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PubMed2002

Epithelial neoplasms of the appendix and colorectum: an analysis of cell proliferation, apoptosis, and expression of p53, CD44, bcl-2.

CONTEXT: Carcinomas of the appendix are usually well-differentiated mucinous adenocarcinomas that tend to produce pseudomyxoma peritonei and do not show metastatic spread until late in the disease process. In contrast, adenocarcinomas of the colon and rectum rarely result in pseudomyxoma peritonei and frequently metastasize, even if mucinous and well differentiated. These differences in behavior may be reflected by differences at the molecular level. OBJECTIVES: To examine adenocarcinomas and their precursor lesions (adenomas) of the appendix and colorectum and to determine whether differences exist in the numbers of proliferating and apoptotic cells or in expression of p53, bcl-2, and the standard form of CD44 (CD44s). DESIGN: Retrospective analysis of surgical specimens. SETTING: Multicenter study. PATIENTS: Individuals treated surgically for tumors of the appendix or colorectum. INTERVENTIONS: Sections were cut from formalin-fixed surgical specimens and immunohistochemical tests were performed for Ki-67 (as a marker of proliferating cells), M30 (as a marker of apoptotic cells), p53, CD44s, and bcl-2. MAIN OUTCOME MEASURES: Expression of Ki-67, M30, p53, CD44s, and bcl-2 in tumor cells. RESULTS: The appendiceal adenomas showed significantly lower Ki-67 counts, p53 expression, and bcl-2 expression. When compared with adenocarcinomas of the colorectum in general (mucinous and nonmucinous), the appendiceal adenocarcinomas showed significantly lower Ki-67 counts, M30 counts, and CD44s expression. However, when the analysis was confined to well-differentiated mucinous adenocarcinomas, only the M30 count was significantly different. CONCLUSIONS: The lower proliferative and apoptotic activity of appendiceal carcinomas and the lower CD44s expression are in keeping with their more indolent behavior compared with adenocarcinomas of the colorectum. However, when only the subset of well-differentiated mucinous adenocarcinomas was compared, only the apoptotic activity was different, suggesting that the other differences were related to the morphologic structure of the lesions.

Adenocarcinoma↗

PubMed2005

Frozen section of the gastrointestinal tract, appendix, and peritoneum.

CONTEXT: Intraoperative consultation is frequently requested by surgeons operating on the gastrointestinal tract, appendix, and peritoneum. In this setting, the pathologist's diagnosis plays a central role in determining whether a resection is needed, and if so, how much to resect and whether it was adequate. There is no room for errors in the frozen section laboratory, because a small mistake can have serious consequences. To my knowledge, no recent books or publications in the literature have dealt with this important topic. OBJECTIVE: To review the intraoperative consultation of the gastrointestinal tract, appendix, and peritoneum. DATA SOURCES: The MEDLINE database was queried for keywords, including gastrointestinal, esophagus, stomach, esophageal, gastric, small intestine, and all other names of the gastrointestinal tract, peritoneum, and appendix in combination with frozen section. All suitable articles were retrieved and reviewed. This literature search and my personal experience formed the basis of this review. CONCLUSIONS: The role, value, and limitations of frozen section and gross consultation are different for different areas of the gastrointestinal tract, even for the same types of lesions. Close interaction with the surgeon and knowing what is intended from the frozen section, what will be done following a certain diagnosis, and what is the minimal information needed from the pathologist at the time of frozen section are essential for proper patient management.

Appendicitis↗

PubMed1998

[A case of fibrous histiocytoma of the appendix with twisted stalk].

A 74-year-old man consulted this hospital with the chief complaint of lower right abdominal pain on February 13, 1998. He was hospitalized, subjected to abdominalechography and CT, and diagnosed as having subileus caused by an intraperitoneal tumor. Surgery was performed on February 25, 1998. When the abdomen was incised, a chicken egg-sized tumor at the end of theappendix were found. In addition, the stalk of the appendix was twisted. Appendectomy was therefore performed. Upon histopathological examination, it was found that the submucosal tumor originated at the end of the appendix, and proliferation of spindle-shaped fibroblast-like cells and histocytic oval cells was observed in the tumor. Since various histiocyte markers were positive upon immunohistological examination, the tumor was considered to be of histiocytic origin. However, the tumordid not exhibit polymorphism, heteromorphism, or mitotic figures which would confirm a diagnosis of malignant fibrous histiocytoma. It was thus diagnosed as a fibrous histiocytic tumor on the borderline between malignant and benign. We report the present case because the occurrence of a primary fibrous histiocytoma in an appendix of which the stalk is twisted is very rare.

Aged↗

PubMed2000

[Adenocarcinoma of the appendix--case report].

The authors describe a case with a rare diagnosis of adenocarcinoma of the appendix in an adult female patient. The patient was indicated for surgical revision on account of acute appendicitis with a peroperative finding suspect of malignity of the vermiform appendix. A radical resection of the ileocoecal area was performed along with part of the ascendant colon and appropriate mesocolon as a primary operation. According to the postoperative histological evaluation of the resected portion the diagnosis of adenocarcinoma of the appendix was confirmed.

Adenocarcinoma↗

PubMed2000

Pathology of the appendix.

An audit of 3374 appendectomy specimens in 2578 Saudi and 796 non-Saudi nationals revealed a diagnosis rate of 74.7% of inflamed appendix, a normal appendix range of 7.8% to 22.5% with the higher rate of normal appendix found among females. The finding of high incidence of schistosomal appendicitis among Egyptian males is not surprising given the high incidence of schistosomiasis among Egyptians in general. The alternate diagnoses, which include such conditions as neoplasm, mucocele, other inflammatory conditions such as periappendicitis, and parasitic infestations, are not different from findings in the reported literature.

Appendectomy↗

PubMed2001

Mucinous cystadenoma of the appendix--an unusual cause of intestinal obstruction.

INTRODUCTION: Report of a rare presentation of mucinous cystadenoma of the vermiform appendix. CLINICAL PICTURE: A lady who presented with intestinal obstruction and peritonitis was found to have gangrenous small bowel caused by strangulation by a tumour of the appendix. TREATMENT: Right hemicolectomy. OUTCOME: The histology of the appendicular tumour was mucinous cystadenoma. The patient recovered well. CONCLUSION: Mucinous cystadenoma of the appendix can present in many ways and it is important to recognise the pathology at operation.

Aged↗

PubMed2004

Simultaneous serous cystadenoma of the pancreas and mucinous cystadenoma of the appendix.

CONTEXT: Serous cystadenoma of the pancreas and mucinous tumors of the vermiform appendix are rare. To our knowledge, the simultaneous occurrence of these two tumors has not been reported. CASE REPORT: Here, we report an adult female who presented with signs and symptoms of appendicitis. A preoperative CT scan confirmed the findings of appendicitis and also showed an incidental large mass in the head of the pancreas. The patient underwent uneventful appendectomy. Her pathology revealed an acutely inflamed appendix with a benign mucinous cystadenoma at the tip. Several months after her recovery, a Whipple procedure was performed. Pathologic examination showed a 5x5 cm serous cystadenoma of the head of the pancreas without evidence of malignancy. Two years later, the patient is alive and well without evidence of tumor recurrence. CONCLUSIONS: Cystadenomas of the pancreas and appendix are unusual and their simultaneous occurrence is a rare event.

Appendiceal Neoplasms↗

PubMed2004

Mucinous tumors of the appendix presenting as primary tumors of the ovary. Report of two cases.

Primary tumors of the appendix are rare and most of them are unrecognized preoperatively, presenting as appendicits, pelvic masses or with no typical abdominal pain. Two cases of mucinous tumors of the appendix presenting as primary ovarian tumors are described. It is important for the gynecologist-oncologist to include mucinous tumors of the appendix into the differential diagnosis of any case of mucinous ovarian tumor and peritoneal pseudomyxoma, especially when these tumors are associated with extraovarian disease.

Adenocarcinoma, Mucinous↗

PubMedDate not supplied

Carcinoid tumors of the appendix. Prognostic factors and evaluation of indications for right hemicolectomy.

BACKGROUND/AIMS: Carcinoid tumors of the appendix are thought to be the most common type of appendiceal neoplasms. Although the vast majority of appendiceal carcinoids behave in a benign fashion, they are considered malignant because they all have the potential for invasion, metastasis and production of physiologically active substances. The aim of our study is to evaluate the gravity of the prognostic factors and the indications for extended surgical treatment. METHODOLOGY: Twenty-four patients, six male (aged from 18 to 59 years) and eighteen female (aged from 16 to 27 years) are included in our study. All these patients were managed and followed-up in our section during the last 17 years (follow-up range 10-17 years). Following confirmation of the diagnosis, secretion of 5-HLAA (5-Hydroxy-Inndole-Acetic Acid) was measured after a 24-hour collection of urine. Moreover, ultrasound (US) examination of the liver and computerized tomography (CT) scanning of the upper abdomen were performed after the operation in all patients. Also, patients with tumor size more than 1cm underwent a Somatostatin Receptor Scintigraphy (Octreoscan). The follow-up data of all patients included measurement of 5-HLAA and US examination every six months. RESULTS: The most common site for the tumors was the tip of the appendix (18/22). In the rest of the cases, the neoplasms were located in the base (4/22) and in the body (2/22), while in one patient the mesoappendix was invaded. In sixteen patients the tumor size was less than 1cm, in seven patients the tumor diameter was measured to be 1 to 2cm and in one patient the tumor was 3cm. Most of our patients (16/22) underwent only an appendicectomy, while in the rest of them (in the patients with tumor size between 1-2cm and in the patient with invasion of mesoappendix) a right hemicolectomy was performed. No patient was found to have metastatic disease during the operation, while the patient with invasion of the mesoappendix developed metastases in the lung, two years after the operation. CONCLUSIONS: Carcinoid tumors of the appendix, in most cases, are found incidentally during appendicectomies, especially in young females and usually are less than 1cm in size, which is probably the reason of the absence of metastases in all cases. Histological examination and size of the tumor are important factors that contribute to the selection of the surgical treatment and both must be estimated by the surgeons to make the final choice.

Adolescent↗

PubMed1991

Calcified mucocele of the appendix presenting as ureteral obstruction.

Mucocele of the appendix, a rare lesion, occurs in 0.3% of patients undergoing appendectomy. Only 46 cases of calcified mucocele have been reported. Complications reported include appendiceal intussusception, rupture resulting in acute abdomen, and infection. We report the case of a 74-year-old man with a calcified mucocele of the appendix that was discovered in the evaluation of a ureteral obstruction. During exploratory surgery, the patient was found to have a 6 x 5 cm appendiceal tumor and underwent a right ileocolectomy. Pathologic examination showed calcified mucous cystadenoma of the appendix. Calcification of a mucocele is believed to denote chronicity. Our case is the first report of ureteral obstruction secondary to calcified mucocele and the second calcified mucocele to be seen on computerized tomography. Calcified mucocele should be included in the differential diagnosis of any calcified tumor in the right lower quadrant.

Aged↗

PubMed1990

[An inflammatory pseudotumor of the appendix].

A 41-year-old male, complaining of an abdominal pain and suspected of having acute appendicitis, underwent examination on hospitalization. Ultrasonography revealed a tumorous lesion of the appendix. Thus, a laparotomy was performed and mass lesions were found in the mid and distal parts of the appendix. A subsequent histological examination revealed an inflammatory pseudotumor consisting of remarkable eosinophilic cell and fibroblastic infiltrations, similar to that seen in a inflammatory fibroid polyp (Helwig). Although such lesions, polypoid in appearance, have been found to occur in the stomach and intestines, to find them in the appendix is extremely rare. In this instance, as the growth of this mass of lesions was more predominant in the wall rather than in intraluminal area, it was decided that pseudotumor was the appropriate term to describe this case.

Adult↗

PubMed1988

Goblet cell carcinoids of the appendix.

A review of goblet cell carcinoid of the appendix was undertaken. This interesting tumor appears to lie somewhere between an ordinary carcinoid and a well differentiated adenocarcinoma of the appendix in regard to its biologic behavior. The histologic features of the goblet cell carcinoid of the appendix are distinctive enough to facilitate a diagnosis, although the histogenesis remains controversial and unsettled. The prognosis is generally good in a patient treated by simple appendectomy, the treatment of choice in the majority of patients.

Acute Disease↗

PubMedDate not supplied

Endometriosis of the appendix.

Endometriosis has been encountered in different sites of the gastrointestinal tract. Involvement of the vermiform appendix, however, is rather unusual. Two cases of appendiceal endometriosis are reported in the present study: one patient had symptoms simulating acute appendicitis; in another patient it was an incidental finding during pelvic surgery. There are no clinical signs and findings pathognomonic of endometriosis of the appendix, but the condition may present as appendicitis. At surgery, the diagnosis can only be suspected when it is associated with obvious genital endometriosis. Correct diagnosis is established by microscopic examination of the lesion. Symptomatic endometriosis of the appendix will be cured by appendectomy.

Adenocarcinoma↗

PubMedDate not supplied

[Carcinoid tumor of the appendix in children].

Carcinoid tumor of the appendix has been known since 1808, and currently we know that it may appear all along the intestinal tract, biliary tree, ovaries, bronchi, lungs and pancreas. It is usually uncommon during infancy, representing 1.8% of all the tumors of the intestinal tract, approximately 70% of the appendiceal tumors and 0.16 to 0.7% of all operated appendixes. It is more frequent in females. With no typical clinical picture, it is usually an incidental finding, as well as a cause of inflammatory processes of the appendix. When the diameter is less than 1.0 cm, the treatment of choice is appendectomy; and in tumors of larger size, surgery is more extensive. Two cases are reported.

Appendectomy↗

PubMed1983

Adenocarcinoma of the vermiform appendix: retrospective study and literature review.

Adenocarcinoma of the vermiform appendix is a rare clinical entity, fewer than 200 cases having been reported. The authors carried out a retrospective review over a 25-year period and found five patients admitted to the Vancouver General Hospital with primary appendiceal adenocarcinoma. Four other patients, initially reported as having appendiceal adenocarcinoma, were found after critical microscopic review to have had either benign disease or mucinous carcinoid. Primary epithelial neoplasms of the appendix demonstrate a wide variety of histologic types and because of the different clinical behaviour, an accurate diagnosis must be made. For the benign tumours, appendectomy alone will suffice but for adenocarcinoma of the appendix, right hemicolectomy is recommended.

Adenocarcinoma↗

PubMed1984

The appendix stump: should it be invaginated?

In a prospective trial of 103 patients undergoing appendicectomy, one group of patients had the appendix stump treated by ligation alone and the other group underwent ligation and invagination. The two groups of patients were similar with respect to age, sex, incision and degree of inflammation of the appendix. Perforated appendices were excluded and in neither group were drains used or antibiotics given. No significant difference between the two methods of treatment of the appendix stump was noted, either with respect to wound infection or postoperative stay in hospital.

Adolescent↗

PubMed1984

[Carcinoid tumors of the appendix and small intestine as unusual secondary findings during gynecologic operations in and outside of pregnancy].

Report is given on 9 patients suffering from a carcinoid observed at the Department of Gynecology of the Medical Academy of Erfurt from 1963 till 1982: one carcinoid of the small intestine with metastases and abdominal syndrome and eight cases with carcinoid of appendix. Two of these during pregnancy and the carcinoid of small intestine show the difficulties of the differential diagnosis and the possible combinations in face of gynecologic diseases. In 2 cases of carcinoid of the appendix during pregnancy the children didn't show any malformations. On the strength of supervision of the course we think in accordance to the international literature the sole appendectomy will be sufficient. Nevertheless we make demands for a careful investigation and palpation of the appendix in all gynecologic operations and if necessary the appendectomy.

Adolescent↗

PubMed1980

[Isolated Crohn's disease of the appendix].

A case of isolated Crohn's disease involving the appendix and, indeed, presenting as acute appendicitis is described and related to 12 analogous cases reported in the literature. Crohn's disease of the appendix is exclusively diagnosed by histopathological evidence. According to published data isolated Crohn's disease of the appendix would not seem to predispose towards the formation of fistulae after appendectomy. Subsequent evidence of Crohn's disease in other sites is similar in frequency to cases with primary Crohn's disease in other parts of the intestinal tract.

Adult↗