Medline ® Abstracts for References 61,66-69
of 'Cancer of the appendix and pseudomyxoma peritonei'
http://www.pmppals.org/surgeons-and-specialists.html (Accessed on April 20, 2011).
no abstract available
Goblet cell carcinoid of the appendix.
Pahlavan PS, Kanthan R
World J Surg Oncol. 2005;3:36. Epub 2005 Jun 20.
BACKGROUND: Goblet cell carcinoid (GCC) of the appendix is a rare neoplasm that share histological features of both adenocarcinoma and carcinoid tumor. While its malignant potential remains unclear, GCC's are more aggressive than conventional carcinoid. The clinical presentations of this neoplasm are also varied. This review summarizes the published literature on GCC of the appendix. The focus is on its diagnosis, histopathological aspects, clinical manifestations, and management.
METHODS: Published studies in the English language between 1966 to 2004 were identified through Medline keyword search utilizing terms "goblet cell carcinoid," "adenocarcinoid", "mucinous carcinoid" and "crypt cell carcinoma" of the appendix.
RESULTS: Based on the review of 57 published papers encompassing nearly 600 diagnosed patients, the mean age of presentation for GCC of the appendix was 58.89 years with equal representation in both males and females. Accurate diagnosis of this neoplasm requires astute observations within an acutely inflamed appendix as this neoplasm has a prominent pattern of submucosal growth and usually lacks the formation of a well-defined tumor mass. The mesoappendix was involved in 21.64% followed by perineural involvement in 2.06%. The most common clinical presentations in order of frequency were acute appendicitis in 22.5%; asymptomatic in 5.4%; non-localized abdominal pain in 5.15% and an appendicular mass in 3.09%. The most common surgical treatment of choice was appendectomy with right hemicolectomy in 34.70% followed by simple appendectomy in 24.57%. Concomitant distant metastasis at diagnosis was present in 11.16% of patients with the ovaries being the most common site in 3.60% followed by disseminated abdominal carcinomatosis in 1.03%. Local lymph node involvement was seen in 8.76% of patients at the time of diagnosis. The reported 5-year survival ranges from 60 % to 84%. GCC's of the appendix remains a neoplasm of unpredictable biological behavior and thus warrants lifelong surveillance for recurrence of the disease upon diagnosis and successful surgical extirpation.
CONCLUSION: GCC of the appendix is a rare neoplasm. Due to its wide range of presentation, this tumor should be considered as a possible diagnosis in many varied situations leading to abdominal surgery. Histopathological features such as increased number of Paneth cells, increased amount of mucin secretion and presence of pancreatic polypeptide may predict a more aggressive behavior. The advocated plan of management recommended for patients with tumors that involve the adjacent caecum or with high-grade tumors with histological features such as an increased mitotic rate involve initial appendectomy with completion right hemicolectomy due to the high possibility of local recurrence with intraperitoneal seeding prior to lymph node involvement and a 20% risk of metastatic behavior. In female patients with GCC of the appendix regardless of age, bilateral salpingo-oophorectomy is advocated. In cases with obvious spread of the disease chemotherapy, mostlywith 5-FU and leucovorin is advised. Cytoreductive surgery with adjuvant intraperitoneal chemotherapy can offer improved survival in cases with advanced peritoneal dissemination.
Department of Physiology and Pathophysiology, University of Heidelberg, Heidelberg, Germany. firstname.lastname@example.org
Goblet cell carcinoid of the appendix.
Butler JA, Houshiar A, Lin F, Wilson SE
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.
Department of Surgery, University of California, Irvine.
Krukenberg tumor from an occult appendiceal adenocarcinoid: a case report and review of the literature.
Mandai M, Konishi I, Tsuruta Y, Suginami N, Kusakari T, Iwasaki T, Fujii S
Eur J Obstet Gynecol Reprod Biol. 2001;97(1):90.
Appendiceal neoplasms with ovarian metastasis are rare. A 35-year-old woman with a left ovarian tumor underwent left salpingo-oophorectomy, partial resection of the right ovary, and a total hysterectomy. Pathological diagnosis of both ovaries was typical, Krukenberg tumor with signet-ring cells, and the second laparotomy revealed an occult appendiceal tumor to be the primary lesion. The appendix showed no evidence of malignant change of the mucosa, but the tumor cells were observed infiltrating from the basiglandular region into the underlying stroma, associated with mucocele. Although, argentaffin and argyrophil staining were negative, a few tumor cells showed immunohistochemical positivity for Chromogranin A. Accordingly, the tumor was diagnosed as adenocarcinoid rather than adenocarcinoma of the appendix. A review of the literature showed less than 40 cases of metastatic ovarian tumor from appendiceal primary, one-third of which were occult and could be detected at the second laparotomy. Cisplatin-based chemotherapy may have partial effect in the treatment of patient with adenocarcinoid tumor.
Department of Gynecology and Obstetrics, Faculty of Medicine, Kyoto University, Kyoto, Japan.
Adenocarcinoid of the appendix: is right hemicolectomy necessary? A meta-analysis of retrospective chart reviews.
Varisco B, McAlvin B, Dias J, Franga D
Am Surg. 2004;70(7):593.
The purpose of this study was to determine the efficacy of simple appendectomy versus right hemicolectomy in the treatment of localized adenocarcinoid of the appendix. A literature review of retrospective chart reviews from 1966 to March 1, 2003, was performed. Outcomes of retrospective chart reviews were assessed on the basis of treatment modality. Meta-analysis of studies by determining odds ratios for appendectomy versus extended resection using the Hunter-Schmidt meta-analytic method was performed. One hundred patients from 13 studies met inclusion criteria. Seven per cent failure rate with appendectomy alone and 10 per cent with extended resection were observed [OR 1.9 (0.6-5.8); association chi2 1.15, 1 df, P = 0.28]. Our data supports the use of appendectomy alone in localized cases of adenocarcinoid of the appendix provided there is no cecal involvement and the tumor's histology is low grade.
Department of Surgery and Office of Biostatistics and Bioinformatics, Medical College of Georgia, Augusta, Georgia 30912, USA.