Appendicular Neuroendocrine Neoplasm is Associated with Acute Appendicitis - Don't Miss the Boat

Khan, Khalid; Patil, Sangram; Roomi, Shahid; Shiwani, Muhammad Hanif

doi:10.21614/chirurgia.114.4.461

Cited by 3 publications

(2 citation statements)

References 19 publications

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“…21,22 Over the past years, there has been growing interest in managing both complicated and uncomplicated appendicitis nonoperatively. 16 Nonoperative management of acute appendicitis without an interval appendectomy would lead to worse outcomes in patients with underlying malignancy. 23,24 The literature that identifies interval appendectomy as a risk factor for an appendiceal tumor may be simply reflecting the shift in the management of acute appendicitis with higher rates of nonoperative management.…”

Section: Discussionmentioning

confidence: 99%

Increased risk of malignancy for patients older than 40 years with appendicitis and an appendix wider than 10 mm on computed tomography scan: A post hoc analysis of an EAST multicenter study

Naar¹,

Kim²,

Byerly³

et al. 2020

Surgery

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Background: The incidence of underlying malignancy in appendicitis ranges between 0.5% and 1.7%. We sought to identify the subset of patients with appendicitis who are at increased risk of appendiceal malignancy. Methods: Using the Eastern Association for the Surgery of Trauma Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous database, we included all patients from 28 centers undergoing immediate, delayed, or interval appendectomy between 2017 and 2018. Univariate then multivariable analyses were performed to compare patients with and without malignancy and to identify independent demographic, clinical, laboratory, and/or radiological predictors of malignancy. Akaike information criteria for regression models were used to evaluate goodness of fit. Results: A total of 3,293 patients were included. The median age was 38 (27e53) years, and 46.5% were female patients. On pathology, 48 (1.5%) had an underlying malignancy (adenocarcinoma [60.4%], neuroendocrine [37.5%], and lymphoma [2.1%]). Patients with malignancy were older (56 [34.5e67] vs 37 [27e52] years, P < .001), had longer duration of symptoms before presentation (36e41 vs 18e23 hours, P ¼ .03), and were more likely to have a phlegmon on imaging (6.3% vs 1.3%, P ¼ .03). Multivariable analyses showed that an enlarged appendiceal diameter was independently associated with malignancy (odds ratio ¼ 1.06, 95% confidence interval ¼ 1.01e1.12; P ¼ .01). The incidence of malignancy in patients >40 years with an appendiceal diameter >10 mm on computed tomography was 2.95% compared with 0.97% in patients 40 years old with appendiceal diameter 10 mm. The corresponding risk ratio for that population was 3.03 (95% confidence interval: 1.24e7.42; P ¼ .02). Conclusion:The combination of age >40 and an appendiceal diameter >10 mm is associated with a greater than 3-fold increased risk of malignancy in patients presenting with appendicitis.

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Section: Discussionmentioning

confidence: 99%

Increased risk of malignancy for patients older than 40 years with appendicitis and an appendix wider than 10 mm on computed tomography scan: A post hoc analysis of an EAST multicenter study

Naar¹,

Kim²,

Byerly³

et al. 2020

Surgery

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“…Obstruction of the appendiceal lumen by various causes seems to be the most likely origin of appendicitis [ 3 ]. Despite the fact that the obstruction resulted usually from lymphoid hyperplasia secondary to inflammatory bowel disease or infections, fecal stasis and fecaliths, It has been less commonly attributed to various unusual causes like bacteria (Yersinia species [ 4 ], adenovirus [ 5 ], cytomegalovirus, actinomycosis [ 4 ], Mycobacteria species, Histoplasma species), parasites [ 3 , 6 ] (e.g., Schistosomes species [ 3 , 5 , 7 ], Entamoeba histolytica [ 8 , 9 ]), Pinworms 'Enterobius vermicularis' [ [10] , [11] , [12] , [13] ], enterocele [ 14 ], Ascariasis [ 11 , 15 , 16 ], serositis [ 10 ], Eosinophilic infiltration [ 5 , 7 , 11 ], foreign bodies [ 4 , 17 ], tuberculosis [ 4 , 7 , [18] , [19] , [20] ], carcinoid [ 3 , 7 , 11 , [21] , [22] , [23] , [24] ], mucocele [ 11 , 16 ], Endometriosis [ 5 , [25] , [26] , [27] , [28] , [29] ],Intussusception [ 17 , 29 , 30 ] Diverticulosis and Diverticulitis [ 17 , [31] , [32] , [33] ], or even malignancy such as adenocarcinoma [ 3 , 5 , 11 , 24 , 25 ] or appendiceal neuroma [ 33 , 34 ].This pape...…”

Section: Introductionmentioning

confidence: 99%

Unusual histopathological findings in appendectomy specimens with clinical diagnosis of acute appendicitis: A retrospective cohort analysis

Al-Balas

Al-Saffar

Al-Balas

et al. 2021

Annals of Medicine &Amp; Surgery

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Introduction While appendicitis is considered one of most common acute surgical conditions, several studies have reported abnormal histopathological findings in appendectomy specimens; however, sending all appendices to histopathology is not yet routinely done.Here we report many unusual findings. Those unusual findings played a role not only in confirming acute appendicitis as a cause of the presentation in some cases but also discovering etiologies that mimic it with great impact on its management. Methods Between January 2011 and December 2017, a total of 1510 patients were operated with appendectomy for a primary diagnosis of acute appendicitis. Among them, a total of 72 patients had incidental histopathologic findings in association with acute appendicitis or other pathologies instead of acute appendicitis. A retrospective analysis for those 72 patients was performed with all data being retrieved from the electronic health record system. Results Patients ages ranged between 4 and 71 years with a mean age equal to 23.1 years (SD = 14.2). Majority of patients were women (n = 52; 72.2%). Sixty of the seventy-two cases were seen in patients with negative appendectomies (n = 333) with an overall rate of 18% among this group of patients. The remaining 12 patients had additional findings in histopathology specimens beside acute appendicitis (n = 1131) with an overall rate of 1%. The most commonly reported pathologies were serositis, ovarian cysts, and Enterobius vermicularis in descending frequency. Conclusion Identification of unusual histopathological findings during microscopic examination of resected appendices is more common in female patients and in patients with negative appendectomy. histopathologic assessment of specimens will allow detection of congenital, infectious or malignant pathologies that mimic acute appendicitis clinically even in the absence appendicitis microscopically.

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Lights and darks of neuroendocrine tumors of the appendix

2021

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Appendicular Neuroendocrine Neoplasm is Associated with Acute Appendicitis - Don't Miss the Boat

Cited by 3 publications

References 19 publications

Increased risk of malignancy for patients older than 40 years with appendicitis and an appendix wider than 10 mm on computed tomography scan: A post hoc analysis of an EAST multicenter study

Increased risk of malignancy for patients older than 40 years with appendicitis and an appendix wider than 10 mm on computed tomography scan: A post hoc analysis of an EAST multicenter study

Unusual histopathological findings in appendectomy specimens with clinical diagnosis of acute appendicitis: A retrospective cohort analysis

Lights and darks of neuroendocrine tumors of the appendix

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