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Tumors of Appendix PowerPoint Presentation

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Description : Check out this medical presentation on appendix cancer, which is titled "Tumors of Appendix", to know about the appendiceal malignancies.

Tags : appendix cancer, Tumors, appendiceal malignancies, Carcinoid

Published on : May 06, 2021 | Views : 3170 | Downloads : 1

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Slide 1-

Tumors of Appendix Dr Amit Gupta Associate Professor Dept of Surgery
Slide 2-

Introduction Appendiceal malignancies are extremely rare. Diagnosed in 0.9-1.4% of appendectomy specimens. Carcinoid is the most common appendiceal malignancy It represents more than 50% of the primary lesions of the appendix.
Slide 3-

WHO classification of Appendiceal tumors
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Carcinoid Most common site: Jejunum>Appendix > rectum Mean age at presentation is 32-43 years (range-6 to 80 years) More frequently in females than in males Carcinoid syndrome is rarely associated with appendiceal carcinoid Symptoms attributable directly to the carcinoid are rare Tumor can occasionally obstruct the appendiceal lumen and result in acute appendicitis
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Macroscopy Firm, greyish-white (yellow after fixation), fairly well circumscribed, but not encapsulated Measure usually less than 1 cm in diameter Tumours > 2 cm are rare Most are located at the tip of the appendix Goblet-cell carcinoids and mixed endocrine-exocrine carcinomas of the appendix may be found in any portion of the appendix.
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Carcinoid Tumours with endocrine differentiation arising in the appendix Majority of carcinoids are located in the tip of the appendix. Malignant potential is related to size Treatment : carcinoid tumor is localized to the appendix: simple appendectomy tumors <1 cm with extension into the mesoappendix and tumors >1.5 cm: right hemicolectomy
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Carcinoid tumour of appendix with typical yellow colouration
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Adenocarcinoma Primary adenocarcinoma: rare neoplasm Three major histologic subtypes: Mucinous adenocarcinoma Colonic adenocarcinoma Adenocarcinoid
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TNM Staging
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Most common mode of presentation is of acute appendicitis. Ascites Palpable mass Incidental intraoperative finding Treatment: Right hemicolectomy Appendiceal adenocarcinomas have a propensity for early perforation Overall 5-year survival is 55% Patients have significant risk for both synchronous and metachronous neoplasms
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Mucocele Progressive enlargement of the appendix from the intraluminal accumulation of a mucoid substance. Mucocele are of four histologic types Retention cysts Mucosal hyperplasia Cystadenomas Cystadenocarcinomas A mucocele of benign etiology is adequately treated by simple appendectomy
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Pseudomyxoma Peritonei Diffuse collections of gelatinous fluid are associated with mucinous implants on peritoneal surfaces and omentum. Two to three times more common in females than males. Recent immunocytologic and molecular studies suggest that the appendix is the site of origin for most cases of pseudomyxoma. Pseudomyxoma is invariably caused by neoplastic mucous-secreting cells within the peritoneum. Clinical presentation: abdominal pain, distension, mass, “jelly-belly”
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Tumor Markers: CA-19.9, CEA, CA-125 Imaging: CT scanning is the preferred imaging modality Role of colonoscopy in the diagnosis of PMP is minimal
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Intra operative photograph of patient PMP
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Complete Cytoreductive Surgery is the mainstay of treatment All gross disease should be removed Appendectomy is routinely performed Hysterectomy with bilateral salpingo-oophorectomy is performed in women. At surgery a variable volume of mucinous ascites is found together with tumor deposits Pseudomyxoma is a disease that progresses slowly and in which recurrences may take years to develop or become symptomatic.
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Hyperthermic intraperitoneal chemotherapy (HIPEC) Highly concentrated Heated chemotherapy treatment Delivered directly to the abdomen during surgery Intraoperative HIPEC was initiated at the Washington Hospital Center in 1992
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Lymphoma Extremely uncommon Gastrointestinal tract is the most frequently involved extranodal site for non-Hodgkin's lymphoma Frequency of primary lymphoma of the appendix ranges from 1 to 3% of gastrointestinal lymphomas Usually presents as acute appendicitis
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Lymphoma CT scan showing appendiceal diameter greater than or equal to 2.5 cm or surrounding soft-tissue thickening should prompt suspicion of an appendiceal lymphoma management of appendiceal lymphoma confined to the appendix is appendectomy. Right hemicolectomy is indicated if there is extension of tumor beyond the appendix onto the cecum or mesentery.