39 years old female was operated for apendicular lump. ct scan of the abdomen revealed apendicular lump only. no other pathology. the ceacum was distended so coloscopy was not done. during surgery the tip of apendix was inflammed and omentum was adherent to it apendectomy done and the omentum adherent over it was also sent for histopathology which revealed low grade mucinous neoplasm of apendix.
The is nothing to do more. With the appendectomy is sufficient. There is not need to do any more test only periodic follow. This is considered as a "casual finding" with our clinical relevance
It is required that the cut end of the appendix was confirmed as tumor free and that no microscopic lymphvascular invasion was present. If so, no more attention except for careful follow-up is needed.
If there is no extra-appendiceal spread only follow up is needed. I agree that intestinal endometriosis should be excluded and colorectal cancer also.
This maybe the origin of pseudomyxoma peritonei. So the question is: The diagnosis was made because of the omental segment resected or because of the appendix. If the omentum was affected, a re-do is necessary with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). If there was no serosal impairment of the serosa of the appendix and a R0- resection was accomplished only follow-up is the treatment of choice. Low malignant musinous neoplasia of the appendix and endometriosis have nothing in common and are 2 different diseases!
Dear Dr. Rajesh Chaudary, I'm not clear if the omentum was free from tumour or not. A clarification or second opinion on the histopathology of the appendix and omentum is needed. If the disease is confined to appendix, the stump of the appendix needs to be removed. If the omentum is involved, it means the tumour has spread so less likely the HPE is low grade malignancy. In such a case, further evaluation via CT or MRI of abdomen and pelvis is warranted including removal of appendix stump.
Dear Dr. Chaudary, if the appendix was affected, and margins were negative in the pathology, appendectomy is the treatment of choice. If there is invasion to the serosa, or omentum, patient monitoring is needed for the possibility of a pseudomyxoma peritonei.
Dear Dr. Chaudary, if the appendix was affected, and margins were negative in the pathology, appendectomy is the treatment of choice. If there is invasion to the serosa, or omentum, patient monitoring is needed for the possibility of a pseudomyxoma peritonei.
Low-grade appendiceal mucinous neoplasm (LAMN) is a precursor lesion for pseudomyxoma peritonei (PMP), which, if treated suboptimally, may later disseminate throughout the abdominal cavity. The role of cytoreductive surgery for these relatively early lesions is unclear.
Two distinct lesions were identified: type I (disease confined to the appendiceal lumen) and type II (mucin and/or neoplastic epithelium in the appendiceal submucosa, wall and/or periappendiceal tissue, with or without perforation). Type I lesions should be managed by a watch-and-wait surveillance policy with serial measurement of tumour markers and computed tomography. Type II lesions should undergo risk-reducing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
See this paper: McDonald JR1, O'Dwyer ST, Rout S, Chakrabarty B, Sikand K, Fulford PE, Wilson MS, Renehan AG. Classification of and cytoreductive surgery for low-grade appendiceal mucinous neoplasms. Br J Surg. 2012 Jul;99(7):987-92. doi: 10.1002/bjs.8739. Epub 2012 Apr 20.
Don't forget to do a colonoscopy for synchronous lesions and check up the cecum. Other fact, a laparoscopy for monitoring residual lesions is useful.
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