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PubMedDate not supplied

Primary adenocarcinoma of the appendix and pseudomyxoma peritonei.

Two cases of primary adenocarcinoma of the appendix are reported. Both patients presented with a clinical picture resembling acute appendicitis. One case was complicated by a pseudomyxoma peritonei. The other patient additionally had several colonic adenomatous polyps and a malignant neoplasm of the ascending colon. Primary adenocarcinoma of the appendix is rare and only some 250 cases have been reported. It usually presents as acute appendicitis in the 6th or the 7th decade. Prognosis and histology closely resemble that of colonic adenocarcinoma. Resection of the ileocecal segment is the first choice treatment in all stages except Dukes A. In Dukes A appendectomy alone is sufficient treatment. After ileocecal resection the 5 year survival is better than after appendectomy alone for Dukes' stages B and C. Clinical presentation and treatment of the adenocarcinoma and a remarkable complication, the pseudomyxoma peritonei, will be discussed.

Adenocarcinoma↗
PubMedDate not supplied

Crohn's disease limited to the vermiform appendix.

Thirteen cases of Crohn's disease confined to the vermiform appendix were seen during a 12-year period. They constituted 16.9% of patients with primary resection of the bowel for Crohn's disease in the same period, but only 0.4% of the cases of acute appendicitis. In 10 of the 13 cases there was marked fibrous thickening of the appendiceal wall, and in 11 there were epithelioid cell granulomas. Appendectomy was performed in all cases. None had postoperative fistula or later manifestations of the disease within the observation time averaging 6.3 years. The recurrence rate was previously believed to approach that of recurrence after resection in other parts of the intestines. Collective review of this and three other relatively large case series gave an estimated recurrence rate of 3.5%. We conclude that in Crohn's disease initially confined to the appendix the course appears to be indolent.

Acute Disease↗
PubMed1986

The continuing challenge of the negative appendix.

A 15-20% negative appendix rate at emergency appendectomy is considered compatible with appropriate aggressiveness of approach for avoidance of perforation and heightened morbidity rate. But the morbidity rate after negative exploration has been estimated as high as 15%. We compared the morbidity rate after emergency appendectomy among patients with acute appendicitis with that in patients with nonacute appendiceal pathology or with normal appendix. Local septic complications (wound infection and/or intraabdominal abscess) were significantly more common in perforative appendicitis than in nonperforative or in cases without appendicitis. Excluding perforative appendicitis, the incidence of such complications did not differ significantly between the other diagnostic groups. The incidence of other complications was evenly distributed among all groups. A scoring system--possibly computer-aided--taking into account predictive factors in appendicitis, combined with careful in-hospital observation, would probably reduce the negative exploration rate in suspected acute appendicitis without increasing the perforation and morbidity rates.

Acute Disease↗
PubMed1987

The appendix and its metastatic potential in epithelial ovarian cancer.

The role of appendectomy in the management of epithelial ovarian cancer is unknown as a staging and cytoreductive procedure. In this series, the appendix was found to have metastatic disease in 40 of 78 patients (51%) and in 40 of 57 patients (70%) with advanced disease (stage III/IV). Occult or microscopic disease was found only in two patients (5%) with grossly normal appearing appendices. The appendix as a site of metastatic ovarian cancer is common with advanced stages (stage III/IV) and rare with early disease.

Appendectomy↗
PubMedDate not supplied

[Primary malignant tumors of the vermiform appendix: clinico-pathologic study of 8 cases].

In Botucatu, São Paulo, Brazil, 8 cases of primary tumors were encountered among 895 operated vermiform appendices: Five were colonic type adenocarcinomata and occurred above 40 years of age and three were carcinoids all in persons aged 25 or less. The diagnosis of appendical adenocarcinoma is almost never realized preoperatively. The importance of frozen sections in all suspicious cases is stressed since right hemicolectomy is the treatment of choice in cases of adenocarcinoma of the appendix. When malignant lesion goes unrecognized at initial operation, secondary hemicolectomy may be justified if histology shows invasion beyond the submucosa, at the line of ressection, or in lymph nodes. However, since the tumors is restricted to the mucosa, the patient must be followed with periodical radiology and endoscopy. In carcinoids limited to the appendix appendectomy is the treatment of choice.

Adenocarcinoma↗
PubMed1977

Primary carcinoma of the appendix.

Primary adenocarcinoma of the appendix is a rare tumor. Fewer than 200 cases are on record. Correct preoperative diagnosis is virtually nonexistent. Two patients with adenocarcinoma of the appendix are described. Although appendectomy appears to be adequate treatment for carcinoid, right hemicolectomy is, in our opinion, the treatment of choice for mucinous cystadenocarcinoma, while it is mandatory in cases of adenocarcinoma of the colonic type.

Adenocarcinoma↗
PubMed1984

CT diagnosis of adenocarcinoma of the appendix.

We report the CT findings in a patient with adenocarcinoma of the appendix. Previously reported cases are reviewed, and a CT appearance which is suggestive of adenocarcinoma of the appendix is presented.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

Carcinoma of colon and appendix related to faecal 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 faecal 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, faecal stasis is probably not important in the aetiology of carcinoma of the appendix.

Adult↗
PubMed1983

[Adenocarcinoma of the appendix. Apropos of 11 new cases].

The authors review 11 new cases of adenocarcinoma of the appendix and 220 other cases drawn from the literature. In the first series, 6 patients presented with abscess or perforations. The tumor was proximal in 5, distal in 2, medial in 2, and total in 2. It extended to the cecum in 4 cases and to the lymph nodes in two. The clinical picture was one of appendicitis in seven patients, an iliac growth in three and occlusion in one. The diagnosis was made by the surgeon in four cases, and by postoperative histological examination in seven. The authors stress the need to open the appendix at operation, to take frozen sections in the event of any doubts, and systematic postoperative histological examination of operative specimens. Appendectomy is a poor solution, even accompanied by partial cecectomy, the survival rate at five years being only 20 %. It is only licit for a unperforated, proximal mucosal or submucosal tumor. The best solution is immediate or secondary right hemicolectomy, for which the survival rate, of 45 % at five years, is close to that of other forms of colic cancers.

Adenocarcinoma↗
PubMed1978

Mucinous carcinoid and endometriosis in an inside-out appendix.

This is the first report of the simultaneous occurrence of mucinous carcinoid and endometriosis in an inside-out appendix. The literature concerning carcinoids, endometriosis and intussusception of the appendix is reviewed. The mucinous, or goblet cell carcinoid was positive for mucin, argentaffin and argyrophil stains. Paneth cells were present. Two and one-half years with no tumor recurrence suggest good prognosis as previously reported.

Adult↗
PubMed1983

Relationship between the removal of the nonacute appendix and the menstrual cycle.

The significantly higher incidence of removal of a normal appendix in females in the second, third and fourth decades of life for suspected acute appendicitis lead to a study of the frequency of appendicectomy and the peroperative findings at the time of surgery in patients in different phases of the menstrual cycle. The results showed that the frequency of acute appendicitis in the luteal phase was more than twice the frequency of the disease in the remaining half of the menstrual cycle. Further, there was a significantly higher proportion of gangrenous, perforated and normal appendices removed from patients in the menstrual and follicular phases of the menstrual cycle. The diseases mimicking acute appendicitis are tabulated. From these results it can be concluded that the female sex hormones might play an important aetiological role in the development of acute appendicitis or influence the inflammatory process in the appendix.

Adolescent↗
PubMed1983

Primary adenocarcinoma of the appendix. Can preoperative or intraoperative diagnosis be made?

Adenocarcinoma of the appendix is a rare entity with a reported incidence of .03 to .08 per cent. A review of all appendectomies performed at St. Joseph Mercy Hospital (a private community hospital) between 1963 and 1979 was undertaken to assess the efficacy of preoperative diagnosis. Six adenocarcinomas were found, consisting of five male patients and one female patient with a mean age of 65 years. Symptoms were present for 24 hours or greater in all cases. A preoperative diagnosis was not made in any patient. Three patients later required a definitive therapeutic procedure, and two patients died from metastatic disease during their initial hospitalization. The literature was reviewed to evaluate methods of preoperative and intraoperative diagnosis of appendical adenocarcinoma. A suspicion of carcinoma of the appendix should be entertained for patients over the age of 50 years who present with signs and symptoms of appendicitis for greater than 24 hours. A barium enema performed preoperatively and especially a frozen section at the time of surgery of any suspicious appendiceal lesions may improve the diagnostic accuracy and survival of patients with this disease entity. If preoperative or intraoperative diagnosis is made, the patient can be better prepared and definitive surgical therapy carried out. This avoids delay in treatment and a second operative procedure.

Adenocarcinoma↗
PubMed1983

[An autopsy case of pancreatic cancer with carcinoid tumor of the appendix].

A 78-year-old man with pancreatic carcinoma with carcinoid tumor of the appendix is reported. Upon autopsy, the tumor consisted of poorly differentiated adenocarcinoma with scirrhous-like spreading. In the appendix a carcinoid tumor, size measuring 2 mm X 1 mm, was seen; the carcinoid cells were argentaffin.

Adenocarcinoma↗
PubMed1982

Carcinoid tumours of the appendix: 21 cases, with a review of the literature.

Twenty-one carcinoid tumours of the appendix are reviewed. These represented 77 percent of all appendiceal primary tumours over a 16 year period and presented at a mean age of 32.3 years. No difference in sex incidence or significant racial trends were revealed. Discovery of the tumour followed presentation as appendicitis in most cases (14) and was incidental after routine appendicectomy at laparotomy in the rest. Most tumours were less than 2 cm in diameter, and five involved the appendix wall diffusely. All were argentaffin and contained significant areas of type A histological pattern. Lymphatic permeation was noted in nearly half the cases and invasion of the mesoappendix in 33 percent. Treatment was by simple appendicectomy in nineteen patients, appendicectomy with removal of a wedge of caecum in one, and right hemicolectomy in another. The literature is reviewed.

Adolescent↗
PubMed1995

Acute appendicitis: does removal of a normal appendix matter, what is the value of diagnostic accuracy and is surgical delay important?

A prospective study with long-term follow-up was undertaken of 248 patients (137 males, median age 18 years (range 6-81 years), undergoing emergency appendicectomy during a 12-month period. Acute inflammation was present in 182 patients (73.4%) (males 86.1%, females 57.8%; P < 0.001). Before surgery, the positive predictive value of diagnostic accuracy was 82.0% (males 91.2%, females 67.7%). Delaying surgery did not significantly increase the proportion of perforated appendices (22.0%), hospital stay, or frequency of postoperative complications (overall 49.6%). Hospital complications were significantly more common among patients with a perforated appendix. There was no significant difference in the complication rate between patients with or without appendicitis while in hospital, during the first 18 months after operation or 8 years after operation. At 18 months, 17 of 238 patients (7.1%) continued to experience their original pain. After 8 years the original pain was still present in 10 of 155 patients (6.5%). Continued pain was more likely in patients having undergone removal of a normal appendix (P < 0.001)

Abdominal Pain↗
PubMed1995

Expression of cytokeratin 7 in simultaneous mucinous tumors of the ovary and appendix.

Cytokeratin 7 (CK-7) is a simple epithelial keratin that may be used to investigate the site of origin of adenocarcinomas. In fact, CK-7 is present in ovarian epithelial neoplasms but is generally absent in colonic carcinomas. This pattern of CK-7 expression may aid in elucidating the genesis of mucinous tumors occurring simultaneously in the ovary and appendix, accompanied by psuedomyxoma peritonei. Five such cases were immunostained with anti-CK-7, and all showed a concordant staining pattern of the appendiceal, ovarian, and peritoneal lesions. Two cases showed a negative reaction for CK-7 and thus would appear to represent ovarian and peritoneal metastases from an appendiceal primary tumor. Three cases were CK-7 positive, and the nature of these mucinous lesions remains open to debate; they may either represent independent primary tumors or originate from the appendix. For comparison, five Stage I mucinous borderline tumors of the ovary and their normal appendices were also stained with anti-CK-7. These ovarian tumors were all CK-7 positive, whereas the appendices were negative. It is concluded that CK-7 is capable of distinguishing a group of tumors that can reliably be classified as primary appendiceal neoplasms metastatic to the ovaries and peritoneum.

Adult↗
PubMed1995

Psoas abscess due to mucinous cystadenocarcinoma of the appendix: a case report.

Psoas muscle abscess is an uncommon and challenging entity. The present report describes a 64-year-old man presenting with right flank mass. Abdominal computerized tomography showed a right psoas abscess. Extraperitoneal drainage was performed, and pathology revealed metastatic mucinous adenocarcinoma. After further study, laparotomy and right hemicolectomy were performed under the impression of colon cancer. The final pathology showed mucinous cystadenocarcinoma of appendix. The literature about the etiology, diagnosis and treatment of psoas abscess are reviewed. Additionally, the treatment and prognosis for mucinous cystadenocarcinoma of the appendix are noted.

Appendiceal Neoplasms↗
PubMed1994

[Clinical study on torsion of appendix in intrascrotal organ].

We reviewed 12 cases of torsion of appendix in the intrascrotal organ treated surgically and discussed its clinical features. An accurate diagnosis could be made in 5 of the 12 patients before operation because they had a palpable localized tender nodule at the affected area, but not in the other 7 patients because their whole scrotal contents had become swollen with time. The histological study on 6 patients with testicular swelling revealed their spermatogenesis intact. Therefore, we believe that torsion of the appendix in the intrascrotal organ has little influence on future fertility, and thus, correct preoperative diagnosis may diminish the necessity for surgical treatment.

Adult↗