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Primary adenocarcinoma of the vermiform appendix: report of a series of ten cases, and review of the literature.

Ten cases of primary adenocarcinoma of the vermiform appendix are presented. The condition is rare and usually presents after middle age as acute appendicitis. It is seldom recognized during appendicectomy. The tumours resemble colonic adenocarcinomas but, because of peculiarities in the anatomy of the appendix, there is a tendency to early local spread. Right hemicolectomy performed as soon as the true nature of the lesion is recognized is the treatment of choice and has been shown to improve survival. Even after hemicolectomy the prognosis must be guarded, as local spread of disease may not be controlled in many cases.

Adenocarcinoma

Primary adenocarcinoma of the appendix: a report of two cases.

Primary adenocarcinoma of the appendix is rare; approximately 200 cases have been reported. Preoperative diagnosis is extremely difficult. We report two cases with two distinctive histologic patterns of adenocarcinoma resulting in different outcomes. The classification and treatment of primary epithelial malignant tumors of the appendix are also discussed.

Adenocarcinoma

Primary adenocarcinoma of the appendix with bilateral Krukenberg ovarian tumors.

An unusual case of a 22-year-old white female with known chronic ulcerative colitis presented with a several-day history of lower abdominal pain and a pelvic mass. Laparotomy revealed a primary carcinoma of the appendix with Krukenberg metastasis to both ovaries. Pathologically this tumor appeared to arise from an appendix which showed no evidence of chronic ulcerative colitis and therefore could not be associated with the above-mentioned entity.

Adenocarcinoma

Primary adenocarcinoma of the appendix: report of five cases and review of the literature.

Five patients with primary adenocarcinoma of the appendix are reported. All patients presented with symptoms resembling those of acute appendicitis or periappendicular abscess. In none of them was malignancy suspected prior to operation. It is advisable that every patient above 50 years of age presenting with symptoms of appendicitis undergo laparotomy, thus enabling a better exploration of the cecal region. If an appendiceal mass is present and frozen section shows malignancy, a right hemicolectomy should be performed. The prognosis of adenocarcinoma of the appendix is dismal as most patients present with an advanced stage of the disease.

Adenocarcinoma

The demonstration of a subset of carcinoid tumours of the appendix by in situ hybridization using synthetic probes to proglucagon mRNA.

Previous studies using immunohistochemistry have shown variable hormone production by carcinoid tumours of the appendix. In order to confirm the existence of a specific subset of these tumours, in situ hybridization using synthetic oligonucleotide probes to detect pre-proglucagon and pre-proinsulin mRNA was performed in formalin-fixed, paraffin-embedded material from eight tubular carcinoids, 12 insulin carcinoids, and two mucinous carcinoids. The results were correlated with standard silver and mucin stains. All tubular carcinoids but none of the insular or mucinous carcinoids contained proglucagon mRNA. Proinsulin mRNA was not detected in any of the tumours. Tubular carcinoids of the appendix constitute a definable subset of appendiceal carcinoids which have a similar distribution and prognosis to typical insular carcinoids and can be diagnosed on haematoxylin and eosin-stained sections confirmed by routine special stains. The main need for recognition is to avoid confusion with mucinous carcinoids, which have a worse prognosis and may require more aggressive treatment.

Appendiceal Neoplasms

[Inversion versus amputation of the appendix: an objective comparison of 440 randomized cases (author's transl)].

Normal or scarred appendixes may be removed by amputation or inversion. Inversion is appealing for its high degree of asepsis, but criticized for the possibility of organ retention with consecutive invagination. The risks and advantages of amputation appear to be exactly the opposite. For objective comparison, a prospective study was undertaken, using both procedures in 400 cases of solitary and 40 cases of complementary appendectomies at a random number key. Wound infection was observed in 0.5% following inversion, in 8% following amputation as a solitary procedure. Both methods were equally followed by wound infections which performed as complementary procedures. However, inversion was free of enterogenous infection in all cases. Technical precautions were taken to facilitate sloughing of inverted appendixes. No clinical symptoms indicating retention or correlated complications were observed.

Adolescent

Sigmoid invasion as a late complication of mucinous cystadenoma of the appendix. Report of a case.

A cystic mass arising from the right iliac fossa was an incidental finding at laparotomy and was treated conservatively after a biopsy had shown no evidence of malignancy. Nine years later the patient presented with shock and colonic bleeding. A large cystic lesion arising from the vermiform appendix and invading the sigmoid colon was found and excised. Histologic examination indicated that the underlying lesion was an inflamed mucinous cystadenoma of the appendix. Frank invasion of viscera by such lesions has not previously been described. Complications of such lesions and their association with other colonic neoplasms are discussed.

Aged

Adenocarcinoma of the appendix.

Three cases of adenocarcinoma of the appendix are reported. All three patients presented with acute appendicitis and the tumors were diagnosed only on histologic examination of the excised appendix. The first patient subsequently had a right hemicolectomy and was proven to have a Dukes' B tumor. The second patient probably had a Dukes' B also, but no further surgery was performed because of advanced presenile dementia. Advanced disease was found in the third patient. Analysis of 145 cases reported over the last ten years suggests that, unless the tumor is in Dukes' A stage, right hemicolectomy should be carried out if the patient is fit for radical surgery. The overall prognosis appears to be the same as that for carcinoma of the colon.

Adenocarcinoma

Preoperative colonoscopic diagnosis of villous adenoma of the appendix. Report of a case and review of the literature.

This case of villous adenoma of the appendix reported is unique by virtue of its having been diagnosed preoperatively using colonoscopy. Only 45 such lesions have been described previously, and a review of those cases reveals that 93 percent were discovered at appendectomy performed either incidentally or for acute appendicitis. The malignant potential of this entity is unknown and its treatment is controversial. Because of a report association between adenomas of the appendix and other gastrointestinal neoplasms, long-term surveillance is recommended.

Adenoma

Carcinoma of colon and appendix related to fecal stasis.

It is widely accepted that carcinoma of the large bowel is common in the Western world because we eat a low-residue diet which causes fecal stasis. The part of the large bowel with the most stasis is the appendix, which has similar mucosa; but the incidence of carcinoma per unit area of appendicular mucosa is four times less than carcinoma per unit area of large bowel. Therefore, fecal stasis is probably not important in the etiology of carcinoma of the appendix.

Appendiceal Neoplasms

Adenocarcinoma of the appendix: a clinicopathologic study.

Clinicopathologic correlation and survival were evaluated in 11 patients with adenocarcinomas of the appendix. This extremely rare tumor was seen most often in patients in the fifth decade of life. Acute appendicitis was the most common mode of presentation (8/11). A few patients (3/11) showed signs of distant metastases from an occult primary tumor in the appendix.

Adenocarcinoma

Carcinoma in situ of the vermiform appendix associated with adenomatosis of the colon.

A case is reported of carcinoma in situ of the vermiform appendix associated with adenomatosis of the colon. Histologic examination revealed the presence of tubulovillous adenocarcinoma in an adenoma. Other lesions associated with this neoplasm were multiple adenomatous polyps in the colon and duodenum and two fibromas in the neck. Since the vermiform appendix is a part of the large intestine, it should be expected that careful examination may reveal the adenomatous involvement and may lead to the discovery of carcinoma in situ.

Adenocarcinoma

Villous adenoma of the appendix: report of a case and review of the literature.

This report presents a case of a 23-year-old white woman who presented with symptoms of acute appendicitis, confirmed at laparotomy. The appendectomy specimen revealed an isolated, noninvasive villous adenoma of the appendix. Appendectomy was judged to be sufficient treatment in this case since the base of the organ was not involved, and there was no submucosal spread of the villous adenoma. Literature on the subject is reviewed, and modalities of surgical treatment of "invasive" villous adenoma of the appendix are discussed.

Adenoma

Perforation of the appendix in the neonatal period.

Perforation of the appendix in the neonatal period may be a complication of neonatal necrotizing enterocolitis and should be differentiated from perforating appendicitis in later life. A patient is presented together with a review of the literature to illustrate this concept. Perforation of the appendix occurred in a 12-day-old preterm baby. Th cause of this perforation is assumed to be localized full thickness necrosis of the appendiceal wall, a form of neonatal necrotizing enterocolitis. The similarity between the clinical histories of neonates with so called "appendicitis" and those with necrotizing enterocolitis is pointed out. It is argued that "idiopathic primary peritonitis" probably does not exist, but that the peritonitis may be secondary to similar small perforations of the bowel. The importance of a thorough search for such a perforation is stressed.

Appendicitis

Adenocarcinoma of the appendix penetrating the bladder.

We report a case of a mucous papillary tumor in the bladder. Initial treatment was transurethral resection but open partial bladder resection became necessary. Operation revealed an appendix tumor penetrating the bladder. Histologically, it was primary adenocarcinoma of the appendix.

Adenocarcinoma, Papillary

Primary carcinoma of the appendix.

Primary adenocarcinoma of the appendix is rare and less than 200 cases are on record. The present material consisted of 20 cases collected from different hospitals. The cases are described in respect of sex and age-distribution, symptoms, treatment and prognosis. Of 7 patients with malignant mucocele, 6 subjected to appendectomy only, were still alive 5 years after the operation. Of 12 patients with colonic type of adenocarcinoma, 3 had been treated with appendectomy only. Of these, 2 were still alive 5 years after the operation. The remaining 9 patients had undergone right hemicolectomy. Only one of them was alive 5 years after the operation. A compilation of a further 39 cases garnered from the literature, however, showed that 60% had survived at least 5 years after right hemicolectomy, compared with 46% after appendectomy alone. Appendectomy alone is probably a sufficiently radical operation for malignant mucocele provided the tumor has not grown through the submucosa and that it is confined to the tip of the appendix. Right hemicolectomy is indicated for the colonic type of adenocarcinoma.

Adenocarcinoma