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
AIM:To present a comprehensive analysis of incidence,clinicopathological features,appropriateness of surgical procedures,and survival for adenocarcinoma of the appendix.METHODS:A retrospective case analysis was conduc...AIM:To present a comprehensive analysis of incidence,clinicopathological features,appropriateness of surgical procedures,and survival for adenocarcinoma of the appendix.METHODS:A retrospective case analysis was conducted for the 10-year period 1998-2008.All patients diagnosed with adenocarcinoma of the appendix were analyzed for their demographics details,clinical features,tumor incidence and characteristics,tumor stage,surgical procedures performed,and their survival.RESULTS:Nine thousand three hundred and twentythree patients underwent appendectomies during the study period,and of these,10 (0.1%:8 men and 2 women with a mean age of 53.1 years,age range 21-83 years) were found to have primary adenocarcinoma of the appendix.Appendicular neoplasia was not suspected pre-operatively in any of the patients.Six (60%) patients underwent secondary right hemicolectomy.Four (40%) cases had appendectomy alone,and two of them died,whereas all those who underwent right hemicolectomy are alive and disease free.Five (50%) were reported to have grade 1 disease,three (30%) grade 2,and two (20%) grade 3 with mean survival of 34,48,and 22 mo,respectively.Six (60%) patients presented with advanced disease (Duke's C and D).At the end of follow up (mean period:37.9 mo),eight patients are alive and disease free at the end of follow up.Overall mean survival was 36.3 mo (conf idence interval;16%-56%) with 41.3 and 16 mo for men and women,respectively.Mean survival for those with and without lymph node involvement was 33.6 and 40.2 mo,respectively.Right hemicolectomy gave better results than appendectomy alone,although the difference was not statistically signif icant due to the small number of cases.CONCLUSION:Adenocarcinoma of the appendix is extremely rare neoplasm with varied presentations,and is usually advanced when diagnosed.Right hemicolectomy is the treatment of choice for such tumors.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
Malignant neoplasms of the appendix are rare and represent less than 1% of gastrointestinal cancers.Goblet cell carcinoids(GCC) tumors are a distinctive group of heterogeneous appendiceal neoplasm that exhibit unique ...Malignant neoplasms of the appendix are rare and represent less than 1% of gastrointestinal cancers.Goblet cell carcinoids(GCC) tumors are a distinctive group of heterogeneous appendiceal neoplasm that exhibit unique clinical and pathologic features.This review focuses on the current diagnostic procedures,pathogenesis,possible signaling mechanisms and treatment options for GCC.Perspectives for future research are discussed.The tumor likely arises from pluripotent intestinal epithelial crypt base stem cells.Previous findings of Notch signaling as a tumor suppressor in Neuroendocrine tumors may have a similar role in this tumor too.Loss of Notch signaling may be the driver mutation with other successive downstream mutations likely favors them into progressing and behavior similar to poorly differentiated adenocarcinoma with minimal neuroendocrine differentiation.A multidisciplinary approach is suggested for optimal outcomes.Surgery remains the main treatment modality.Simple appendectomy may be sufficient in early stages while right hemicolectomy is recommended for advanced tumors.Cytoreductive surgery with heated intraperitoneal chemotherapy may improve survival in a select few with metastatic peritoneal disease.These tumors have an unpredictable behavior even in early stages and local recurrence and delayed metastases may be seen.Lifelong surveillance is warranted.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 Duplication of the appendix is an infrequent congenital malformation with a complex classification.The horseshoe appendix is a subtype of the duplex appendix and is rarely reported in the literature.Endomet...BACKGROUND Duplication of the appendix is an infrequent congenital malformation with a complex classification.The horseshoe appendix is a subtype of the duplex appendix and is rarely reported in the literature.Endometriosis is a common gynecological disease that rarely occurs in the appendix.Moreover,horseshoe appendix combined with endometriosis has not been previously reported.CASE SUMMARY Here,we describe a 44-year-old woman who was admitted with a 1-d history of migratory lower right quadrant pain.Physical examination was consistent with the signs of acute appendicitis.The patient underwent an emergency exploratory laparotomy.The distal tip of the appendix was in contact with the cecum by another base,or“horseshoe appendix”.In addition,a small intestinal mass and an ovarian mass were identified.Subsequently,appendectomy,partial resection of the small intestine,and right oophorectomy were successively performed.The histopathology confirmed the diagnosis of acute inflammation of the duplex appendix with endometriosis,small intestine endometriosis,and ovarian endometriosis.CONCLUSION Surgeons need to be aware of the possibility of the duplex appendix when performing an appendectomy,and this study emphasizes the importance of exploring the entire abdomen.展开更多
Primary adenocarcinoma of the appendix is a rare malignancythat constitutes < 0.5% of all gastroin-testinalneoplasms. Moreover, primary signet ring cell carcinomaof the appendix is an exceedingly rare entity. In th...Primary adenocarcinoma of the appendix is a rare malignancythat constitutes < 0.5% of all gastroin-testinalneoplasms. Moreover, primary signet ring cell carcinomaof the appendix is an exceedingly rare entity. In the present report, we describe a rare case of primary signet ring cell carcinoma of the appendix with ovarian metastasesand unresectable peritoneal dissemination occurring in a 45-year-old female patient. She was clinically misdiagnosed as torsion of ovarian cyst. She underwent appendicectomy and unilateral salpingooophorectomy.Histopathology revealed signet ring cell carcinoma and a right hemicolectomy was done. She then received palliative systemic chemotherapy with 12 cycles of oxaliplatin, 5-fluorouracil, and leucovorin(FOLFOX-4). The patient is doing well till today on follow up without progression of disease 10 mo after beginning chemotherapy.展开更多
Double cecal appendix is a rare anatomical variation. Approximately 100 cases have been reported worldwide. It is usually diagnosed incidentally during emergency appendectomies due to inflammatory processes in the cec...Double cecal appendix is a rare anatomical variation. Approximately 100 cases have been reported worldwide. It is usually diagnosed incidentally during emergency appendectomies due to inflammatory processes in the cecal appendix. Case presentation: male, white, 36 years old, obese, presenting with pain in the lower abdomen for 24 h followed by nausea, vomiting and mild fever. He was subjected to additional tests, with the leukogram showing leukocytosis and abdominal ultrasonography depicting cecal appendix with thickened wall, locally associated with small quantities of liquid and intestinal loop obstruction. He underwent laparotomy, revealing acute appendicitis. Another intestinal loop obstruction was identified next to the ileum, leading to recognizing another cecal appendix after local dissection. Double appendectomy and segmental iliectomy were performed although not needed. Results of the anatomopathological examination of the surgical samples showed acute inflammation in the two cecal appendices. So, performing a routine retroperitoneal release and a complete cecum evaluation during such surgical procedures is recommended and suggested due to the possibility of not identifying a second cecal appendix.展开更多
BACKGROUND:Ultrasound has the first line investigation role in the diagnosis of acute appendicitis in children.The purpose of this study was to perform a quality assessment review on the visualization rate of appendix...BACKGROUND:Ultrasound has the first line investigation role in the diagnosis of acute appendicitis in children.The purpose of this study was to perform a quality assessment review on the visualization rate of appendix on ultrasound in children in the community hospital setting.METHODS:A retrospective chart review of the abdominal ultrasound findings for the visualization of the appendix was performed on paediatric patients ranging from 5 to 18 years.Data were collected from the two community hospitals of Toronto by using hospital electronic medical record for the ultrasound findings in patients presented with abdominal pain.RESULTS:Data from two community hospitals indicated visualization rate of the appendix as 11.0%and 23.2%for site 1 and site 2 respectively.In cases where the ultrasound was repeated the visualization rate remains the same.A two-proportion z-test was performed to find whether the visualization of appendix increases the likelihood of diagnosing appendicitis.The results revealed that the visualization of an appendix(P=0.52),significantly improved the diagnosis of appendicitis(z=34,P<0.001).CONCLUSION:Visualization of an appendix on ultrasound increases the likelihood of correctly diagnosing appendicitis.In our study,we found low visualization rate of appendix on ultrasound that could be the result of many factors that contribute towards the low visualization rate of an appendix on ultrasound.Hence,the challenges in identifying appendix should be minimized to improve the visualization and diagnosis of appendicitis on ultrasound.展开更多
BACKGROUND Despite negligible absorption of elemental mercury after acute ingestion,retention in the appendix with subsequent local and systemic complications is possible. We present a case of elemental mercury seques...BACKGROUND Despite negligible absorption of elemental mercury after acute ingestion,retention in the appendix with subsequent local and systemic complications is possible. We present a case of elemental mercury sequestration in the appendix,managed by laparoscopic appendectomy.CASE SUMMARY A 57-year-old Caucasian female was found unconscious following application of long-lasting insulin detemir and ingestion of elemental mercury in a suicidal attempt. Diagnostic investigations revealed several radiopaque collections in the gastrointestinal(GI) tract and elevated mercury levels in the blood. Much of the ingested elemental mercury was eliminated from the GI tract with stools stimulated by several enemas. However, a significant amount of mercury remained sequestrated in the appendix despite all conservative measures.Consequently, following deliberations by an interdisciplinary team of specialists,laparoscopic appendectomy was performed 29 d after the mercury ingestion. The surgery itself and postoperative course were uneventful.CONCLUSION Since conservative measures are often unsuccessful in the management of mercury retention in the appendix, surgery remains a compelling option to prevent possible associated complications.展开更多
Neuroendocrine neoplasms are the most common epithelial tumors among appendix tumors. Appendix tumors that are completely or partially composed of neuroendocrine cells are divided into two categories: Classic carcinoi...Neuroendocrine neoplasms are the most common epithelial tumors among appendix tumors. Appendix tumors that are completely or partially composed of neuroendocrine cells are divided into two categories: Classic carcinoid tumors and goblet cell carcinoid tumors(GCCT). They are known to progress more aggressively than classic(neuro) endocrine tumors. In this study, three cases with acute appendicitis symptoms are presented, including their clinical and histopathological findings. Microscopic examination detected GCCT in two cases and mixed adenoneuroendocrine carcinoma in one case, in addition to acute appendicitis.展开更多
BACKGROUND Neuroendocrine tumors of appendix(ANETs)known as carcinoids,are rare endocrine neoplasms originated from enterochromaffin cells of gastrointestinal tract.ANETs are the third most frequent(16.7%)gastrointest...BACKGROUND Neuroendocrine tumors of appendix(ANETs)known as carcinoids,are rare endocrine neoplasms originated from enterochromaffin cells of gastrointestinal tract.ANETs are the third most frequent(16.7%)gastrointestinal neuroendocrine tumors,with the incidence of 0.08-0.2 cases/100000 during one year.Incidental ANETs occur in 0.2%-0.7%of emergency surgical resections because of suspected appendicitis which is usually the first manifestation of ANET.Although there are a lot of papers about application of somatostatin receptor scintigraphy in gastrointestinal neuroendocrine tumors,there are very rare sporadic cases described about ANETs particularly.AIM To establish the role of somatostatin receptor scintigraphy(SRS)in the management of patients with neuroendocrine tumors of appendix(ANET).METHODS The total of 35 patients was investigated,23 females and 12 males,average age(43.7±17.3 years).All patients had histological diagnosis of ANET(34 carcinoids of appendix and one tubular carcinoid).Majority of tumors have been found incidentally during surgery of:Acute appendicitis(n=15),perforated appendicitis(n=2),ileus(n=3),hysterectomy(n=3),ruptured ovarian cyst(n=2),caecal volvulus(n=1),while 9 patients had diagnosis of appendiceal tumor before the surgery.Seventeen patients had tumor grade(G)G1,12 G2 and 6 G3.The right hemicolectomy was performed in 13,while the rest of the patients had appendectomy only.SRS was done early(2 h)and late(24 h)after i.v.application of 740 MBq technetium-99 m ethylenediamine-N,N’-diacetic acid Hydrazinonicotinyl-Tyr3-Octreotide(technetium-99 m-Tektrotyd,Polatom,Poland).SRS was performed for restaging in all the patients after surgery.RESULTS There were 12 true positive(TP),19 true negative,3 false positive and 1 false negative SRS result.Sensitivity of the method was 92.31%,specificity was 86.36%,positive predictive value was 80.00%,negative predictive value was 95.00%and accuracy 88.57%.Receiver operating characteristics analysis showed that SRS scintigraphy is a good test for detection TP cases[area under the curve of 0.850,95%confidence interval(CI):0.710-0.990,P<001].Single photon emission computed tomography contributed diagnosis in 7 TP findings.In 10 patients Krenning score was 4 and in 2 was 3.In 8 patients SRS significantly changed the management of the patients(in two surgery was repeated,in 4 somatostatin analogues and in two peptide receptor radionuclide therapy).Median progression-free survival in SRS positive patients was 52 months(95%CI:39.7-117.3 mo)while in SRS negative patients it was 60 months(95%CI:42.8-77.1 mo),without statistically significant difference between the two groups(P=0.434).CONCLUSION In conclusion,our results confirmed the value of SRS in the follow-up of the patients with ANET after surgery,if recurrences or metastases are suspected.展开更多
Epiploic appendages can become ischemic and infarcted, which can present acute abdominal pain that mimics other diseases, such as diverticulitis or appendicitis. Particularly, inflammation of an epiploic appendage att...Epiploic appendages can become ischemic and infarcted, which can present acute abdominal pain that mimics other diseases, such as diverticulitis or appendicitis. Particularly, inflammation of an epiploic appendage attached to the vermiform appendix is a very rare cause of acute abdominal pain, and it is difficult to diagnose this condition preoperatively. We present a case of epiploic appendagitis of the vermiform appendix that was identified with a typical radiologic image and was pathologically confirmed. In addition, we review the literature of similar cases and analyze the clinical and radiologic features of EA of the vermiform appendix.展开更多
Acute appendicitis,which requires immediate surgical intervention,is an important diagnosis in patients with acute abdomen.However,developmental abnormalities may interfere with the preoperative diagnosis and surgical...Acute appendicitis,which requires immediate surgical intervention,is an important diagnosis in patients with acute abdomen.However,developmental abnormalities may interfere with the preoperative diagnosis and surgical treatment in some cases.Agenesis and atresia of the cecal vermiform appendix is an extremely rare clinical diagnosis.In addition,preoperative diagnosis may be difficult in some cases.Thus,diagnosis of the congenital absence of the vermiform appendix requires a thorough exploration of the retrocecal and ileocecal regions.A 59-year-old male was admitted from the emergency services with right lower abdominal pain.A celiotomy was performed with the suspicion of acute appendicitis.However,an atresia of the vermiform appendix was observed.The patient's appendix was thus removed.Pathological examination confirmed suppurative appendicitis.This case underlines the importance of the clinical entity for surgeons who may deal with a similar case.展开更多
Ingested foreign bodies are rarely impacted in the appendix.They may be clinically latent or cause complications such as appendicitis or intestinal perforation,thus requiring prompt and appropriate therapy.A case is r...Ingested foreign bodies are rarely impacted in the appendix.They may be clinically latent or cause complications such as appendicitis or intestinal perforation,thus requiring prompt and appropriate therapy.A case is reported of a psychiatric,but in other respects asymptomatic,patient who presented with an ingested metal key deeply impacted within the appendix.The patient underwent urgent coloscopy for retrieval.Initially all conventional endoscopic instruments proved ineffective and the key was finally extracted using a simple manoeuvre, described herein.展开更多
Mucocele of the appendix due to endometriosis is extremely rare,and there are only 10 previously reported cases in the English literature.We report a case of mucocele of the appendix due to endometriosis and provide t...Mucocele of the appendix due to endometriosis is extremely rare,and there are only 10 previously reported cases in the English literature.We report a case of mucocele of the appendix due to endometriosis and provide the first review of the literature.A 43-year-old woman was admitted to the hospital because of recurrent right lower abdominal pain during her menstrual periods.Colonoscopy revealed submucosal tumorlike elevations of the appendiceal orifice.Computed tomography and magnetic resonance imaging of the abdomen suggested cystic lesions near the appendix.Consequently,mucocele of the appendix was suspected preoperatively.An open ileocecal resection was performed.Multiple cystic lesions were observed around the appendix.The cystic lesions contained mucus.Histopathological examination was consistent with a mucocele of the appendix due to endometriosis.The postoperative course was uneventful.We present the first review of the literature to clarify the clinical features.展开更多
BACKGROUND Acute epiploic appendagitis of the appendix (AEAA) is a rare self-limiting inflammatory disorder of the epiploic appendages (EA) close to the vermiform appendix, which often times mimicking the presentation...BACKGROUND Acute epiploic appendagitis of the appendix (AEAA) is a rare self-limiting inflammatory disorder of the epiploic appendages (EA) close to the vermiform appendix, which often times mimicking the presentation of acute appendicitis (AA). To date, very few cases of AEAA have been reported. We report a case of a 52-year old man with the clinical suspicion of AA, but post-operative specimen examination confirmed AEAA as the final diagnosis. CASE SUMMARY A 52-year-old morbidly obese man presented to the emergency department with a 1-d history of the right lower quadrant (RLQ) abdominal pain. Physical examination revealed localized RLQ tenderness mimicking AA. The computed tomography abdomen was inconclusive, and a decision was made to perform laparoscopic appendectomy (LA). During the LA, an infarcted epiploic appendage at the tip of appendix and adherent to the abdominal wall was found, which was entirely excised. Final pathology showed congested and hemorrhagic epiploic appendage without any accompanied acute inflammatory changes in the wall of the appendix. Postoperative course was uneventful and he was doing well at seven months follow-up. CONCLUSION The possibility of AEAA should be considered in patients clinically suspected of having AA. Surgery is considered for those refractory to conservative management, with inconclusive diagnosis or develop complications at presentation.展开更多
[Objectives] The aim was to analyze the effect of Salvia miltiorrhiza injection combined with laparoscopic reduction on the degree of appendix injury in intussusception.[Methods]Seventy-four children with intussuscept...[Objectives] The aim was to analyze the effect of Salvia miltiorrhiza injection combined with laparoscopic reduction on the degree of appendix injury in intussusception.[Methods]Seventy-four children with intussusception who were treated in the Xuchang Municipal Hospital from August 2014 to August 2017 were randomly and evenly divided into two groups,control group and treatment group.The children in the control group were treated by laparoscopic reduction,and those in the treatment group were treated with S.miltiorrhiza injection combined with laparoscopic reduction.The clinical effect on intussusception in the children was compared between the two groups.[Results] Before treatment,no significant difference was founding serum NO level between the control and treatment groups(P > 0.05).On Day 1,3 and 5 of treatment,the serum NO levels of the treatment group[(74.16 ± 6.81),(61.98 ± 4.77) and(54.76 ± 4.36) μmol/L] were significantly lower than those of the control group[(89.67 ± 6.34),(84.75 ± 5.21) and(71.95 ± 4.58) μmol/L](P < 0.05).After treatment,the TNF-α and IL-6 levels of the treatment group[(184.32 ± 10.67) and(332.16 ± 34.17) pg/m L] were significantly lower than those of the control group[(268.26 ± 12.74) and(438.23 ± 35.26) pg/m L](P < 0.05);and the Chiu score of the treatment group(2.34 ± 1.12) was also significantly lower than that of the control group(4.85 ± 1.67)(P < 0.05).[Conclusions]For children with intussusception,S.miltiorrhiza injection combined with laparoscopic reduction is effective in reducing serum NO level and reducing the degree of appendix injury,which is worthy of clinical application.展开更多
A new plate-to-plate method for performanceprediction of azeotropic distillation processes isdeveloped.Azeotropic distillation is character-ized by the strong interaction among componentsand by a samll number of compo...A new plate-to-plate method for performanceprediction of azeotropic distillation processes isdeveloped.Azeotropic distillation is character-ized by the strong interaction among componentsand by a samll number of components involved.By plate-to-plate method,the number of intera-rive variables depends only on the number ofcomponents,therefore a combination of theplate-to-plate approach and the Newton-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AIM:To present a comprehensive analysis of incidence,clinicopathological features,appropriateness of surgical procedures,and survival for adenocarcinoma of the appendix.METHODS:A retrospective case analysis was conducted for the 10-year period 1998-2008.All patients diagnosed with adenocarcinoma of the appendix were analyzed for their demographics details,clinical features,tumor incidence and characteristics,tumor stage,surgical procedures performed,and their survival.RESULTS:Nine thousand three hundred and twentythree patients underwent appendectomies during the study period,and of these,10 (0.1%:8 men and 2 women with a mean age of 53.1 years,age range 21-83 years) were found to have primary adenocarcinoma of the appendix.Appendicular neoplasia was not suspected pre-operatively in any of the patients.Six (60%) patients underwent secondary right hemicolectomy.Four (40%) cases had appendectomy alone,and two of them died,whereas all those who underwent right hemicolectomy are alive and disease free.Five (50%) were reported to have grade 1 disease,three (30%) grade 2,and two (20%) grade 3 with mean survival of 34,48,and 22 mo,respectively.Six (60%) patients presented with advanced disease (Duke's C and D).At the end of follow up (mean period:37.9 mo),eight patients are alive and disease free at the end of follow up.Overall mean survival was 36.3 mo (conf idence interval;16%-56%) with 41.3 and 16 mo for men and women,respectively.Mean survival for those with and without lymph node involvement was 33.6 and 40.2 mo,respectively.Right hemicolectomy gave better results than appendectomy alone,although the difference was not statistically signif icant due to the small number of cases.CONCLUSION:Adenocarcinoma of the appendix is extremely rare neoplasm with varied presentations,and is usually advanced when diagnosed.Right hemicolectomy is the treatment of choice for such tumors.
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.
文摘Malignant neoplasms of the appendix are rare and represent less than 1% of gastrointestinal cancers.Goblet cell carcinoids(GCC) tumors are a distinctive group of heterogeneous appendiceal neoplasm that exhibit unique clinical and pathologic features.This review focuses on the current diagnostic procedures,pathogenesis,possible signaling mechanisms and treatment options for GCC.Perspectives for future research are discussed.The tumor likely arises from pluripotent intestinal epithelial crypt base stem cells.Previous findings of Notch signaling as a tumor suppressor in Neuroendocrine tumors may have a similar role in this tumor too.Loss of Notch signaling may be the driver mutation with other successive downstream mutations likely favors them into progressing and behavior similar to poorly differentiated adenocarcinoma with minimal neuroendocrine differentiation.A multidisciplinary approach is suggested for optimal outcomes.Surgery remains the main treatment modality.Simple appendectomy may be sufficient in early stages while right hemicolectomy is recommended for advanced tumors.Cytoreductive surgery with heated intraperitoneal chemotherapy may improve survival in a select few with metastatic peritoneal disease.These tumors have an unpredictable behavior even in early stages and local recurrence and delayed metastases may be seen.Lifelong surveillance is warranted.
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.
基金Supported by Department of Science and Technology of Jiaxing,No.2017AY33037
文摘BACKGROUND Duplication of the appendix is an infrequent congenital malformation with a complex classification.The horseshoe appendix is a subtype of the duplex appendix and is rarely reported in the literature.Endometriosis is a common gynecological disease that rarely occurs in the appendix.Moreover,horseshoe appendix combined with endometriosis has not been previously reported.CASE SUMMARY Here,we describe a 44-year-old woman who was admitted with a 1-d history of migratory lower right quadrant pain.Physical examination was consistent with the signs of acute appendicitis.The patient underwent an emergency exploratory laparotomy.The distal tip of the appendix was in contact with the cecum by another base,or“horseshoe appendix”.In addition,a small intestinal mass and an ovarian mass were identified.Subsequently,appendectomy,partial resection of the small intestine,and right oophorectomy were successively performed.The histopathology confirmed the diagnosis of acute inflammation of the duplex appendix with endometriosis,small intestine endometriosis,and ovarian endometriosis.CONCLUSION Surgeons need to be aware of the possibility of the duplex appendix when performing an appendectomy,and this study emphasizes the importance of exploring the entire abdomen.
文摘Primary adenocarcinoma of the appendix is a rare malignancythat constitutes < 0.5% of all gastroin-testinalneoplasms. Moreover, primary signet ring cell carcinomaof the appendix is an exceedingly rare entity. In the present report, we describe a rare case of primary signet ring cell carcinoma of the appendix with ovarian metastasesand unresectable peritoneal dissemination occurring in a 45-year-old female patient. She was clinically misdiagnosed as torsion of ovarian cyst. She underwent appendicectomy and unilateral salpingooophorectomy.Histopathology revealed signet ring cell carcinoma and a right hemicolectomy was done. She then received palliative systemic chemotherapy with 12 cycles of oxaliplatin, 5-fluorouracil, and leucovorin(FOLFOX-4). The patient is doing well till today on follow up without progression of disease 10 mo after beginning chemotherapy.
文摘Double cecal appendix is a rare anatomical variation. Approximately 100 cases have been reported worldwide. It is usually diagnosed incidentally during emergency appendectomies due to inflammatory processes in the cecal appendix. Case presentation: male, white, 36 years old, obese, presenting with pain in the lower abdomen for 24 h followed by nausea, vomiting and mild fever. He was subjected to additional tests, with the leukogram showing leukocytosis and abdominal ultrasonography depicting cecal appendix with thickened wall, locally associated with small quantities of liquid and intestinal loop obstruction. He underwent laparotomy, revealing acute appendicitis. Another intestinal loop obstruction was identified next to the ileum, leading to recognizing another cecal appendix after local dissection. Double appendectomy and segmental iliectomy were performed although not needed. Results of the anatomopathological examination of the surgical samples showed acute inflammation in the two cecal appendices. So, performing a routine retroperitoneal release and a complete cecum evaluation during such surgical procedures is recommended and suggested due to the possibility of not identifying a second cecal appendix.
文摘BACKGROUND:Ultrasound has the first line investigation role in the diagnosis of acute appendicitis in children.The purpose of this study was to perform a quality assessment review on the visualization rate of appendix on ultrasound in children in the community hospital setting.METHODS:A retrospective chart review of the abdominal ultrasound findings for the visualization of the appendix was performed on paediatric patients ranging from 5 to 18 years.Data were collected from the two community hospitals of Toronto by using hospital electronic medical record for the ultrasound findings in patients presented with abdominal pain.RESULTS:Data from two community hospitals indicated visualization rate of the appendix as 11.0%and 23.2%for site 1 and site 2 respectively.In cases where the ultrasound was repeated the visualization rate remains the same.A two-proportion z-test was performed to find whether the visualization of appendix increases the likelihood of diagnosing appendicitis.The results revealed that the visualization of an appendix(P=0.52),significantly improved the diagnosis of appendicitis(z=34,P<0.001).CONCLUSION:Visualization of an appendix on ultrasound increases the likelihood of correctly diagnosing appendicitis.In our study,we found low visualization rate of appendix on ultrasound that could be the result of many factors that contribute towards the low visualization rate of an appendix on ultrasound.Hence,the challenges in identifying appendix should be minimized to improve the visualization and diagnosis of appendicitis on ultrasound.
文摘BACKGROUND Despite negligible absorption of elemental mercury after acute ingestion,retention in the appendix with subsequent local and systemic complications is possible. We present a case of elemental mercury sequestration in the appendix,managed by laparoscopic appendectomy.CASE SUMMARY A 57-year-old Caucasian female was found unconscious following application of long-lasting insulin detemir and ingestion of elemental mercury in a suicidal attempt. Diagnostic investigations revealed several radiopaque collections in the gastrointestinal(GI) tract and elevated mercury levels in the blood. Much of the ingested elemental mercury was eliminated from the GI tract with stools stimulated by several enemas. However, a significant amount of mercury remained sequestrated in the appendix despite all conservative measures.Consequently, following deliberations by an interdisciplinary team of specialists,laparoscopic appendectomy was performed 29 d after the mercury ingestion. The surgery itself and postoperative course were uneventful.CONCLUSION Since conservative measures are often unsuccessful in the management of mercury retention in the appendix, surgery remains a compelling option to prevent possible associated complications.
文摘Neuroendocrine neoplasms are the most common epithelial tumors among appendix tumors. Appendix tumors that are completely or partially composed of neuroendocrine cells are divided into two categories: Classic carcinoid tumors and goblet cell carcinoid tumors(GCCT). They are known to progress more aggressively than classic(neuro) endocrine tumors. In this study, three cases with acute appendicitis symptoms are presented, including their clinical and histopathological findings. Microscopic examination detected GCCT in two cases and mixed adenoneuroendocrine carcinoma in one case, in addition to acute appendicitis.
基金Ministry of Science,Education and Technology Republic of Serbia,No. 175018。
文摘BACKGROUND Neuroendocrine tumors of appendix(ANETs)known as carcinoids,are rare endocrine neoplasms originated from enterochromaffin cells of gastrointestinal tract.ANETs are the third most frequent(16.7%)gastrointestinal neuroendocrine tumors,with the incidence of 0.08-0.2 cases/100000 during one year.Incidental ANETs occur in 0.2%-0.7%of emergency surgical resections because of suspected appendicitis which is usually the first manifestation of ANET.Although there are a lot of papers about application of somatostatin receptor scintigraphy in gastrointestinal neuroendocrine tumors,there are very rare sporadic cases described about ANETs particularly.AIM To establish the role of somatostatin receptor scintigraphy(SRS)in the management of patients with neuroendocrine tumors of appendix(ANET).METHODS The total of 35 patients was investigated,23 females and 12 males,average age(43.7±17.3 years).All patients had histological diagnosis of ANET(34 carcinoids of appendix and one tubular carcinoid).Majority of tumors have been found incidentally during surgery of:Acute appendicitis(n=15),perforated appendicitis(n=2),ileus(n=3),hysterectomy(n=3),ruptured ovarian cyst(n=2),caecal volvulus(n=1),while 9 patients had diagnosis of appendiceal tumor before the surgery.Seventeen patients had tumor grade(G)G1,12 G2 and 6 G3.The right hemicolectomy was performed in 13,while the rest of the patients had appendectomy only.SRS was done early(2 h)and late(24 h)after i.v.application of 740 MBq technetium-99 m ethylenediamine-N,N’-diacetic acid Hydrazinonicotinyl-Tyr3-Octreotide(technetium-99 m-Tektrotyd,Polatom,Poland).SRS was performed for restaging in all the patients after surgery.RESULTS There were 12 true positive(TP),19 true negative,3 false positive and 1 false negative SRS result.Sensitivity of the method was 92.31%,specificity was 86.36%,positive predictive value was 80.00%,negative predictive value was 95.00%and accuracy 88.57%.Receiver operating characteristics analysis showed that SRS scintigraphy is a good test for detection TP cases[area under the curve of 0.850,95%confidence interval(CI):0.710-0.990,P<001].Single photon emission computed tomography contributed diagnosis in 7 TP findings.In 10 patients Krenning score was 4 and in 2 was 3.In 8 patients SRS significantly changed the management of the patients(in two surgery was repeated,in 4 somatostatin analogues and in two peptide receptor radionuclide therapy).Median progression-free survival in SRS positive patients was 52 months(95%CI:39.7-117.3 mo)while in SRS negative patients it was 60 months(95%CI:42.8-77.1 mo),without statistically significant difference between the two groups(P=0.434).CONCLUSION In conclusion,our results confirmed the value of SRS in the follow-up of the patients with ANET after surgery,if recurrences or metastases are suspected.
文摘Epiploic appendages can become ischemic and infarcted, which can present acute abdominal pain that mimics other diseases, such as diverticulitis or appendicitis. Particularly, inflammation of an epiploic appendage attached to the vermiform appendix is a very rare cause of acute abdominal pain, and it is difficult to diagnose this condition preoperatively. We present a case of epiploic appendagitis of the vermiform appendix that was identified with a typical radiologic image and was pathologically confirmed. In addition, we review the literature of similar cases and analyze the clinical and radiologic features of EA of the vermiform appendix.
文摘Acute appendicitis,which requires immediate surgical intervention,is an important diagnosis in patients with acute abdomen.However,developmental abnormalities may interfere with the preoperative diagnosis and surgical treatment in some cases.Agenesis and atresia of the cecal vermiform appendix is an extremely rare clinical diagnosis.In addition,preoperative diagnosis may be difficult in some cases.Thus,diagnosis of the congenital absence of the vermiform appendix requires a thorough exploration of the retrocecal and ileocecal regions.A 59-year-old male was admitted from the emergency services with right lower abdominal pain.A celiotomy was performed with the suspicion of acute appendicitis.However,an atresia of the vermiform appendix was observed.The patient's appendix was thus removed.Pathological examination confirmed suppurative appendicitis.This case underlines the importance of the clinical entity for surgeons who may deal with a similar case.
文摘Ingested foreign bodies are rarely impacted in the appendix.They may be clinically latent or cause complications such as appendicitis or intestinal perforation,thus requiring prompt and appropriate therapy.A case is reported of a psychiatric,but in other respects asymptomatic,patient who presented with an ingested metal key deeply impacted within the appendix.The patient underwent urgent coloscopy for retrieval.Initially all conventional endoscopic instruments proved ineffective and the key was finally extracted using a simple manoeuvre, described herein.
文摘Mucocele of the appendix due to endometriosis is extremely rare,and there are only 10 previously reported cases in the English literature.We report a case of mucocele of the appendix due to endometriosis and provide the first review of the literature.A 43-year-old woman was admitted to the hospital because of recurrent right lower abdominal pain during her menstrual periods.Colonoscopy revealed submucosal tumorlike elevations of the appendiceal orifice.Computed tomography and magnetic resonance imaging of the abdomen suggested cystic lesions near the appendix.Consequently,mucocele of the appendix was suspected preoperatively.An open ileocecal resection was performed.Multiple cystic lesions were observed around the appendix.The cystic lesions contained mucus.Histopathological examination was consistent with a mucocele of the appendix due to endometriosis.The postoperative course was uneventful.We present the first review of the literature to clarify the clinical features.
文摘BACKGROUND Acute epiploic appendagitis of the appendix (AEAA) is a rare self-limiting inflammatory disorder of the epiploic appendages (EA) close to the vermiform appendix, which often times mimicking the presentation of acute appendicitis (AA). To date, very few cases of AEAA have been reported. We report a case of a 52-year old man with the clinical suspicion of AA, but post-operative specimen examination confirmed AEAA as the final diagnosis. CASE SUMMARY A 52-year-old morbidly obese man presented to the emergency department with a 1-d history of the right lower quadrant (RLQ) abdominal pain. Physical examination revealed localized RLQ tenderness mimicking AA. The computed tomography abdomen was inconclusive, and a decision was made to perform laparoscopic appendectomy (LA). During the LA, an infarcted epiploic appendage at the tip of appendix and adherent to the abdominal wall was found, which was entirely excised. Final pathology showed congested and hemorrhagic epiploic appendage without any accompanied acute inflammatory changes in the wall of the appendix. Postoperative course was uneventful and he was doing well at seven months follow-up. CONCLUSION The possibility of AEAA should be considered in patients clinically suspected of having AA. Surgery is considered for those refractory to conservative management, with inconclusive diagnosis or develop complications at presentation.
基金Supported by Medical Science and Technology Project of Henan Province(201503137)
文摘[Objectives] The aim was to analyze the effect of Salvia miltiorrhiza injection combined with laparoscopic reduction on the degree of appendix injury in intussusception.[Methods]Seventy-four children with intussusception who were treated in the Xuchang Municipal Hospital from August 2014 to August 2017 were randomly and evenly divided into two groups,control group and treatment group.The children in the control group were treated by laparoscopic reduction,and those in the treatment group were treated with S.miltiorrhiza injection combined with laparoscopic reduction.The clinical effect on intussusception in the children was compared between the two groups.[Results] Before treatment,no significant difference was founding serum NO level between the control and treatment groups(P > 0.05).On Day 1,3 and 5 of treatment,the serum NO levels of the treatment group[(74.16 ± 6.81),(61.98 ± 4.77) and(54.76 ± 4.36) μmol/L] were significantly lower than those of the control group[(89.67 ± 6.34),(84.75 ± 5.21) and(71.95 ± 4.58) μmol/L](P < 0.05).After treatment,the TNF-α and IL-6 levels of the treatment group[(184.32 ± 10.67) and(332.16 ± 34.17) pg/m L] were significantly lower than those of the control group[(268.26 ± 12.74) and(438.23 ± 35.26) pg/m L](P < 0.05);and the Chiu score of the treatment group(2.34 ± 1.12) was also significantly lower than that of the control group(4.85 ± 1.67)(P < 0.05).[Conclusions]For children with intussusception,S.miltiorrhiza injection combined with laparoscopic reduction is effective in reducing serum NO level and reducing the degree of appendix injury,which is worthy of clinical application.
文摘A new plate-to-plate method for performanceprediction of azeotropic distillation processes isdeveloped.Azeotropic distillation is character-ized by the strong interaction among componentsand by a samll number of components involved.By plate-to-plate method,the number of intera-rive variables depends only on the number ofcomponents,therefore a combination of theplate-to-plate approach and the Newton-
