Carcinoid tumor of appendix: Review of consecutive 5131 appendectomy

Yıl 2018, Cilt: 2 Sayı: 2, 134 - 136, 01.05.2018

İlyas Kudaş Olgun Erdem Ahmet Topçu Abdullah Şişik

https://doi.org/10.28982/josam.414055

Öz

Aim: Appendiceal carcinoid tumor (neuroendocrine tumor) is rarely seen, and it is frequently found incidentally after evaluation of appendectomy specimen. Histopathologically, the appendiceal carcinoid tumor is usually the type of enterochromafine cell and stems from a sub-epithelial cell population that differs from the neuroendocrine tumor in other regions. Although it is often detected in appendectomy, appendiceal one is the most common type of primary malignant lesion and is detected in 0.3-0.9% of patients with appendectomy. In this study, it is intended to present an appendix carcinoid tumor series that is diagnosed incidentally after appendectomy.

Methods: 5131 appendectomy that was performed between years of 2009 and 2017 constituted the study universe. 35 (0.68%) patients diagnosed with carcinoid tumors were evaluated in the histopathological examination. The patients were recorded in terms of demographic data, clinical status, histopathology and surgical reports. Additional operations and follow-up data were noted.  

Results: 21 of the 35 patients with appendiceal carcinoid tumors were males, and 14 were women. Male/Female ratio was 1.5. The mean age of the patients was 27.3±11.0. There was no difference in terms of gender and age with other appendectomy patients who diagnosed non-tumor (p=0.476 and p=0.413, respectively). The clinical presentation of the patients with all carcinoid tumors was in favor of acute appendicitis. Histopathological examination revealed simultaneous acute appendicitis in 25 (71.4%) patients.

Conclusion: The treatment of the appendiceal carcinoid tumor is controversial, but tumor size, tumor localization, surgical margin and lympho-vascular invasion are the main determining factors. The evaluation of pathological examination and the necessary additional therapies should be planned due to the fact that it is often diagnosed with incidental and is unlikely to be noticeable during surgery.

Anahtar Kelimeler

appendectomy, Carcinoid tumor, Right hemicolectomy

Apendiksin karsinoid tümörü: Ardışık 5131 apendektominin incelemesi

Öz

Amaç: Apendikste karsinoid tümör (nöroendokrin tümör) nadir olarak görülmekle birlikte, apendiks karsinoid tümörün sık olarak bulunduğu bir alandır. Histopatolojik olarak apendiks karsinoid tümör çoğunlukla enterokromaffin hücre tipindedir ve diğer bölgelerdeki nöroendokrin tümörden farklı olan bir subepitelyal hücre popülasyonundan kaynaklanmaktadır. Genellikle tesadüfen apendektomide tespit edilse de, apendiks primer malign lezyonunun en sık rastlanan türüdür ve apendektomi yapılan hastaların %0,3-0,9'unda saptanmaktadır. Bu çalışmada apendektomi sonrası insidental tespit edilen apendiks karsinoid tümör serisini sunmak amaçlanmıştır.

Yöntemler: Çalışma evrenini 2009-2017 yılları arasında gerçekleştirilen 5131 apendektomi olgusu oluşturdu. İncelemede karsinoid tümör saptanan 35 (%0,68) hasta değerlendirildi. Hastalar demografik veriler, klinik durum, histopatoloji, ameliyat raporları ve takipler açısından kayıt edildi.  

Bulgular: Apendiks karsinoid tümör saptanan 35 hastanın 21’i erkek, 14’ü kadın olmak üzere Erkek/Kadın oranı 1,5 olarak bulundu. Hastaların yaş ortalamasının 27,3±11,0 olduğu görüldü. Tümör dışı tanı alan diğer apendektomi yapılan hastalar ile cinsiyet ve yaş açısından fark saptanmadı (sırasıyla p=0,476 ve p=0,413). Tüm karsinoid tümör saptanan hastalar için klinik tablo akut apandisit lehinde idi. 

Sonuç: Apendiks karsinoid tümörün tedavisi tartışmalı olmakla birlikte tümör boyutu, tümör lokalizayonu, cerrahi sınır ve lenfovasküler invazyon ana belirleyici faktörlerdir. Sıklıkla insidental saptanan ve ameliyat esnasında fark edilme ihtimali düşük olması nedeniyle patolojik inceleme ile değerlendirme ve gerekli ek tedaviler planlanmalıdır.

Anahtar Kelimeler

Apendektomi, Karsinoid tümör, Sağ hemikolektomi

Kaynakça

• 1. De Vita VT, Hellman S, Rosenberg SA. Cancer. In: Morton AJ, Levin B, Jensen RT, editors. Principles and Practice of Oncology. 4th edition. Cancer of the Endocrine System. Philadelphia: Lippincott Company, 1993. p.1371.
• 2. Hermans JJ, Hermans AL, Risseuw GA, Verthaar JC, Meradji M. Appendicitis caused by carcinoid tumor. Radiology. 1993;188:71-2.
• 3. Pastore C, D’Annibale A, Piazza A, et al. Diagnosis and treatment of gastrointestinal carcinoid. Report of a clinical case with duodenal site. Minerva Chir. 1997;52(3):283-7.
• 4. Godwin JD. Carsinoid tumors: an analysis of 2837 cases. Cancer. 1975;36:560.
• 5. Modlin IM, Sander A. An analysis of 8305 cases of carsinoid tumors. Cancer. 1996;79(4):813-29.
• 6. Çalışkan YK. Ten years ago, what was the main etiology of intestinal obstructions? Historical perspective: A retrospective cohort study. J Surg Med. 2017;1(2):21-23.7. Cakit H, Sisik A, Ozel Y, Kudas I, Basak F, Topal CS, Ezberci F. Association of granulomatous appendicitis and simple laboratory tests. Controlled observational study. Arch Clin Exp Med. 2016;1(1):11-14.
• 8. Çalışkan YK. Original Alvarado scoring system in the diagnosis of acute appendicitis: A cohort study. J Surg Med. 2017;1(2):28-31.
• 9. Vinik AI, McLeod MK, Fig LM, et al. Clinical features, diagnosis and lokalization of carsinoid tumors and their manegment. Gastroenterol Clin North Am. 1989;18:865.
• 10. Moertel CG, Dockerty MB, Judd ES. Carcinoid tumors of the vermiform appendix. Cancer. 1968;21:270-8.
• 11. Markgraff WH, Dunn TM. Appendiceal carcinoid with carcinoid syndrome. Am J Surg. 1964;107:730-2.
• 12. Schmutzer KJ, Bayar M, Zakı AE, Regan JF, Poletti JB. Tumors of the appendix. Dis Col Rect. 1975;18(4):324-31.
• 13. Deans GT, Spence RA. Neoplastic lesions of the appendix. Br J Surg. 1995;82(3):299-306.
• 14. Adolfsson G. Benign and malignant tumours of the appendix. Acta Chir Scand. 1974;140:151-5.
• 15. Loftus JP, van Heerden JA. Surgical management of gastrointestinal carcinoid tumors. Adv Surg. 1995;28:317-36.
• 16. Başak F, Hasbahçeci M, Canbak T, Acar A, Baş G, Alimoğlu O. Carcinoid Tumor of the Appendix Detected Incidentally. J Kartal TR. 2014;25(1):19-22.