EP.FRI.247 Incidence and diversity of the primary appendiceal tumours in patients presenting with acute appendicitis: Our Experience

Background Primary appendiceal tumours are rare. Our experience with the incidental primary appendiceal tumours and their histological diversity. Patients and Method Operative and pathological databases of appendicectomies for presumed diagnosis of acute appendicitis between January 2015 and December 2020 were interrogated. Clinicopathological data were collected and analysed to present the incidence of primary appendiceal tumours, histopathological diversity and outcomes. Results 1908 appendicectomies were performed over the study period. 22 patients with primary appendiceal tumours (incidence rate 1.2%) had a mean age of 45.6(15-97) years and M:F ratio of 1:1.2. Only six patients (27.3%) had appendiceal tumour suspected either before or during surgery. 91% of the patients underwent laparoscopic appendicectomy. Right hemicolectomy was performed as the first intervention and further surgical procedure in 1 and 5 patients respectively. Histological tumour types included carcinoid(10), adenocarcinoma(4), low grade appendiceal mucinous neoplasm(4) mucinous adenocarcinoma & carcinoid(1), goblet cell carcinoid(2) and dysplastic serrated polyp(1). Tumours were located at the tip(10), body(10) and base(2). Median tumour size was 13(2.0-55.0) mm. Median hospital stay was 1.5(0-25) days. The mean survival was 30.9(2.80-73.70) months. Disease related death was a 97-year-old lady with a T4 adenocarcinoma and peritoneal disease who stayed for 25 days and offered palliative supports post appendicectomy. Conclusion Primary appendiceal tumours are diverse in histological types and are of varying prognosis. Appendicectomy alone seemed to be adequate in most cases with early-stage disease. Further surgery such as right hemicolectomy was required for adenocarcinoma and other high-grade tumours.

Adult intussusception secondary to an appendiceal tumour in a patient with ulcerative colitis: a case report

Background Intussusception in adult patients is uncommon and appendiceal lead points are particularly rare. Case presentation We present the case of a 42-year-old male with a history of ulcerative colitis, presenting with sudden onset abdominal pain and bloody diarrhoea. Endoscopy revealed grossly normal mucosa in the descending colon with a congested polypoid mass in the proximal transverse colon. Computed tomography revealed ileocecal intussusception at the hepatic flexure. A right hemicolectomy was performed, where a grossly dilated appendix was noted, resected and sent for histopathological evaluation. Results revealed low-grade appendiceal mucinous neoplasm. Post-operatively, the patient remained symptom free, however required reintroduction of biologic therapy due to relapse of his ulcerative colitis 12 weeks later. Conclusion This case depicts a rare acute surgical presentation and reminds physicians and surgeons of the importance of ‘thinking outside the box’ in clinical practice.

Preserving fertility in pseudomyxoma peritonei, a novel approach

BackgroundCytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is the gold standard treatment for patients with pseudomyxoma peritonei (PMP) but involves routine bilateral salpingo-oophorectomy. Young women wishing to maintain fertility may be reluctant to pursue this. An alternative strategy in women with low-grade PMP has been explored in the form of laparoscopic evacuation of pelvic and ovarian mucin with resection of the appendiceal tumour.MethodsBetween January 2012 and January 2015, four young women (aged 28–35 years) with PMP seeking to maintain fertility underwent laparoscopy, appendicectomy and pelvic mucinous evacuation and washout. Data regarding intra-operative and histopathological findings were collected. Endpoints were fertility-related outcomes and oncological follow-up.ResultsInfertility was a presenting symptom in three of the four women. All four had significant pelvic mucinous disease on radiological imaging and were offered CRS and HIPEC as definitive treatment, but chose laparoscopy with appendicectomy and copious irrigation and washout of the pelvis with stripping of mucinous disease off the ovarian surfaces. Postoperative histology demonstrated a low-grade appendiceal mucinous neoplasm (LAMN) in all patients with acellular mucin or low-grade mucinous carcinoma peritonei in the peritoneal cavity. All patients successfully conceived subsequently and gave birth to healthy babies. After 12–29 months follow-up, all women are well with no radiological or laparoscopic evidence of disease recurrence.ConclusionsIn patients with low-grade PMP, initial therapeutic laparoscopy can restore fertility, whilst providing short- to medium-term disease control. This modality in young women wishing to have children appears to be a feasible alternative to immediate CRS and HIPEC.