Download MBBS Surgery Presentations 62 Tumors of Appendix Lecture Notes

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