UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Medline ® Abstracts for References 61,66-69

of 'Cancer of the appendix and pseudomyxoma peritonei'

61
TI
Goblet cell carcinoid of the appendix.
AU
Butler JA, Houshiar A, Lin F, Wilson SE
SO
Am J Surg. 1994;168(6):685.
 
BACKGROUND: Over the past 15 years, a variant of appendiceal carcinoid has been recognized which is not widely known to the general surgeon. This tumor, variously labeled adenocarcinoid or goblet cell carcinoid, has a more aggressive natural history than classic appendiceal carcinoids and requires a different surgical approach.
PATIENTS AND METHODS: A survey of the tumor registries of 10 hospitals identified 7 female and 2 male patients with goblet cell carcinoid of the appendix between 1983 and 1993. The clinical data of these patients were reviewed.
RESULTS: Median age was 58 years (range 31 to 73). Clinical presentation followed two distinct patterns: acute onset suggestive of appendicitis or chronic symptoms associated with a pelvic mass. In no case was the diagnosis suspected preoperatively or established intraoperatively. Four patients with discrete distal appendiceal tumors treated with appendectomy are alive without evidence of disease 2 to 11 years since their diagnoses. The 5 patients with diffuse appendiceal involvement all had intra-abdominal metastases. Four are dead of disease at intervals from 5 months to 2 years postdiagnosis.
CONCLUSIONS: Goblet cell carcinoids are a distinct clinical and pathologic entity with variable malignant potential. Patients with diffuse appendiceal involvement require aggressive surgery as part of multimodal therapy.
AD
Department of Surgery, University of California, Irvine.
PMID
66
TI
Carcinoid tumour of the appendix.
AU
Goede AC, Caplin ME, Winslet MC
SO
Br J Surg. 2003;90(11):1317.
 
BACKGROUND: Appendiceal carcinoid tumours are found in 0.3-0.9 per cent of patients undergoing appendicectomy. Controversy exists over the management following appendicectomy, especially with regard to the role of right hemicolectomy in patients with tumours smaller than 2 cm in diameter.
METHODS AND RESULTS: The literature pertaining to the behaviour of appendiceal carcinoids was reviewed in order to formulate indications for right hemicolectomy. Metastatic disease from appendiceal carcinoids is a rare occurrence, but is more common when lesions are larger than 2 cm in diameter. The risk-benefit balance of right hemicolectomy needs to be better defined, and an improved understanding of tumour cell biology may aid prognostic accuracy and decision-making.
CONCLUSION: There is limited evidence on which to base clear indications for right hemicolectomy in patients with a diagnosis of appendiceal carcinoid. Acceptable indications are carcinoids larger than 2 cm in size, any high-grade malignant carcinoid (including those with a high mitotic index), mesoappendiceal invasion, lesions at the base of the appendix with tumour-positive margins, and goblet cell adenocarcinoid tumours.
AD
University Department of Surgery, Royal Free Hospital and University College London Medical School, London, UK. agoede@rfc.ucl.ac.uk
PMID
67
TI
Management of goblet cell carcinoid.
AU
Byrn JC, Wang JL, Divino CM, Nguyen SQ, Warner RR
SO
J Surg Oncol. 2006;94(5):396.
 
BACKGROUND AND OBJECTIVES: Goblet cell carcinoid, a rare tumor of intermediate malignant potential, is known to account for a significant minority of appendiceal neoplasms. Sixteen new cases of gastrointestinal goblet cell carcinoid were reviewed to describe their presentation, treatment, and outcome.
METHODS: A review of 16 cases from a single institution.
RESULTS: Sixteen patients were diagnosed with goblet cell carcinoid between 1995 and 2005. Presenting diagnoses included appendicitis (n=8), abdominal or liver mass (n=5), uterine fibroids (n=1), ovarian mass (n=1), and Crohn's Disease exacerbation (n=1). Mean follow-up was 12 months with a mortality of 19% (n=3). Patients were divided into two groups: those where the diagnosis was an incidental finding at operation (Group 1) and those where the presentation was of an abdominal mass or metastatic disease (Group 2). Nine of ten patients in Group 1 initially received appendectomies. Group 2 included patients presenting with Krukenberg type lesions (n=2) and abdominal masses (n=4).
CONCLUSIONS: Goblet cell carcinoid is a rare malignant tumor largely affecting the appendix. In patients presenting with appendicitis, our series does not support the recommendation of right hemicolectomy based on pathologic diagnosis alone and surgical intervention must be customized to the individual patient.
AD
Department of Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA.
PMID
68
TI
Goblet cell carcinoids of the appendix.
AU
Berardi RS, Lee SS, Chen HP
SO
Surg Gynecol Obstet. 1988;167(1):81.
 
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.
AD
Department of Surgery, Veterans Administration Medical Center, Des Moines, Iowa 50310.
PMID
69
TI
Surgical treatment of appendiceal adenocarcinoid (goblet cell carcinoid).
AU
Bucher P, Gervaz P, Ris F, Oulhaci W, Egger JF, Morel P
SO
World J Surg. 2005;29(11):1436.
 
Adenocarcinoid of the appendix is an infrequent tumor with histologic features of both adenocarcinoma and carcinoid tumor. Although its malignant potential remains unclear, adenocarcinoids seem to be biologically more aggressive than conventional carcinoids. The aim of this study was to analyze long-term results of surgical treatment for appendiceal adenocarcinoid. A retrospective review (1991-2003) identified seven patients (median age 72, range 27-81 years) treated for appendiceal adenocarcinoid. The clinical data of these patients were reviewed. Follow-up was complete for all patients (median 60 months, range 24-108 months). Most cases presented with associated acute appendicitis (71%). First intention surgery consisted of appendectomy (m = 6) and right hemicolectomy (m = 1). In three patients, additional surgical procedures were performed (right colectomy). Indications for colectomy were tumor size (three cases) associated with appendectomy margin invasion in one case. One patient with lymph node and peritoneal involvement experienced recurrence 9 months after hemicolectomy and died of the disease at 2 years. One patient subsequently died of colon carcinoma 6 years after adenocarcinoid treatment. Five patients were alive without disease at the time of the last follow-up. Synchronous or metachronous colon carcinomas developed in three patients (43%). Our results suggest that appendectomy alone could be used for appendiceal adenocarcinoid provided that the tumor (1) is less than 1 cm; (2) does not extend beyond the appendix adventitia; (3) has less than 2 mitoses/10 high power fields; and (4) has surgical margins that are tumor free. Otherwise, carcinologic right colectomy seems to be indicated. The risk for developing colorectal adenocarcinoma seems to be extremely high in patients treated for appendiceal adenocarcinoid and warrants close follow-up with colonoscopic screening.
AD
Clinic of Visceral and Transplantation Surgery, Department of Surgery, University Hospital Geneva, 24 Rue Micheli-du-Crest, Geneva 14, 1211 Switzerland. Pascal.Bucher@hcuge.ch
PMID