BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have impr...BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have improved the recognition of this self-limiting condition,but clinical awareness remains critical.AIM To provide a comprehensive update on the epidemiology,anatomy,pathogenesis,clinical presentation,diagnostic strategies,differential diagnosis,and management of epiploic appendagitis,emphasizing its distinguishing features from other causes of acute abdomen.METHODS A review of the literature was conducted,focusing on the clinical characteristics,imaging findings,differential diagnoses,and evidence-based management strategies for epiploic appendagitis.RESULTS Epiploic appendagitis typically presents with acute,localized,non-radiating abdominal pain without significant systemic symptoms.Diagnosis is heavily reliant on imaging,with computed tomography(CT)being the gold standard.Hallmark CT findings include a small,fat-density ovoid lesion adjacent to the colon,with the usual characteristic ring and dot signs.Differential diagnoses include mainly diverticulitis,appendicitis,omental infarction,and many other causes.Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation,reserving surgical intervention for rare,complicated cases.CONCLUSION Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions.Increased clinician awareness,coupled with judicious use of imaging,facilitates timely diagnosis and appropriate management,ensuring optimal patient outcomes.展开更多
BACKGROUND Complete appendiceal intussusception(CAI)coexisting with appendiceal tumor represents an exceptionally rare clinical tumor.This study presented a retrospective analysis of a case involving CAI complicated b...BACKGROUND Complete appendiceal intussusception(CAI)coexisting with appendiceal tumor represents an exceptionally rare clinical tumor.This study presented a retrospective analysis of a case involving CAI complicated by appendiceal mucinous tumor,supplemented by a review of 10 previously reported cases to distill diagnostic and therapeutic insights.CASE SUMMARY A 74-year-old male patient presented with abdominal pain.Abdominal contrastenhanced computed tomography(CECT)initially suggested a colonic tumor with intussusception.Colonoscopy identified a mass in the colon 60 cm from the anus.Intraoperative exploration confirmed CAI secondary to an appendiceal neoplasm.The patient underwent laparoscopic right hemicolectomy with regional lymphadenectomy under general anesthesia.Postoperative recovery was uneventful,and the patient was discharged 9 days post-surgery.Twelve-month follow-up revealed no evidence of recurrence or metastasis.CONCLUSION Plain abdominal computed tomography may underestimate the presence of CAI and appendiceal mucinous tumor,whereas CECT significantly improves diagnostic accuracy.Preoperative suspicion of appendiceal malignancy should be entertained in cases of CAI.In the absence of definitive biopsy results,intraoperative frozen section analysis is recommended to guide radical resection.展开更多
BACKGROUND Low-grade appendiceal mucinous neoplasms(LAMNs)are a class of histolo-gically well-differentiated adenomas that can proliferate outside the appendix in the form of malignant tumours,resulting in the accumul...BACKGROUND Low-grade appendiceal mucinous neoplasms(LAMNs)are a class of histolo-gically well-differentiated adenomas that can proliferate outside the appendix in the form of malignant tumours,resulting in the accumulation of external appen-diceal mucus.They may present as an extra-appendiceal mass-like bulge,mucus or polypoid tissue at the appendiceal orifice,or even with abdominal dissem-ination.The surgical approach is usually appendectomy,ileocecal resection or right hemicolectomy.It is essential to raise awareness of LAMNs and choose an appropriate treatment.CASE SUMMARY A 68-year-old man underwent a routine physical examination at our hospital on May 17,2022.The patient had no symptoms of abdominal pain,bloating,or weight loss,and his tumour marker levels were normal.The faecal occult blood test was negative,and no abnormalities were identified on physical examination.Colonoscopy revealed a submucosal protrusion at the appendiceal orifice.During endoscopic ultrasound,uneven echoes were observed in the appendix cavity.A contrast-enhanced computed tomography scan of the abdomen revealed a nodular thickening at the base of the appendix,with a diameter of approximately 1 cm.When all the examination results were considered,we suspected the lesion to be an appendiceal mucinous tumour.Laparoscopic surgery was performed using the double purse-string suture method.Postoperative pathology suggested a low-grade mucinous cystadenoma of the appendix with no involvement of the margins.A repeat colonoscopy 18 months after surgery revealed no significant abnormality at the appendiceal orifice.A contrast-enhanced computed tomography scan of the abdomen suggested only postoperative changes.CONCLUSION This study describes a case of LAMN that was treated by resecting the mass at the appendiceal orifice via the double purse-string suture technique and provides new insights on the diagnosis and treatment of LAMNs.展开更多
Appendiceal mucinous neoplasms(AMNs)are rare tumors originating from mucin-producing epithelial cells of the appendix.They can exhibit both benign and malignant behavior.They are often incidentally discovered during a...Appendiceal mucinous neoplasms(AMNs)are rare tumors originating from mucin-producing epithelial cells of the appendix.They can exhibit both benign and malignant behavior.They are often incidentally discovered during appendectomy.Clinical presentation ranges from asymptomatic to mimicking acute appendicitis.Histologically,noninvasive AMNs are classified as low-grade AMNs(LAMNs)or high-grade AMNs(HAMNs),whereas invasive tumors are categorized as mucinous adenocarcinomas.Although LAMNs and HAMNs are generally nonmalignant,rupture can lead to pseudomyxoma peritonei(PMP).Surgical resection is the primary diagnostic and therapeutic approach,with intraoperative assessment to prevent rupture.Treatment strategies vary based on findings and include appendectomy,right hemicolectomy,and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.Histological diagnosis relies on mucin detection,and immunohistochemical markers such as cytokeratin 20(diffusely positive),cytokeratin 7(often negative),mucin 5AC,and special ATrich sequence-binding protein 2 assist in characterization.Molecular profiling frequently identifies KRAS,GNAS,and TP53 mutations.KRAS mutations are generally associated with a favorable prognosis,whereas GNAS and TP53 mutations correlate with poorer survival outcomes.These findings highlight the potential role of molecular profiling in guiding treatment strategies for AMN and PMP.展开更多
BACKGROUND Ileocecal laterally spreading tumors(LSTs)complicated by appendiceal tubular adenoma are rare and challenging to diagnose because of the absence of typical symptoms and specific diagnostic signs.Traditional...BACKGROUND Ileocecal laterally spreading tumors(LSTs)complicated by appendiceal tubular adenoma are rare and challenging to diagnose because of the absence of typical symptoms and specific diagnostic signs.Traditionally,the primary treatment has been laparoscopic appendectomy(LA).CASE SUMMARY A 63-year-old female presented with changes in bowel habits.Colonoscopy revealed an ileocecal LST.The patient underwent endoscopic submucosal dissection.Postoperative follow-up colonoscopy revealed mucosal elevation at the appendiceal orifice,with pathology confirming tubular adenoma.Abdominal computed tomography indicated a suspicious appendiceal tumor,leading to LA with partial cecectomy.The postoperative recovery was uneventful.At the 1-year follow-up,colonoscopy revealed no evidence of tumor recurrence.CONCLUSION Ileocecal LSTs with appendiceal tubular adenomas are traditionally treated with LA.endoscopic submucosal dissection can also yield favorable outcomes.展开更多
BACKGROUND Laparoscopic appendectomy(LA)is the standard treatment for acute appendicitis in children,offering reduced postoperative pain and quicker recovery compared to open surgery.A critical aspect of LA is the sec...BACKGROUND Laparoscopic appendectomy(LA)is the standard treatment for acute appendicitis in children,offering reduced postoperative pain and quicker recovery compared to open surgery.A critical aspect of LA is the secure closure of the appendiceal stump to avoid complications such as leakage and abscess formation.Various closure techniques are employed,including endoloops(ELs),staplers,clips,and energy devices;however,the optimal method remains unclear due to inconsistent evidence.AIM To systematically evaluate and rank the effectiveness and safety of different appendiceal stump closure techniques used in pediatric LA.By assessing outcomes such as postoperative complications,operative time,and length of hospital stay,this analysis seeks to provide evidence-based guidance to clarify clinical decision-making and optimize patient care.METHODS This systematic review and network meta-analysis,conducted according to PRISMA and Cochrane guidelines,compared the effectiveness and safety of stump closure methods in pediatric LA.Databases searched included PubMed,Cochrane Central,Web of Science,and Scopus up to May 1,2025.Eligible studies included both randomized and non-randomized designs reporting surgical outcomes in pediatric patients.Two reviewers independently extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale.A frequentist network meta-analysis with a random-effects model was conducted using R software to evaluate total complications(primary outcome),as well as operative time and hospital stay(secondary outcomes).P-scores were used to rank the effectiveness of treatments.RESULTS Fourteen studies comprising over 50000 pediatric patients were included in the network meta-analysis comparing appendiceal stump closure techniques in LA.No significant differences in total postoperative complications or hospital stay were observed among techniques,including EL,endostapler,polymer clip,LigaSure,harmonic scalpel(HS),and sutures.HS showed a statistically significant reduction in operative time compared to EL(mean difference:-13.5 minutes),while other methods did not demonstrate significant time savings.No technique was associated with a statistically significant increase or decrease in postoperative complications or length of stay.Publication bias was minimal,and the methodological quality of included studies was moderate to good.CONCLUSION While all closure techniques show similar safety profiles,HS offers shorter operating times.These findings support tailoring stump closure method selection based on operative efficiency and resource availability.展开更多
Some studies have reported that approximately 50%of appendiceal lesions are sessile serrated lesions(SSLs).Traditionally,surgical intervention has been the preferred method.Endoscopic procedures such as endoscopic muc...Some studies have reported that approximately 50%of appendiceal lesions are sessile serrated lesions(SSLs).Traditionally,surgical intervention has been the preferred method.Endoscopic procedures such as endoscopic mucosal resection(EMR)serve as alternative treatments for lesions at the appendiceal orifice(AO).However,EMR is not appropriate when the lesion margin within the AO cannot be visualized.When lesions extend into the lumen,extended laparoscopic appendectomy(ELA)or combined surgery can be used to resect the lesions.Compared with traditional surgery and EMR,ELA or combined surgery is a safer and more precise option that preserves the function of the ileocecal region.However,the need for coordination between surgeons and endoscopists,along with the requirement for staged procedures and multiple bowel preparations,increases the complexity of the treatment.In recent years,with the advancement of endoscopic full-thickness resection,endoscopic transcecal appendectomy(ETA)has been used to treat SSLs involving the AO.The use of choledochoscopy in conjunction with ETA can further enhance treatment precision.This integrated approach holds promise for replacing the combined endoscopic and laparoscopic surgical techniques.However,additional data are required to confirm its safety and efficacy.展开更多
Acellular mucin refers to pools of mucin without epithelial component,oftentimes harboring inflammatory cells.Acellular mucin can be observed in both neoplastic and non-neoplastic lower gastrointestinal(GI)conditions....Acellular mucin refers to pools of mucin without epithelial component,oftentimes harboring inflammatory cells.Acellular mucin can be observed in both neoplastic and non-neoplastic lower gastrointestinal(GI)conditions.While mucinous neoplasms are classified and staged using established guidelines,interobserver variability occurs when acellular mucin pools are encountered,leading to inconsistent interpretation and staging.In particular,acellular mucin found in regional lymph nodes of colorectal adenocarcinoma patients who have not received treatment presents a diagnostic challenge,as its prognostic implication is not clearly defined.Acellular mucin is also commonly seen in treated colorectal adenocarcinoma,post neoadjuvant therapy.Although acellular mucin is not counted toward T or N staging in this setting,variation in how pathologists report and stage these cases persists.Acellular mucin can also be seen in non-neoplastic specimens,such as those from interval appendectomies,appendiceal diverticula,colonic diverticulitis,volvulus,and Crohn’s disease where it may mimic a neoplastic lesion.Acellular mucin in this setting is often a byproduct of inflammation,increased luminal pressure,and mural defect.This review highlights the clinical relevance and diagnostic complexity of acellular mucin in pathologic conditions of the lower GI tract.Further studies are needed to clarify its prognostic value and develop standardized guidelines.展开更多
BACKGROUND Low-grade appendiceal mucinous neoplasms are papillary or flat mucinous tumors with low-grade cytologic atypia.They are the most frequent source of pseudomyxoma peritonei.They can be easily misdiagnosed,due...BACKGROUND Low-grade appendiceal mucinous neoplasms are papillary or flat mucinous tumors with low-grade cytologic atypia.They are the most frequent source of pseudomyxoma peritonei.They can be easily misdiagnosed,due to unspecific symptoms,with acute appendicitis,retroperitoneal tumors or adnexal mass.Cases of huge appendiceal mucinous neoplasms are even more extremely rare.CASE SUMMARY We report a 54-year-old patient who presented with a 10-month history of constant dull distension accompanied by nausea.A surgical procedure of total hysterectomy,bilateral adnexectomy,appendectomy,greater omentectomy and right hemicolectomy was performed as a result of the findings on ultrasound,computed tomography scan and magnetic resonance imaging.Diagnosis was made after the pathological examination,which revealed low-grade appendiceal mucinous neoplasm.The patient received hyperthermic intraperitoneal chemotherapy with cisplatin and was discharged from the hospital.CONCLUSION Low-grade appendiceal mucinous adenomas are rare tumors that are easily misdiagnosed,and a more thorough clinical workup is required to make a defi-nitive diagnosis.展开更多
BACKGROUND Appendiceal signet-ring cell carcinoma(SRCC)with terminal ileum metastasis is extremely rare.There have been no reported cases in domestic and foreign literature.CASE SUMMARY In this case report,we present ...BACKGROUND Appendiceal signet-ring cell carcinoma(SRCC)with terminal ileum metastasis is extremely rare.There have been no reported cases in domestic and foreign literature.CASE SUMMARY In this case report,we present an 88-year-old man with appendiceal SRCC with terminal ileum metastasis.The tumour stage was stage pT4bN2M1bG3 IVB,and the Tumour,Node,Metastasis staging system was used.The patient was admitted to our hospital on 12 July,2022 and underwent laparoscopic appendectomy under general anaesthesia after the examination.The pathological examination that took place 1 week after the operation showed that SRCC of the appendix invaded the whole layer,vessels and nerves of the appendix wall.It was suggested that the primary appendix should be considered after excluding metastasis.Based on the postoperative pathology findings,the patient underwent a secondary surgery on 2 August,2022.The second pathological examination showed residual SRCC in the appendiceal area of the ileocecal region,which infiltrated the serosal fibres and adipose tissue of the ileocecal region to the surface mesothelium.The tumour infiltrated the whole layer of the ileum wall,serosa fibres,adipose tissue and the surface mesothelium.Postoperative follow-up showed no signs of tumour recurrence or metastasis.CONCLUSION In clinical practice,a heightened awareness of rare diseases,coupled with thorough intraoperative exploration and rapid pathological examination,enables more accurate judgments,potentially sparing patients from unnecessary secondary surgery and ensuring optimal treatment.展开更多
BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)is an emerging technique.However,its efficacy remains uncertain,and postoperative complications often exacerbate inflammation,thereby increasing the difficult...BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)is an emerging technique.However,its efficacy remains uncertain,and postoperative complications often exacerbate inflammation,thereby increasing the difficulty of surgery.The use of ERAT in appendicitis remains contentious,prompting the presentation of this case report.CASE SUMMARY We report the case of a 43-year-old female patient presenting with intermittent right lower abdominal pain for one day.The patient had undergone ERAT six months previously.Examination revealed stent impaction in the appendix,leading to exacerbated inflammation.Subsequently,a solo single-incision laparo-scopic appendectomy(SSLA)was performed.The ERAT-related complications increased surgical difficulty and prolonged the operation time.Post-SSLA,the patient was hospitalized for one day and showed favorable recovery upon follow-up.CONCLUSION This case highlights the risks of ERAT.Thorough preoperative assessment,proper stent placement during surgery and regular postoperative follow-up are crucial in preventing complications,as their occurrence can increase surgical difficulty.Compared to ERAT,SSLA remains more widely used in clinical practice.Both techniques require further clinical data and research to optimize their application.展开更多
AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data ...AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gan- grenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out. RESULTS: A total of 912 males and 709 females, from16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell non-hodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy. CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases.展开更多
Mucinous cystadenoma of the appendix is a rare condition and represents one of the three entities with the common name mucocele of the appendix. It is characterized by a cystic dilatation of the lumen with stasis of m...Mucinous cystadenoma of the appendix is a rare condition and represents one of the three entities with the common name mucocele of the appendix. It is characterized by a cystic dilatation of the lumen with stasis of mucus inside it. Histopathologically mucocele is divided into three groups： focal or diffuse mucosal hyperplasia, mucinous cystadenoma and mucinous cystadenocarcinoma. This condition is often associated with other neoplasia, especially adenocarcinoma of the colon and ovaries. We here describe a 57 year old male patient who presented with abdominal discomfort, constipation, fresh blood in stool and frequent urination. He had a big cystadenoma of the appendix associated with adenocarcinoma of the colon and hepatocellular carcinoma of the liver. The patient underwent right haemicolectomy, sigmoid colon resection and segmental resection of the liven Now 3 years later he has no evidence of disease relapse. According to this, we stress the need of accurate preoperative diagnosis and intraoperative exploration of the whole abdomen in these patients.展开更多
Goblet cell carcinoid is an enigmatic and rare tumor involving the appendix almost exclusively. Since its identification in 1969, understanding of this disease has evolved greatly, but issues regarding its histogenesi...Goblet cell carcinoid is an enigmatic and rare tumor involving the appendix almost exclusively. Since its identification in 1969, understanding of this disease has evolved greatly, but issues regarding its histogenesis, nomenclature and management are still conjectural. The published English language literature from 1966 to 2009 was retrieved via PubMed and reviewed. Various other names have been used for this entity such as adenocarcinoid, mucinous carcinoid, crypt cell carcinoma, and mucin-producing neuroendocrine tumor, although none have been found to be completely satisfactory or universally accepted. The tumor is thought to arise from pluripotent intestinal epithelial crypt-base stem cells by dual neuroendocrine and mucinous differentiation. GCCs present in the fifth to sixth decade and show no definite sex predominance. The most common clinical presentation is acute appendicitis, followed by abdominal pain and a mass. Fifty percent of the female patients present with ovarian metastases. The histologic hallmark of this entity is the presence of clusters of goblet cells in the lamina propria or submucosa stain for various neuroendocrine markers, though the intensity is often patchy. Atypia is usually minimal, but carcinomatous growth patterns may be seen. These may be of signet ring cell type or poorly differentiated adenocarcinoma. Recently molecular studies have shown these tumors to lack the signatures of adenocarcinoma but they have some changes similar to that of ileal carcinoids (allelic loss of chromosome 11q, 16q and 18q). The natural history of GCC is intermediate between carcinoids and adenocarcinomas of the appendix. The 5-year overall survival is 76%. The most important prognostic factor is the stage of disease. Appendectomy and right hemicolectomy are the main modalities of treatment, followed by adjuvant chemotherapy in select cases. There is some debate about the surgical approach for these tumors, and a summary of published series and recommendations are provided.展开更多
Microcystic/reticular schwannoma is a recently described variant of schwannoma with a predilection for the gastrointestinal tract. Due to overlapping features with other tumors, unawareness of this tumor type may lead...Microcystic/reticular schwannoma is a recently described variant of schwannoma with a predilection for the gastrointestinal tract. Due to overlapping features with other tumors, unawareness of this tumor type may lead to diagnostic and therapeutic pitfalls. We here report a case of microcystic/reticular schwannoma arising in the meso-appendix of a 43-year-old woman. The tumor was incidentally discovered by computed tomography scan for unrelated reasons. A laparoscopic operation was performed shortly after admission. Histological examination revealed a circumscribed tumor with a striking microcystic and cribriform architecture. Immunohistochemically, the tumor cells were diffusely positive for S100 protein, glial fibrillary acid protein and protein gene product 9.5, which were consistent with a peripheral nerve sheath tumor. The patient remains well with no signs of recurrence at a 10-mo follow-up. To our knowledge, this is the first case of microcystic/reticular schwannoma arising in the meso-appendix. Albeit very rare, microcystic/reticular schwannoma should be included in the differential diagnosis of appendiceal tumors.展开更多
The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned.Furthermore,emergency appendicectomy for appendiceal mass is increasingly performed ...The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned.Furthermore,emergency appendicectomy for appendiceal mass is increasingly performed with equal success and safety to that performed in non-mass forming acute appendicitis.There is an increasing volume of evidence-although mostly retrospective-that if traditional conservative management is adopted,there is no need for routine I.A except for a small number of patients who continue to develop recurrent symptoms.On the other hand,the routine adoption of emergency laparoscopic appendicectomy (LA) in patients presenting with appendiceal mass obviates the need for a second admission and an operation for I.A with a considerable complication rate.It also abolishes misdiagnoses and deals promptly with any unexpected ileo-cecal pathology.Moreover,it may prove to be more cost-effective than conservative treatment even without I.A due to a much shorter hospital stay and a shorter period of intravenous antibiotic administration.If emergency LA is to become the standard of care for appendiceal mass,I.A will certainly become 'something' of the past.展开更多
Non-carcinoid appendiceal malignancies are rare entities,representing less than 0.5% of all gastrointestinal malignancies.Because of their rarity and particular biological behavior,a substantial number of patients aff...Non-carcinoid appendiceal malignancies are rare entities,representing less than 0.5% of all gastrointestinal malignancies.Because of their rarity and particular biological behavior,a substantial number of patients affected by these neoplasms do not receive appropriate surgical resection.In this report,we describe a rare case of primary signetring cell carcinoma of the appendix with peritoneal seeding which occurred in a 40-year old man admitted at the Emergency Surgery Department with the clinical suspicion of acute appendicitis.After a surgical debulking and right hemicolectomy,the patient had systemic chemotherapy according to FOLFOX protocol.After completion of the latter,the patient underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.This report offers a brief review of the literature and suggests an algorithm for the management of non-carci-noid appendiceal tumors with peritoneal dissemination.展开更多
Pseudomyxoma peritonei (PMP) is an uncommon "bor-derline malignancy" generally arising from a perforated appendiceal epithelial tumour. Optimal treatment involves a combination of cytoreductive surgery (CRS)...Pseudomyxoma peritonei (PMP) is an uncommon "bor-derline malignancy" generally arising from a perforated appendiceal epithelial tumour. Optimal treatment involves a combination of cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC). Controversy persists regarding the pathological classification and its prognostic value. Computed tomography scanning is the optimal preoperative staging technique. Tumour marker elevations correlate with worse prognosis and increased recurrence rates. Following CRS with HIPEC, 5-year survival ranges from 62.5% to 100% for low grade, and 0%-65% for high grade disease. Treat-ment related morbidity and mortality ranges from 12 to 67.6%, and 0 to 9%, respectively. Surgery and HIPEC are the optimal treatment for PMP which is at best a "borderline" peritoneal malignancy.展开更多
Primary adenocarcinoma of the appendix is a rare malignancy that constitutes 〈 0.5% of all gastrointestinal neoplasms. Moreover, primary signet ring cell carc noma of the appendix is an exceedingly rare entity. We ha...Primary adenocarcinoma of the appendix is a rare malignancy that constitutes 〈 0.5% of all gastrointestinal neoplasms. Moreover, primary signet ring cell carc noma of the appendix is an exceedingly rare entity. We have encountered 15 cases of primary appendiceal cancer among 3389 patients who underwent appen- dectomy over the past 18 years. In the present report, we describe a rare case of primary signet ring cell carcinoma of the appendix with ovarian metastases and unresectable peritoneal dissemination occurring in a 67-year-old female patient. She underwent ap- pendectomy and bilateral salpingo-oophorectomy with a laparoscopy procedure. She then received palliative systemic chemotherapy with 12 cycles of oxaliplatin, 5-flurorouracil, and leucovorin （FOIFOX-4）. The patient currently is well without progression of disease 12 mo after beginning chemotherapy.展开更多
AIM: To study the clinical features and computed tomography(CT) findings of appendiceal diverticulitis vs acute appendicitis.METHODS: We retrospectively reviewed the records of 451 patients who had undergone appendect...AIM: To study the clinical features and computed tomography(CT) findings of appendiceal diverticulitis vs acute appendicitis.METHODS: We retrospectively reviewed the records of 451 patients who had undergone appendectomy inour in stitution from January 2007 to September 2012. Patient demographics, clinical features, pathological findings, and surgical outcomes were analyzed. We also compared preoperative CT images of 25 patients with appendiceal diverticulitis with those of 25 patients with acute appendicitis.RESULTS: Among 451 patients, 44(9.7%) were diagnosed to have appendiceal diverticulitis and 398(86.9%) to have acute appendicitis. Patients with appendiceal diverticulitis were older(59 vs 37 years, P < 0.001) and had a longer duration of the illness(4.0 d vs 1.0 d, P < 0.001). Perforation rates in patients with appendiceal diverticulitis were higher(68% vs 27%, P < 0.001). The appendix could be visualized in only 13 patients(52%) among the appendiceal diverticulitis cases, but in all acute appendicitis cases. CT findings suggestive of appendiceal diverticulitis included the absence of fluid collection in the appendix(84% vs 12%, P < 0.001), absence of appendicolith(92% vs 52%, P = 0.005), and formation of abscess(68% vs 16%, P < 0.001). Appendiceal diverticula were identified in 6 patients(24%).CONCLUSION: Among patients who had undergone appendectomy, 9.7% had appendiceal diverticulitis. Patients with appendiceal diverticulitis had different clinical features and CT findings from patients with acute appendicitis.展开更多
文摘BACKGROUND Epiploic appendagitis is a rare,often underrecognized cause of acute abdominal pain.Misdiagnosis can lead to unnecessary hospitalization,antibiotic use,or surgical intervention.Advances in imaging have improved the recognition of this self-limiting condition,but clinical awareness remains critical.AIM To provide a comprehensive update on the epidemiology,anatomy,pathogenesis,clinical presentation,diagnostic strategies,differential diagnosis,and management of epiploic appendagitis,emphasizing its distinguishing features from other causes of acute abdomen.METHODS A review of the literature was conducted,focusing on the clinical characteristics,imaging findings,differential diagnoses,and evidence-based management strategies for epiploic appendagitis.RESULTS Epiploic appendagitis typically presents with acute,localized,non-radiating abdominal pain without significant systemic symptoms.Diagnosis is heavily reliant on imaging,with computed tomography(CT)being the gold standard.Hallmark CT findings include a small,fat-density ovoid lesion adjacent to the colon,with the usual characteristic ring and dot signs.Differential diagnoses include mainly diverticulitis,appendicitis,omental infarction,and many other causes.Management is predominantly conservative with nonsteroidal anti-inflammatory drugs and observation,reserving surgical intervention for rare,complicated cases.CONCLUSION Recognizing the clinical and imaging features of epiploic appendagitis is essential to avoid unnecessary interventions.Increased clinician awareness,coupled with judicious use of imaging,facilitates timely diagnosis and appropriate management,ensuring optimal patient outcomes.
文摘BACKGROUND Complete appendiceal intussusception(CAI)coexisting with appendiceal tumor represents an exceptionally rare clinical tumor.This study presented a retrospective analysis of a case involving CAI complicated by appendiceal mucinous tumor,supplemented by a review of 10 previously reported cases to distill diagnostic and therapeutic insights.CASE SUMMARY A 74-year-old male patient presented with abdominal pain.Abdominal contrastenhanced computed tomography(CECT)initially suggested a colonic tumor with intussusception.Colonoscopy identified a mass in the colon 60 cm from the anus.Intraoperative exploration confirmed CAI secondary to an appendiceal neoplasm.The patient underwent laparoscopic right hemicolectomy with regional lymphadenectomy under general anesthesia.Postoperative recovery was uneventful,and the patient was discharged 9 days post-surgery.Twelve-month follow-up revealed no evidence of recurrence or metastasis.CONCLUSION Plain abdominal computed tomography may underestimate the presence of CAI and appendiceal mucinous tumor,whereas CECT significantly improves diagnostic accuracy.Preoperative suspicion of appendiceal malignancy should be entertained in cases of CAI.In the absence of definitive biopsy results,intraoperative frozen section analysis is recommended to guide radical resection.
基金Supported by Jinhua City Science and Technology Plan Projects“Improve the Polarization of Cancer-related Fatigue:Clinical Efficacy Study”,No.2018-4-049.
文摘BACKGROUND Low-grade appendiceal mucinous neoplasms(LAMNs)are a class of histolo-gically well-differentiated adenomas that can proliferate outside the appendix in the form of malignant tumours,resulting in the accumulation of external appen-diceal mucus.They may present as an extra-appendiceal mass-like bulge,mucus or polypoid tissue at the appendiceal orifice,or even with abdominal dissem-ination.The surgical approach is usually appendectomy,ileocecal resection or right hemicolectomy.It is essential to raise awareness of LAMNs and choose an appropriate treatment.CASE SUMMARY A 68-year-old man underwent a routine physical examination at our hospital on May 17,2022.The patient had no symptoms of abdominal pain,bloating,or weight loss,and his tumour marker levels were normal.The faecal occult blood test was negative,and no abnormalities were identified on physical examination.Colonoscopy revealed a submucosal protrusion at the appendiceal orifice.During endoscopic ultrasound,uneven echoes were observed in the appendix cavity.A contrast-enhanced computed tomography scan of the abdomen revealed a nodular thickening at the base of the appendix,with a diameter of approximately 1 cm.When all the examination results were considered,we suspected the lesion to be an appendiceal mucinous tumour.Laparoscopic surgery was performed using the double purse-string suture method.Postoperative pathology suggested a low-grade mucinous cystadenoma of the appendix with no involvement of the margins.A repeat colonoscopy 18 months after surgery revealed no significant abnormality at the appendiceal orifice.A contrast-enhanced computed tomography scan of the abdomen suggested only postoperative changes.CONCLUSION This study describes a case of LAMN that was treated by resecting the mass at the appendiceal orifice via the double purse-string suture technique and provides new insights on the diagnosis and treatment of LAMNs.
文摘Appendiceal mucinous neoplasms(AMNs)are rare tumors originating from mucin-producing epithelial cells of the appendix.They can exhibit both benign and malignant behavior.They are often incidentally discovered during appendectomy.Clinical presentation ranges from asymptomatic to mimicking acute appendicitis.Histologically,noninvasive AMNs are classified as low-grade AMNs(LAMNs)or high-grade AMNs(HAMNs),whereas invasive tumors are categorized as mucinous adenocarcinomas.Although LAMNs and HAMNs are generally nonmalignant,rupture can lead to pseudomyxoma peritonei(PMP).Surgical resection is the primary diagnostic and therapeutic approach,with intraoperative assessment to prevent rupture.Treatment strategies vary based on findings and include appendectomy,right hemicolectomy,and cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.Histological diagnosis relies on mucin detection,and immunohistochemical markers such as cytokeratin 20(diffusely positive),cytokeratin 7(often negative),mucin 5AC,and special ATrich sequence-binding protein 2 assist in characterization.Molecular profiling frequently identifies KRAS,GNAS,and TP53 mutations.KRAS mutations are generally associated with a favorable prognosis,whereas GNAS and TP53 mutations correlate with poorer survival outcomes.These findings highlight the potential role of molecular profiling in guiding treatment strategies for AMN and PMP.
文摘BACKGROUND Ileocecal laterally spreading tumors(LSTs)complicated by appendiceal tubular adenoma are rare and challenging to diagnose because of the absence of typical symptoms and specific diagnostic signs.Traditionally,the primary treatment has been laparoscopic appendectomy(LA).CASE SUMMARY A 63-year-old female presented with changes in bowel habits.Colonoscopy revealed an ileocecal LST.The patient underwent endoscopic submucosal dissection.Postoperative follow-up colonoscopy revealed mucosal elevation at the appendiceal orifice,with pathology confirming tubular adenoma.Abdominal computed tomography indicated a suspicious appendiceal tumor,leading to LA with partial cecectomy.The postoperative recovery was uneventful.At the 1-year follow-up,colonoscopy revealed no evidence of tumor recurrence.CONCLUSION Ileocecal LSTs with appendiceal tubular adenomas are traditionally treated with LA.endoscopic submucosal dissection can also yield favorable outcomes.
文摘BACKGROUND Laparoscopic appendectomy(LA)is the standard treatment for acute appendicitis in children,offering reduced postoperative pain and quicker recovery compared to open surgery.A critical aspect of LA is the secure closure of the appendiceal stump to avoid complications such as leakage and abscess formation.Various closure techniques are employed,including endoloops(ELs),staplers,clips,and energy devices;however,the optimal method remains unclear due to inconsistent evidence.AIM To systematically evaluate and rank the effectiveness and safety of different appendiceal stump closure techniques used in pediatric LA.By assessing outcomes such as postoperative complications,operative time,and length of hospital stay,this analysis seeks to provide evidence-based guidance to clarify clinical decision-making and optimize patient care.METHODS This systematic review and network meta-analysis,conducted according to PRISMA and Cochrane guidelines,compared the effectiveness and safety of stump closure methods in pediatric LA.Databases searched included PubMed,Cochrane Central,Web of Science,and Scopus up to May 1,2025.Eligible studies included both randomized and non-randomized designs reporting surgical outcomes in pediatric patients.Two reviewers independently extracted data and assessed the risk of bias using the Newcastle-Ottawa Scale.A frequentist network meta-analysis with a random-effects model was conducted using R software to evaluate total complications(primary outcome),as well as operative time and hospital stay(secondary outcomes).P-scores were used to rank the effectiveness of treatments.RESULTS Fourteen studies comprising over 50000 pediatric patients were included in the network meta-analysis comparing appendiceal stump closure techniques in LA.No significant differences in total postoperative complications or hospital stay were observed among techniques,including EL,endostapler,polymer clip,LigaSure,harmonic scalpel(HS),and sutures.HS showed a statistically significant reduction in operative time compared to EL(mean difference:-13.5 minutes),while other methods did not demonstrate significant time savings.No technique was associated with a statistically significant increase or decrease in postoperative complications or length of stay.Publication bias was minimal,and the methodological quality of included studies was moderate to good.CONCLUSION While all closure techniques show similar safety profiles,HS offers shorter operating times.These findings support tailoring stump closure method selection based on operative efficiency and resource availability.
文摘Some studies have reported that approximately 50%of appendiceal lesions are sessile serrated lesions(SSLs).Traditionally,surgical intervention has been the preferred method.Endoscopic procedures such as endoscopic mucosal resection(EMR)serve as alternative treatments for lesions at the appendiceal orifice(AO).However,EMR is not appropriate when the lesion margin within the AO cannot be visualized.When lesions extend into the lumen,extended laparoscopic appendectomy(ELA)or combined surgery can be used to resect the lesions.Compared with traditional surgery and EMR,ELA or combined surgery is a safer and more precise option that preserves the function of the ileocecal region.However,the need for coordination between surgeons and endoscopists,along with the requirement for staged procedures and multiple bowel preparations,increases the complexity of the treatment.In recent years,with the advancement of endoscopic full-thickness resection,endoscopic transcecal appendectomy(ETA)has been used to treat SSLs involving the AO.The use of choledochoscopy in conjunction with ETA can further enhance treatment precision.This integrated approach holds promise for replacing the combined endoscopic and laparoscopic surgical techniques.However,additional data are required to confirm its safety and efficacy.
文摘Acellular mucin refers to pools of mucin without epithelial component,oftentimes harboring inflammatory cells.Acellular mucin can be observed in both neoplastic and non-neoplastic lower gastrointestinal(GI)conditions.While mucinous neoplasms are classified and staged using established guidelines,interobserver variability occurs when acellular mucin pools are encountered,leading to inconsistent interpretation and staging.In particular,acellular mucin found in regional lymph nodes of colorectal adenocarcinoma patients who have not received treatment presents a diagnostic challenge,as its prognostic implication is not clearly defined.Acellular mucin is also commonly seen in treated colorectal adenocarcinoma,post neoadjuvant therapy.Although acellular mucin is not counted toward T or N staging in this setting,variation in how pathologists report and stage these cases persists.Acellular mucin can also be seen in non-neoplastic specimens,such as those from interval appendectomies,appendiceal diverticula,colonic diverticulitis,volvulus,and Crohn’s disease where it may mimic a neoplastic lesion.Acellular mucin in this setting is often a byproduct of inflammation,increased luminal pressure,and mural defect.This review highlights the clinical relevance and diagnostic complexity of acellular mucin in pathologic conditions of the lower GI tract.Further studies are needed to clarify its prognostic value and develop standardized guidelines.
基金Supported by the National Natural Science Foundation of China,No.82204123.
文摘BACKGROUND Low-grade appendiceal mucinous neoplasms are papillary or flat mucinous tumors with low-grade cytologic atypia.They are the most frequent source of pseudomyxoma peritonei.They can be easily misdiagnosed,due to unspecific symptoms,with acute appendicitis,retroperitoneal tumors or adnexal mass.Cases of huge appendiceal mucinous neoplasms are even more extremely rare.CASE SUMMARY We report a 54-year-old patient who presented with a 10-month history of constant dull distension accompanied by nausea.A surgical procedure of total hysterectomy,bilateral adnexectomy,appendectomy,greater omentectomy and right hemicolectomy was performed as a result of the findings on ultrasound,computed tomography scan and magnetic resonance imaging.Diagnosis was made after the pathological examination,which revealed low-grade appendiceal mucinous neoplasm.The patient received hyperthermic intraperitoneal chemotherapy with cisplatin and was discharged from the hospital.CONCLUSION Low-grade appendiceal mucinous adenomas are rare tumors that are easily misdiagnosed,and a more thorough clinical workup is required to make a defi-nitive diagnosis.
文摘BACKGROUND Appendiceal signet-ring cell carcinoma(SRCC)with terminal ileum metastasis is extremely rare.There have been no reported cases in domestic and foreign literature.CASE SUMMARY In this case report,we present an 88-year-old man with appendiceal SRCC with terminal ileum metastasis.The tumour stage was stage pT4bN2M1bG3 IVB,and the Tumour,Node,Metastasis staging system was used.The patient was admitted to our hospital on 12 July,2022 and underwent laparoscopic appendectomy under general anaesthesia after the examination.The pathological examination that took place 1 week after the operation showed that SRCC of the appendix invaded the whole layer,vessels and nerves of the appendix wall.It was suggested that the primary appendix should be considered after excluding metastasis.Based on the postoperative pathology findings,the patient underwent a secondary surgery on 2 August,2022.The second pathological examination showed residual SRCC in the appendiceal area of the ileocecal region,which infiltrated the serosal fibres and adipose tissue of the ileocecal region to the surface mesothelium.The tumour infiltrated the whole layer of the ileum wall,serosa fibres,adipose tissue and the surface mesothelium.Postoperative follow-up showed no signs of tumour recurrence or metastasis.CONCLUSION In clinical practice,a heightened awareness of rare diseases,coupled with thorough intraoperative exploration and rapid pathological examination,enables more accurate judgments,potentially sparing patients from unnecessary secondary surgery and ensuring optimal treatment.
基金Supported by National Key R and D Program of China-Key Special Project on Diagnostic and Therapeutic Equipment and Biomedical Materials,No.2023YFC2412005。
文摘BACKGROUND Endoscopic retrograde appendicitis therapy(ERAT)is an emerging technique.However,its efficacy remains uncertain,and postoperative complications often exacerbate inflammation,thereby increasing the difficulty of surgery.The use of ERAT in appendicitis remains contentious,prompting the presentation of this case report.CASE SUMMARY We report the case of a 43-year-old female patient presenting with intermittent right lower abdominal pain for one day.The patient had undergone ERAT six months previously.Examination revealed stent impaction in the appendix,leading to exacerbated inflammation.Subsequently,a solo single-incision laparo-scopic appendectomy(SSLA)was performed.The ERAT-related complications increased surgical difficulty and prolonged the operation time.Post-SSLA,the patient was hospitalized for one day and showed favorable recovery upon follow-up.CONCLUSION This case highlights the risks of ERAT.Thorough preoperative assessment,proper stent placement during surgery and regular postoperative follow-up are crucial in preventing complications,as their occurrence can increase surgical difficulty.Compared to ERAT,SSLA remains more widely used in clinical practice.Both techniques require further clinical data and research to optimize their application.
文摘AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gan- grenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out. RESULTS: A total of 912 males and 709 females, from16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell non-hodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy. CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases.
文摘Mucinous cystadenoma of the appendix is a rare condition and represents one of the three entities with the common name mucocele of the appendix. It is characterized by a cystic dilatation of the lumen with stasis of mucus inside it. Histopathologically mucocele is divided into three groups： focal or diffuse mucosal hyperplasia, mucinous cystadenoma and mucinous cystadenocarcinoma. This condition is often associated with other neoplasia, especially adenocarcinoma of the colon and ovaries. We here describe a 57 year old male patient who presented with abdominal discomfort, constipation, fresh blood in stool and frequent urination. He had a big cystadenoma of the appendix associated with adenocarcinoma of the colon and hepatocellular carcinoma of the liver. The patient underwent right haemicolectomy, sigmoid colon resection and segmental resection of the liven Now 3 years later he has no evidence of disease relapse. According to this, we stress the need of accurate preoperative diagnosis and intraoperative exploration of the whole abdomen in these patients.
文摘Goblet cell carcinoid is an enigmatic and rare tumor involving the appendix almost exclusively. Since its identification in 1969, understanding of this disease has evolved greatly, but issues regarding its histogenesis, nomenclature and management are still conjectural. The published English language literature from 1966 to 2009 was retrieved via PubMed and reviewed. Various other names have been used for this entity such as adenocarcinoid, mucinous carcinoid, crypt cell carcinoma, and mucin-producing neuroendocrine tumor, although none have been found to be completely satisfactory or universally accepted. The tumor is thought to arise from pluripotent intestinal epithelial crypt-base stem cells by dual neuroendocrine and mucinous differentiation. GCCs present in the fifth to sixth decade and show no definite sex predominance. The most common clinical presentation is acute appendicitis, followed by abdominal pain and a mass. Fifty percent of the female patients present with ovarian metastases. The histologic hallmark of this entity is the presence of clusters of goblet cells in the lamina propria or submucosa stain for various neuroendocrine markers, though the intensity is often patchy. Atypia is usually minimal, but carcinomatous growth patterns may be seen. These may be of signet ring cell type or poorly differentiated adenocarcinoma. Recently molecular studies have shown these tumors to lack the signatures of adenocarcinoma but they have some changes similar to that of ileal carcinoids (allelic loss of chromosome 11q, 16q and 18q). The natural history of GCC is intermediate between carcinoids and adenocarcinomas of the appendix. The 5-year overall survival is 76%. The most important prognostic factor is the stage of disease. Appendectomy and right hemicolectomy are the main modalities of treatment, followed by adjuvant chemotherapy in select cases. There is some debate about the surgical approach for these tumors, and a summary of published series and recommendations are provided.
基金Supported by National Key Clinical Specialty Project and Key Clinical Program of the Chinese Ministry of Health and the National Natural Science Foundation of China,No.81272630
文摘Microcystic/reticular schwannoma is a recently described variant of schwannoma with a predilection for the gastrointestinal tract. Due to overlapping features with other tumors, unawareness of this tumor type may lead to diagnostic and therapeutic pitfalls. We here report a case of microcystic/reticular schwannoma arising in the meso-appendix of a 43-year-old woman. The tumor was incidentally discovered by computed tomography scan for unrelated reasons. A laparoscopic operation was performed shortly after admission. Histological examination revealed a circumscribed tumor with a striking microcystic and cribriform architecture. Immunohistochemically, the tumor cells were diffusely positive for S100 protein, glial fibrillary acid protein and protein gene product 9.5, which were consistent with a peripheral nerve sheath tumor. The patient remains well with no signs of recurrence at a 10-mo follow-up. To our knowledge, this is the first case of microcystic/reticular schwannoma arising in the meso-appendix. Albeit very rare, microcystic/reticular schwannoma should be included in the differential diagnosis of appendiceal tumors.
文摘The need for interval appendicectomy (I.A) after successful conservative management of appendiceal mass has recently been questioned.Furthermore,emergency appendicectomy for appendiceal mass is increasingly performed with equal success and safety to that performed in non-mass forming acute appendicitis.There is an increasing volume of evidence-although mostly retrospective-that if traditional conservative management is adopted,there is no need for routine I.A except for a small number of patients who continue to develop recurrent symptoms.On the other hand,the routine adoption of emergency laparoscopic appendicectomy (LA) in patients presenting with appendiceal mass obviates the need for a second admission and an operation for I.A with a considerable complication rate.It also abolishes misdiagnoses and deals promptly with any unexpected ileo-cecal pathology.Moreover,it may prove to be more cost-effective than conservative treatment even without I.A due to a much shorter hospital stay and a shorter period of intravenous antibiotic administration.If emergency LA is to become the standard of care for appendiceal mass,I.A will certainly become 'something' of the past.
文摘Non-carcinoid appendiceal malignancies are rare entities,representing less than 0.5% of all gastrointestinal malignancies.Because of their rarity and particular biological behavior,a substantial number of patients affected by these neoplasms do not receive appropriate surgical resection.In this report,we describe a rare case of primary signetring cell carcinoma of the appendix with peritoneal seeding which occurred in a 40-year old man admitted at the Emergency Surgery Department with the clinical suspicion of acute appendicitis.After a surgical debulking and right hemicolectomy,the patient had systemic chemotherapy according to FOLFOX protocol.After completion of the latter,the patient underwent cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy.This report offers a brief review of the literature and suggests an algorithm for the management of non-carci-noid appendiceal tumors with peritoneal dissemination.
文摘Pseudomyxoma peritonei (PMP) is an uncommon "bor-derline malignancy" generally arising from a perforated appendiceal epithelial tumour. Optimal treatment involves a combination of cytoreductive surgery (CRS) with heated intraperitoneal chemotherapy (HIPEC). Controversy persists regarding the pathological classification and its prognostic value. Computed tomography scanning is the optimal preoperative staging technique. Tumour marker elevations correlate with worse prognosis and increased recurrence rates. Following CRS with HIPEC, 5-year survival ranges from 62.5% to 100% for low grade, and 0%-65% for high grade disease. Treat-ment related morbidity and mortality ranges from 12 to 67.6%, and 0 to 9%, respectively. Surgery and HIPEC are the optimal treatment for PMP which is at best a "borderline" peritoneal malignancy.
文摘Primary adenocarcinoma of the appendix is a rare malignancy that constitutes 〈 0.5% of all gastrointestinal neoplasms. Moreover, primary signet ring cell carc noma of the appendix is an exceedingly rare entity. We have encountered 15 cases of primary appendiceal cancer among 3389 patients who underwent appen- dectomy over the past 18 years. In the present report, we describe a rare case of primary signet ring cell carcinoma of the appendix with ovarian metastases and unresectable peritoneal dissemination occurring in a 67-year-old female patient. She underwent ap- pendectomy and bilateral salpingo-oophorectomy with a laparoscopy procedure. She then received palliative systemic chemotherapy with 12 cycles of oxaliplatin, 5-flurorouracil, and leucovorin （FOIFOX-4）. The patient currently is well without progression of disease 12 mo after beginning chemotherapy.
文摘AIM: To study the clinical features and computed tomography(CT) findings of appendiceal diverticulitis vs acute appendicitis.METHODS: We retrospectively reviewed the records of 451 patients who had undergone appendectomy inour in stitution from January 2007 to September 2012. Patient demographics, clinical features, pathological findings, and surgical outcomes were analyzed. We also compared preoperative CT images of 25 patients with appendiceal diverticulitis with those of 25 patients with acute appendicitis.RESULTS: Among 451 patients, 44(9.7%) were diagnosed to have appendiceal diverticulitis and 398(86.9%) to have acute appendicitis. Patients with appendiceal diverticulitis were older(59 vs 37 years, P < 0.001) and had a longer duration of the illness(4.0 d vs 1.0 d, P < 0.001). Perforation rates in patients with appendiceal diverticulitis were higher(68% vs 27%, P < 0.001). The appendix could be visualized in only 13 patients(52%) among the appendiceal diverticulitis cases, but in all acute appendicitis cases. CT findings suggestive of appendiceal diverticulitis included the absence of fluid collection in the appendix(84% vs 12%, P < 0.001), absence of appendicolith(92% vs 52%, P = 0.005), and formation of abscess(68% vs 16%, P < 0.001). Appendiceal diverticula were identified in 6 patients(24%).CONCLUSION: Among patients who had undergone appendectomy, 9.7% had appendiceal diverticulitis. Patients with appendiceal diverticulitis had different clinical features and CT findings from patients with acute appendicitis.
