Medline ® Abstracts for References 70,71
of 'Cancer of the appendix and pseudomyxoma peritonei'
Adenocarcinoid of the appendix presenting as bilateral Krukenberg's tumor of the ovaries. Immunohistochemical and ultrastructural studies and literature review.
Hirschfield LS, Kahn LB, Winkler B, Bochner RZ, Gibstein AA
Arch Pathol Lab Med. 1985;109(10):930.
A patient with an adenocarcinoid of the appendix presented with bilateral Krukenberg's tumors of the ovaries. Immunohistochemical and ultrastructural studies revealed a selective ability of the mucinous (goblet cell) component of the appendiceal neoplasm to metastasize. A review of the literature has revealed nine previously published cases of appendiceal adenocarcinoid metastatic to the ovaries. All showed involvement of both ovaries, but none provided unequivocal evidence of a metastatic proliferating carcinoid element. As the appendiceal lesion is often grossly inconspicuous, it may be overlooked in cases presenting initially with ovarian tumors. Routine appendectomy is therefore recommended in such patients where no grossly obvious primary tumor is evident.
Discordant histology of primary appendiceal adenocarcinoid neoplasms with peritoneal dissemination.
Yan TD, Brun EA, Sugarbaker PH
Ann Surg Oncol. 2008;15(5):1440.
BACKGROUND: Adenocarcinoid is a rare appendiceal tumor that shows histologically both epithelial and neuroendocrine components. We observed that some patients have peritoneal dissemination, which shows adenocarcinoma but lacks the neuroendocrine histology. The objective of the present study was to quantitate these discordant histopathological findings and examine its clinical implication.
METHODS: Twenty-six patients with peritoneal dissemination from primary appendiceal adenocarcinoid tumors underwent cytoreductive surgery and perioperative intraperitoneal chemotherapy. All resected specimens were individually submitted for histopathological examination and immunostaining with three neuroendocrine markers. The anatomic locations for peritoneal implants were prospectively recorded. The loss of the neuroendocrine tumor type in peritoneal implants was referred to as discordant feature of the adenocarcinoid tumor. Clinical and histopathological prognostic factors for survival were analyzed.
RESULTS: In nine of the 26 patients (35%) with a primary adenocarcinoid of the appendix, a loss of the neuroendocrine immunochemical marker was noted in peritoneal implants. Discordant histology between the primary appendiceal adenocarcinoid and the peritoneal implants was statistically significantly associated with an improved survival (p = 0.0262), when patients were treated by cytoreductive surgery and perioperative intraperitoneal chemotherapy.
CONCLUSIONS: Discordant histology of the primary appendiceal tumor as compared to the peritoneal lesions occurs frequently in patients with adenocarcinoid. An assessment of neuroendocrine markers in both primary and peritoneal lesions may help in the clinical assessment of this group of patients. Small numbers of patients were available for this study and the conclusions are therefore limited.
Peritoneal Surface Malignancy Program, Washington Cancer Institute, Washington Hospital Center, Washington, DC, USA.