Download MBBS Surgery Presentations 5 Appendix Tumors Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Surgery 5 Appendix Tumors PPT-Powerpoint Presentations and lecture notes


Appendicular Tumors

Neoplasms of the appendix are not often

suspected before surgery and are found either

intraoperatively or on pathologic examination




Historical background

Appendiceal tumours can be broadly classified

as:
? Epithelial

? Nonepithelial tumors


Epithelial tumors

? Adenoma: mild-to-moderate atypia, mitosis, no

stromal invasion, perforation with mucin

? Mucinous tumor of uncertain potential: adenoma

with positive margin, mucin present within the wall

? Mucinous tumor?low malignant potential: adenoma

with neoplastic cells in peritoneum

? Adenocarcinoma: invasive mucinous tumor

Low grade appendiceal Mucinous Neoplasm


Carcinoid tumor

Nonepithelial tumors

Endocrine tumors
? Classic appendiceal endocrine tumors
? Goblet cell carcinomas
Lymphoma
Sarcoma
Carcinoids

MC located at the tip of the appendix
Two types:
? insular type
? tubular
Management
? Tumors 1 cm: appendectomy.
? 1 cm to 2 cm (without involvement of the base of appendix):

appendectomy

Right hemicolectomy depends on grade, mitotic activity,

invasion of mesoappendix, or lymphovascular invasion.

? 2 cm are at risk for lymph node or distant metastasis and a

right hemicolectomy is indicated.

Epithelial tumors

Presentation:
? Incidental finding in the appendectomy specimen

? Appendicitis

? Pelvic mass

? Peritoneal carcinomatosis with or without ascites.
Diagnosis

Biochemistry
Chromogranin A can be used as tumour marker in appendiceal

endocrine tumours and is useful to differentiate the tumour from goblet

cel carcinoids. It is indicated in metastatic disease as a biochemical

parameter for follow-up

CT scan

Histopathology

Staging

Grade of epithelium beyond appendiceal mucosa

Low-grade mucinous carcinoma

High-grade mucinous carcinoma

Tumor stage

T1: Tumor involves submucosa

?
T2: Tumor invades muscularis propria

?
T3: Tumor invades subserosa or mesoappendix

?
T4a: Tumor penetrates serosa, including tumor in the right lower

quadrant

Distant metastases

?
M1a: Intraperitoneal metastases beyond right lower quadrant

?
M1b: Extra-peritoneal metastases


Pre operative CT scan

Treatment

Surgery
? Appendiceal tumours can be cured by appendectomy if

the tumour is located at the tip of the appendix, the

tumour diameter is <2 cm and no deep meso

appendiceal invasion is observed

? Right hemicolectomy, is indicated if:

? tumour diameter >2 cm
? deep mesoappendiceal invasion
? positive surgical margins
Medical therapy

? No medical therapy is indicated in patients with resected
appendiceal endocrine tumours.

? Chemotherapeutic options are not available on an evidence-

based level, nor are data to recommend peptide

radioreceptor therapy (PRRT).

? PRRT may be an option in a somatostatin receptor-positive,

metastasized, inoperable appendiceal endocrine tumour.

Systemic chemotherapy in appendiceal

tumor

? Preoperative (neoadjuvant)

? Postoperative (adjuvant)

? Postoperative after suboptimal cytoreduction

with residual bulky disease

? Palliative in unresectable or progressive and

metastatic disease
Minimal Consensus Statement on Diagnostic

Procedures for Fol ow-Up

? For wel -differentiated tumours, diagnosed incidental y, with a

maximum diameter < 1 cm and R0 resection, no follow-up is required.

? For wel -differentiated tumours of 1 to < 2 cm and R0 resection there

are no sufficient data for a clear-cut decision.

? In cases with deep mesoappendiceal infiltration or angioinvasion, CT

of the abdomen and somatostatin receptor scintigraphy may be

performed.

? Factors believed to argue for follow-up investigations are a high

proliferation marker, vascular involvement, deep mesoappendiceal

infiltration, and possibly location at the base of the appendix

This post was last modified on 08 April 2022