Clinicopathological Correlation of Invasive Histological Features in Incidentally Detected Appendiceal Neuroendocrine Tumors (aNETs)

Öz

Aim: Appendiceal Neuroendocrine Tumors (aNETs) are rare and mostly detected incidentally patients operated on acute appendicitis. These are indolent tumors and mostly benign, however they carry risk of metastasis. This study aims to identify invasive histological features of aNET cases, that are correlated with aggressive behavior other than stage and grading parameters. Material and Methods: This retrospective study includes patient demographics, surgical margin status and pathological features of tumors. ANETs showing adenocarcinoma features, goblet cell features, and mixed features were not included in our study. Results: The mean age of cases with tumors is 41years (11-61 years). The mean tumor diameter was found to be 6.8 mm. Most of tumors were located in the distal appendix (55.5%). All of the tumors show invasive features. Four cases showed invasion to submucosa (pT₁), four cases to muscularis propria (pT₁), eight cases to subserosa (pT₃), and four cases to mesoappendix (pT₃). Follow-up information was available for only one case with Grade-2 features and MAI, no additional surgical treatment was required, and he has survived at 3-year follow-up with no metastasis. Conclusion: Even if it is grade 1stage 1 tumors, may exhibit invasive features with a risk of metastasis. Although LVI and PNI are not included in ANET staging, they are important factors affecting the course of the disease. The literature lacks consensus on the advisability of performing completion right hemicolectomy in patients exhibiting invasive histological features. We believe it prudent to maintain regular follow-up intervals for these individuals

Anahtar Kelimeler

• Appendix
• neuroendocrine tumors
• invasive histological features

Tesadüfen Tespit Edilen Appendisal Nöroendokrin Tümörlerde (aNET) İnvaziv Histolojik Özelliklerin Klinikopatolojik Korelasyonu

Öz

Amaç: Apendiks Nöroendokrin Tümörleri (aNET'ler) nadir görülen ve çoğunlukla akut apandisit nedeniyle ameliyat edilen hastalarda tesadüfen saptanan tümörlerdir. Bunlar yavaş ilerleyen ve çoğunlukla iyi huylu tümörlerdir ancak metastaz riski taşırlar. Bu çalışma, ANET vakalarının evre ve derecelendirme parametreleri dışındaki agresif davranışlarla ilişkili invazif histolojik özelliklerini tanımlamayı amaçlamaktadır. Gereç ve Yöntemler: Bu retrospektif çalışma hasta demografik özelliklerini, cerrahi sınır durumunu ve tümörlerin patolojik özelliklerini içermektedir. Adenokarsinom özellikleri, goblet hücresi özellikleri ve karma özellikler gösteren ANET'ler çalışmamıza dahil edilmedi. Bulgular: Tümörlü olguların yaş ortalaması 41'dir (11-61). Ortalama tümör çapı 6,8 mm olarak bulundu. Tümörlerin çoğu distal apendiks yerleşimlidir (55.5%). Tümörlerin tamamı invaziv özellik göstermektedir. Dört vakada submukozaya (pT₁), dört vakada muskularis propriaya (pT₁), sekiz vakada subserozaya (pT₃) ve dört vakada mezoapendikse (pT₃) invazyon görüldü. Sadece 2.derece özellikleri ve MAI'si olan bir olgu için takip bilgisi mevcuttu, ek cerrahi tedaviye gerek duyulmadı ve 3 yıllık takipte metastaz olmaksızın hayatta kaldı. Sonuç: Birinci derece ve evre-1 tümörler olsa bile metastaz riski taşıyan invaziv özellikler gösterebilir. LVI ve PNI ANET evrelemesinde yer almasa da hastalığın seyrini etkileyen önemli faktörlerdir. Literatürde invaziv histolojik özellikler sergileyen hastalarda tamamlayıcı sağ hemikolektomi yapılmasının tavsiye edilebilirliği konusunda fikir birliği yoktur. Bu bireyler için düzenli takip aralıklarının sürdürülmesinin akıllıca olacağına inanıyoruz.

Anahtar Kelimeler

• Appendiks
• nöroendokrin tümörler
• invaziv histolojik özellikler

Etik Beyan

Ethics committee approval was given by Recep Tayyip Erdogan University Faculty of Medicine, Non-Interventional Clinical Research Ethics Committee (document number E-40465587-050.01.04-384, decision number 2022/76).

Teşekkür

I would like to thank Dr.Ayberk DURSUN and Dr.Ceren GÜMEDAĞ for their contributions.

Kaynakça

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