Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Surgery 62 Tumors of Appendix PPT-Powerpoint Presentations and lecture notes
Tumors of Appendix
Dept of Surgery
Introduction
? Appendiceal malignancies are extremely rare.
? Diagnosed in 0.9-1.4% of appendectomy specimens.
? Carcinoid is the most common appendiceal malignancy
? It represents more than 50% of the primary lesions of the appendix.
WHO classification of Appendiceal tumors
Carcinoid
? Most common site: Jejunum>Appendix > rectum
? Mean age at presentation is 32-43 years (range-6 to 80 years)
? More frequently in females than in males
? Carcinoid syndrome is rarely associated with appendiceal carcinoid
? Symptoms attributable directly to the carcinoid are rare
? Tumor can occasionally obstruct the appendiceal lumen and result in acute appendicitis
Macroscopy
? Firm, greyish-white (yel ow after fixation), fairly wel circumscribed, but not
encapsulated
? Measure usual y less than 1 cm in diameter
? Tumours > 2 cm are rare
? Most are located at the tip of the appendix
? Goblet-cel carcinoids and mixed endocrine-exocrine carcinomas of the appendix
may be found in any portion of the appendix.
Carcinoid
? Tumours with endocrine differentiation arising in the appendix
? Majority of carcinoids are located in the tip of the appendix.
? Malignant potential is related to size
? Treatment :
? carcinoid tumor is localized to the appendix: simple appendectomy
? tumors <1 cm with extension into the mesoappendix and tumors >1.5 cm: right
hemicolectomy
Carcinoid tumour of appendix with typical yel ow colouration
Adenocarcinoma
? Primary adenocarcinoma: rare neoplasm
? Three major histologic subtypes:
? Mucinous adenocarcinoma
? Colonic adenocarcinoma
? Adenocarcinoid
TNM Staging
? Most common mode of presentation is of acute appendicitis.
? Ascites
? Palpable mass
? Incidental intraoperative finding
Treatment:
? Right hemicolectomy
Appendiceal adenocarcinomas have a propensity for early perforation
Overall 5-year survival is 55%
Patients have significant risk for both synchronous and metachronous neoplasms
Mucocele
Progressive enlargement of the appendix from the intraluminal accumulation
of a mucoid substance.
Mucocele are of four histologic types
? Retention cysts
? Mucosal hyperplasia
? Cystadenomas
? Cystadenocarcinomas
A mucocele of benign etiology is adequately treated by simple appendectomy
Pseudomyxoma Peritonei
? Diffuse collections of gelatinous fluid are associated with mucinous implants on peritoneal
surfaces and omentum.
? Two to three times more common in females than males.
? Recent immunocytologic and molecular studies suggest that the appendix is the site of
origin for most cases of pseudomyxoma.
? Pseudomyxoma is invariably caused by neoplastic mucous-secreting cells within the
peritoneum.
? Clinical presentation: abdominal pain, distension, mass, "jelly-belly"
? Tumor Markers: CA-19.9, CEA, CA-125
? Imaging:
? CT scanning is the preferred imaging modality
? Role of colonoscopy in the diagnosis of PMP is minimal
Intra operative photograph of patient PMP
Complete Cytoreductive Surgery is the mainstay of treatment
? All gross disease should be removed
? Appendectomy is routinely performed
? Hysterectomy with bilateral salpingo-oophorectomy is performed in women.
At surgery a variable volume of mucinous ascites is found together with tumor
deposits
Pseudomyxoma is a disease that progresses slowly and in which recurrences may
take years to develop or become symptomatic.
Hyperthermic intraperitoneal chemotherapy (HIPEC)
? Highly concentrated
? Heated chemotherapy treatment
? Delivered directly to the abdomen during surgery
? Intraoperative HIPEC was initiated at the Washington Hospital Center in
1992
Lymphoma
? Extremely uncommon
? Gastrointestinal tract is the most frequently involved extranodal site for
non-Hodgkin's lymphoma
? Frequency of primary lymphoma of the appendix ranges from 1 to 3% of
gastrointestinal lymphomas
? Usually presents as acute appendicitis
Lymphoma
? CT scan showing appendiceal diameter greater than or equal to 2.5 cm or
surrounding soft-tissue thickening should prompt suspicion of an
appendiceal lymphoma
? management of appendiceal lymphoma confined to the appendix is
appendectomy.
? Right hemicolectomy is indicated if there is extension of tumor beyond the
appendix onto the cecum or mesentery.
This post was last modified on 08 April 2022