, only one patient progressed to PMP, while his yearly MRI (performed in an expert center) showed the absence of suspicious lesions until his third postoperative year.…”

Section: Discussionsupporting

confidence: 92%

Active surveillance for low-grade appendiceal mucinous neoplasm (LAMN)

Mouawad,

Bardier,

Wagner

et al. 2023

Pleura and Peritoneum

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Objectives Due to the scarcity of low-grade appendiceal mucinous neoplasm (LAMN), there is an absence of systematized guidelines concerning its management, especially after incidental finding on an appendiceal specimen. In this study, we evaluate the active surveillance (AS) strategy adopted for a series of patients diagnosed with LAMN on resection specimens who were considered to have a low risk of pseudomyxoma progression. Methods Thirty patients were included between April 2014 and July 2021, with a female majority and a median follow-up period of 3.1 years. The inclusion criteria were as follows: LAMN diagnosis on appendiceal specimens, confirmed in an expert center, limited extra-appendiceal mucin resected and localized around the appendix, normal biology (CEA, CA199, CA125) and normal abdominopelvic MRI. AS included physical exam (trocar scar), biology and MRI, 6 months postoperatively, then yearly for 10 years. Results As an initial surgery, 77 % had an appendectomy as their initial intervention, 17 % had a cecectomy, and 6 % had a right colectomy. After follow-up, 87 % of patients showed no sign of disease progression by MRI, while 13 % progressed to PMP. MRI performed in the first postoperative year predicted the disease prognosis in 97 % of patients. Conclusions The AS strategy, based on MRI, is a valid option after incidental LAMN diagnosis.

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Section: Discussionsupporting

confidence: 92%

Active surveillance for low-grade appendiceal mucinous neoplasm (LAMN)

Mouawad,

Bardier,

Wagner

et al. 2023

Pleura and Peritoneum

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“…Indeed, the term mucinous adenocarcinomas should only be used if accompanied by infiltrative invasion, and should be classified without histologically destructive features: low-grade epithelial dysplasia as LAMN, and high-grade epithelial dysplasia as HAMN. Appendiceal mucinous lesions have poor prognosis if they become cancerous or rupture and progress to PMP [ 4 , 15 – 20 ]. In a prior report, Tomida et al reviewed 10 cases of mucinous lesions derived from the residual appendix that developed 10–40 years after appendectomy [ 11 ]; however, changes in tumors over time were not described in these reports.…”

Section: Discussionmentioning

confidence: 99%

Appendiceal neoplasms derived from appendiceal tip remnants following appendectomy: a report of two cases

Fujii,

Hida,

Sugimoto

et al. 2024

surg case rep

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Background Neoplasms derived from remnant appendix are rarely described, with most cases arising from the appendiceal “stump”. Here, we present two surgical cases of appendiceal neoplasms derived from appendiceal “tip” remnants. Case presentation The first patient was a 71-year-old man who had undergone laparoscopic appendectomy for acute appendicitis 12 years prior. During appendectomy, the appendiceal root was ligated, but the appendix was not completely removed due to severe inflammation. At the most recent presentation, computed tomography (CT) was performed to examine choledocholithiasis, which incidentally revealed a cystic lesion of approximately 90 mm adjacent to the cecum. A retrospective review revealed that the cystic lesion had increased in size over time, and laparoscopic ileocecal resection was performed. Pathology revealed no continuity from the appendiceal orifice to the cyst, and a diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) was made from the appendiceal tip remnant. The patient was discharged without complications. The second patient was a 65-year-old man who had undergone surgery for peritonitis due to severe appendicitis 21 years prior. During this operation, the appendix could not be clearly identified due to severe inflammation; consequently, cecal resection was performed. He was referred to our department with a chief complaint of general fatigue and loss of appetite and a cystic lesion of approximately 85 mm close to the cecum that had increased over time. CT showed irregular wall thickening, and malignancy could not be ruled out; therefore, laparoscopic ileocecal resection with D3 lymph node dissection was performed. The pathological diagnosis revealed mucinous adenocarcinoma (TXN0M0) arising from the remnant appendiceal tip. The patient is undergoing follow-up without postoperative adjuvant chemotherapy, with no evidence of pseudomyxoma peritonei or cancer recurrence for 32 months postoperatively. Conclusions If appendicitis-associated inflammation is sufficiently severe that accurate identification of the appendix is difficult, it may remain on the apical side of the appendix, even if the root of the appendix is ligated and removed. If the appendectomy is terminated incompletely, it is necessary to check for the presence of a residual appendix postoperatively and provide appropriate follow-up.

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“…Additional lymph node dissection is considered unnecessary for accidentally discovered LAMN after appendectomy. As a case of consideration for additional surgery, a positive appendectomy stump may be considered, but there are also reports that this does not pose a risk of occurrence of PMP [ 9 , 10 ], and it is necessary to reconsider. According to a previous study, as it is difficult to predict which patients will progress to PMP, cross-sectional imaging monitoring is recommended for all patients [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Low-Grade Appendiceal Mucinous Neoplasm That Led to Surgery After 12 Years of No Treatment

Makino¹,

Okumura²,

Yamashita³

et al. 2023

Cureus

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Low-grade appendiceal mucinous neoplasm (LAMN) is a relatively rare, non-invasive appendiceal tumor. We experienced a case of LAMN that led to surgery after 12 years of no treatment. Until now, LAMN has been reported to progress more slowly than other tumors, but there have been no reports of long-term follow-up of appendiceal tumors without treatment. Although the tumor had grown over the course of 12 years, there was no mixing or migration of other histological types, and it did not lead to pseudomyxoma peritonei. As this course is considered to be relatively rare, we report it along with a literature review.

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Progression to pseudomyxoma peritonei in patients with low grade appendiceal mucinous neoplasms discovered at time of appendectomy

Cited by 13 publications

References 21 publications

Active surveillance for low-grade appendiceal mucinous neoplasm (LAMN)

Active surveillance for low-grade appendiceal mucinous neoplasm (LAMN)

Appendiceal neoplasms derived from appendiceal tip remnants following appendectomy: a report of two cases

A Case of Low-Grade Appendiceal Mucinous Neoplasm That Led to Surgery After 12 Years of No Treatment

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