Introduction: A practical staging classification that has prognostic significance in mucinous appendiceal neoplasms represents an unmet need in oncology. The purpose of this study is to present a second edition of the...Introduction: A practical staging classification that has prognostic significance in mucinous appendiceal neoplasms represents an unmet need in oncology. The purpose of this study is to present a second edition of the PSDSS in mucinous appendiceal neoplasms with or without peritoneal dissemination based on the AJCC/TNM 8<sup>th</sup> edition. Materials and Methods: We analyzed 229 patients based on the AJCC/TNM 8<sup>th</sup> edition incorporating G (grade) and E (extent of disease). The impact of these 5 clinicopathological variables (T, N, M, G, E) is scored as stages 0 to IV and is reported as the Esquivel Peritoneal Surface Disease Severity Score (E-PSDSS). Results: One hundred and seventy-three patients underwent cytoreductive surgery (CRS) and HIPEC. There were 30 (13.1%), 56 (24.4%), 48 (20.9%), 20 (8.7%) and 75 (32.7%) patients with E-PSDSS 0, I, II, III, and IV, respectively. Five-year overall survival was 100%, 100%, 84.46%, 52.29% and 12.92% for E-PSDSS 0, I, II, III and IV, respectively (p Conclusion: The E-PSDSS combines specimen examination and reporting according to the College of American Pathologists with the pTNM requirements from the AJCC staging manual. It represents an important prognostic indicator in patients with mucinous appendiceal neoplasms.展开更多
A 37-year old male presented with an acute abdomen suggestive of an appendiceal perforation.Urgent laparotomy showed a duplicated appendix with one of the lumens involved with appendicitis and a focal periappendicular...A 37-year old male presented with an acute abdomen suggestive of an appendiceal perforation.Urgent laparotomy showed a duplicated appendix with one of the lumens involved with appendicitis and a focal periappendicular abscess while the other lumen had a localized appendiceal cancer.Recognition of congenital intestinal duplications in adults is important to avoid serious clinical consequences.展开更多
A 68-year-old man presented with progressive right lower quadrant abdominal pain and tenderness without rebound tenderness, and with constipation during the prior 9 mo. Abdomino-pelvic computed tomography and magnetic...A 68-year-old man presented with progressive right lower quadrant abdominal pain and tenderness without rebound tenderness, and with constipation during the prior 9 mo. Abdomino-pelvic computed tomography and magnetic resonance imaging demonstrated a dilated appendix forming a fistula to the sigmoid colon. Open laparotomy revealed a bulky abdominal tumor involving appendix, cecum, and sigmoid, and extending up to adjacent viscera, without ascites or peritoneal implants. The abdominal mass was removed en bloc, including resection of sigmoid colon, cecum(with preservation of ileocecal valve), appendix, right vas deferens, testicular vessels, and minimal amounts of anterior abdominal wall; and shaving off of small parts of the walls of the urinary bladder and small bowel. Gross and microscopic pathologic examination revealed an appendix-to-sigmoid malignant fistula secondary to perforation of mucinous adenocarcinoma of the appendix with minimal local spread(stage T4). However, the surgical margins were clear, all 13 resected lymph nodes were cancer-free, and pseudomyxoma peritonei or peritoneal implants were not present. The patient did well during 1 year of follow-up with no clinical or radiologic evidence of local recurrence, metastases, or pseudomyxoma peritonei despite presenting with extensive stage T4 cancer that was debulked without administering chemotherapy, and despite presenting with malignant appendiceal perforation. This case illustrates the non-aggressive biologic behavior of this low-grade malignancy. The fistula may have prevented free spillage of cancerous cells and consequent distant metastases by containing the appendiceal contents largely within the colon.展开更多
BACKGROUND Primary appendiceal cancers are rare,and they generally present with liver and/or peritoneal metastases.Currently there are no guidelines to treat metastatic appendiceal cancer,and hence they are treated as...BACKGROUND Primary appendiceal cancers are rare,and they generally present with liver and/or peritoneal metastases.Currently there are no guidelines to treat metastatic appendiceal cancer,and hence they are treated as metastatic colorectal cancer.Combining Yttrium 90(Y-90)radioembolization(RE)with systemic chemotherapy early in the treatment of right sided colon cancers has been shown to improve survival.Based on this data,a combination of systemic chemotherapy and Y-90 RE was used to treat a case of metastatic appendiceal cancer.CASE SUMMARY A 76-year-old male presented to the emergency room with progressive right lower quadrant pain.A Computed Tomography of the abdomen and pelvis was performed which showed acute appendicitis and contained perforation.Urgent laparoscopic appendectomy was then followed by histological analysis,which was significant for appendiceal adenocarcinoma.After complete workup he underwent right hemicolectomy and lymph node dissection.He received adjuvant chemotherapy as the local lymph nodes were positive.Follow-up imaging was significant for liver metastasis.Due to rapid growth of the liver lesions and new peritoneal nodules,the patient was treated with a combination of Y-90 RE and folinic acid,fluorouracil,and irinotecan with bevacizumab and not microwave ablation as previously planned.Follow up imaging demonstrated complete response of the liver lesions.At 12-mo follow-up,the patient continued to enjoy good quality of life with no recurrent disease.CONCLUSION Utilization of Y-90 RE concomitantly with systemic chemotherapy early in the treatment of appendiceal cancer may provide improved control of this otherwise aggressive cancer.展开更多
Primary tumors of the appendix are rare, comprising 1.1% of all appendectomy specimens. Nevertheless, it often presents in an emergent fashion, creating a need for a well-defined management algorithm that will ensure ...Primary tumors of the appendix are rare, comprising 1.1% of all appendectomy specimens. Nevertheless, it often presents in an emergent fashion, creating a need for a well-defined management algorithm that will ensure proper acute management. We performed a retrospective review of medical charts from 1982-2007 on all charts with a diagnosis of appendiceal neoplasm. A cohort of 41 patients was diagnosed with a primary appendiceal neoplasm from a total of 8560 appendectomies over the 25-year period. Several tumors were identified: adenocarcinomas (n = 16), carcinoid tumors (n = 15), mucinous cystadenocarcinoma (n = 7), and a combination of adenocarcinoma and goblet cell carcinoid of the appendix (n = 3). Twenty-one patients presented with an acute abdomen. Tumors were discovered intraoperatively in eighteen patients while performing other procedures. At diagnosis, metastatic disease was found in 41.5% of patients (n = 17);average survival ranged from 6 to 21 months based on tumor type. For patients with non-metastatic disease at diagnosis, all survived longer than 2 years and there were no cases of recurrence or post-operative metastasis. We devised an operative strategy dictated by initial presenting characteristics of the tumor. The presence of carcinoma should be suspected and searched for in patients over 40 presenting with acute appendicitis. Intraoperatively any suspicious mass should undergo frozen sectioning as the finding of a malignancy often necessitates a larger or repeat operation. The propensity of these neoplasms for presentation in the guise of acute appendicitis mandates that the surgeon be familiar with the appropriate management algorithm, both in and out of the operating room.展开更多
文摘Introduction: A practical staging classification that has prognostic significance in mucinous appendiceal neoplasms represents an unmet need in oncology. The purpose of this study is to present a second edition of the PSDSS in mucinous appendiceal neoplasms with or without peritoneal dissemination based on the AJCC/TNM 8<sup>th</sup> edition. Materials and Methods: We analyzed 229 patients based on the AJCC/TNM 8<sup>th</sup> edition incorporating G (grade) and E (extent of disease). The impact of these 5 clinicopathological variables (T, N, M, G, E) is scored as stages 0 to IV and is reported as the Esquivel Peritoneal Surface Disease Severity Score (E-PSDSS). Results: One hundred and seventy-three patients underwent cytoreductive surgery (CRS) and HIPEC. There were 30 (13.1%), 56 (24.4%), 48 (20.9%), 20 (8.7%) and 75 (32.7%) patients with E-PSDSS 0, I, II, III, and IV, respectively. Five-year overall survival was 100%, 100%, 84.46%, 52.29% and 12.92% for E-PSDSS 0, I, II, III and IV, respectively (p Conclusion: The E-PSDSS combines specimen examination and reporting according to the College of American Pathologists with the pTNM requirements from the AJCC staging manual. It represents an important prognostic indicator in patients with mucinous appendiceal neoplasms.
文摘A 37-year old male presented with an acute abdomen suggestive of an appendiceal perforation.Urgent laparotomy showed a duplicated appendix with one of the lumens involved with appendicitis and a focal periappendicular abscess while the other lumen had a localized appendiceal cancer.Recognition of congenital intestinal duplications in adults is important to avoid serious clinical consequences.
文摘A 68-year-old man presented with progressive right lower quadrant abdominal pain and tenderness without rebound tenderness, and with constipation during the prior 9 mo. Abdomino-pelvic computed tomography and magnetic resonance imaging demonstrated a dilated appendix forming a fistula to the sigmoid colon. Open laparotomy revealed a bulky abdominal tumor involving appendix, cecum, and sigmoid, and extending up to adjacent viscera, without ascites or peritoneal implants. The abdominal mass was removed en bloc, including resection of sigmoid colon, cecum(with preservation of ileocecal valve), appendix, right vas deferens, testicular vessels, and minimal amounts of anterior abdominal wall; and shaving off of small parts of the walls of the urinary bladder and small bowel. Gross and microscopic pathologic examination revealed an appendix-to-sigmoid malignant fistula secondary to perforation of mucinous adenocarcinoma of the appendix with minimal local spread(stage T4). However, the surgical margins were clear, all 13 resected lymph nodes were cancer-free, and pseudomyxoma peritonei or peritoneal implants were not present. The patient did well during 1 year of follow-up with no clinical or radiologic evidence of local recurrence, metastases, or pseudomyxoma peritonei despite presenting with extensive stage T4 cancer that was debulked without administering chemotherapy, and despite presenting with malignant appendiceal perforation. This case illustrates the non-aggressive biologic behavior of this low-grade malignancy. The fistula may have prevented free spillage of cancerous cells and consequent distant metastases by containing the appendiceal contents largely within the colon.
文摘BACKGROUND Primary appendiceal cancers are rare,and they generally present with liver and/or peritoneal metastases.Currently there are no guidelines to treat metastatic appendiceal cancer,and hence they are treated as metastatic colorectal cancer.Combining Yttrium 90(Y-90)radioembolization(RE)with systemic chemotherapy early in the treatment of right sided colon cancers has been shown to improve survival.Based on this data,a combination of systemic chemotherapy and Y-90 RE was used to treat a case of metastatic appendiceal cancer.CASE SUMMARY A 76-year-old male presented to the emergency room with progressive right lower quadrant pain.A Computed Tomography of the abdomen and pelvis was performed which showed acute appendicitis and contained perforation.Urgent laparoscopic appendectomy was then followed by histological analysis,which was significant for appendiceal adenocarcinoma.After complete workup he underwent right hemicolectomy and lymph node dissection.He received adjuvant chemotherapy as the local lymph nodes were positive.Follow-up imaging was significant for liver metastasis.Due to rapid growth of the liver lesions and new peritoneal nodules,the patient was treated with a combination of Y-90 RE and folinic acid,fluorouracil,and irinotecan with bevacizumab and not microwave ablation as previously planned.Follow up imaging demonstrated complete response of the liver lesions.At 12-mo follow-up,the patient continued to enjoy good quality of life with no recurrent disease.CONCLUSION Utilization of Y-90 RE concomitantly with systemic chemotherapy early in the treatment of appendiceal cancer may provide improved control of this otherwise aggressive cancer.
文摘Primary tumors of the appendix are rare, comprising 1.1% of all appendectomy specimens. Nevertheless, it often presents in an emergent fashion, creating a need for a well-defined management algorithm that will ensure proper acute management. We performed a retrospective review of medical charts from 1982-2007 on all charts with a diagnosis of appendiceal neoplasm. A cohort of 41 patients was diagnosed with a primary appendiceal neoplasm from a total of 8560 appendectomies over the 25-year period. Several tumors were identified: adenocarcinomas (n = 16), carcinoid tumors (n = 15), mucinous cystadenocarcinoma (n = 7), and a combination of adenocarcinoma and goblet cell carcinoid of the appendix (n = 3). Twenty-one patients presented with an acute abdomen. Tumors were discovered intraoperatively in eighteen patients while performing other procedures. At diagnosis, metastatic disease was found in 41.5% of patients (n = 17);average survival ranged from 6 to 21 months based on tumor type. For patients with non-metastatic disease at diagnosis, all survived longer than 2 years and there were no cases of recurrence or post-operative metastasis. We devised an operative strategy dictated by initial presenting characteristics of the tumor. The presence of carcinoma should be suspected and searched for in patients over 40 presenting with acute appendicitis. Intraoperatively any suspicious mass should undergo frozen sectioning as the finding of a malignancy often necessitates a larger or repeat operation. The propensity of these neoplasms for presentation in the guise of acute appendicitis mandates that the surgeon be familiar with the appropriate management algorithm, both in and out of the operating room.
