Mucinous appendiceal neoplasms: classification, imaging, and HIPEC

Bartlett, David J.; Thacker, Paul G.; Grotz, Travis E.; Graham, Rondell P.; Fletcher, Joel G.; VanBuren, Wendaline M.; Iyer, Vivek; Fidler, Jeff L.; Menias, Christine O.; Wasif, Nabil; Sheedy, Shannon P.

doi:10.1007/s00261-018-01888-y

Cited by 32 publications

(27 citation statements)

References 86 publications

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“…In 2016, the Peritoneal Surface Oncology Group International classified mucinous neoplasms into 4 types: LAMN, high-grade appendiceal mucinous neoplasm (HAMN), mucinous adenocarcinoma, and poorly differentiated mucinous adenocarcinoma. As the diagnosis in our case, LAMN is defined as low-grade cytologic atypia with extension beyond the mucosa, but without any wall invasion [1]. Our case was a LAMN with acellular mucin, with better prognosis compared to other types of mucinous neoplasms.…”

Section: Discussionmentioning

confidence: 90%

“…PMP is a silent disease with no symptoms at the beginning. As the disease progresses, patients can present with nonspecific symptoms such as vague abdominal pain, distension, or hernia related directly to the accumulation of mucin [1,10].…”

Section: Discussionmentioning

confidence: 99%

“…Peritoneal surface malignancy (PSM) is defined as a group of tumors arising from abdominal organs, which can lead to peritoneal carcinomatosis (PC) [1]. Since its origin in the 1990s, cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has evolved immensely and opened a new and promising way of treating incurable and palliative cases of PC [1]. The main aim of CRS is to debulk all visible parts of the tumor.…”

Section: Introductionmentioning

confidence: 99%

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Single-Port Laparoscopic Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

et al. 2019

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Unusual or unexpected effect of treatment Background: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is one of the treatment options in low-grade appendiceal mucinous neoplasm with peritoneal dissemination. The minimal invasive surgery approach was introduced to the field after years of traditional open technique. Multi-port laparoscopic and robotic techniques were reported with good short-term outcomes in very selected patients with low PCI scores. We describe here the first single-port laparoscopic approach of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Case Report: We present a case of low-grade appendiceal mucinous neoplasm with peritoneal dissemination, in which single-port laparoscopic approach of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy was completed through a 5.5-cm incision. A 35-year-old man with no medical illness underwent laparoscopic appendectomy for acute appendicitis 3 months earlier. Postoperative surgical pathology reported a low-grade appendiceal mucinous neoplasm with positive margin. After complete assessment and Tumor Board discussion, the patient was scheduled for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. A single gel port access was inserted through a 5.5-cm peri-umbilical incision. The Peritoneal Cancer Index score was 4, and the decision was made to proceed with partial cecectomy, omentectomy, peritonectomy, and hyperthermic intraperitoneal chemotherapy with the Sugarbaker mitomycin C-based regimen. Postoperative care was carried out following the Enhanced Recovery After Surgery protocol. The patient was discharged on day 3 without any complications. Conclusions: A single-port laparoscopic approach in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is safe and feasible in very selected patients, and has the advantage of direct visualization and palpation through the incision to determine more accurate Peritoneal Cancer Index assessment in comparison to other MIS approaches. Nevertheless, additional prospective studies are needed.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Single-Port Laparoscopic Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy

et al. 2019

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“…Imaging indicates non-specific space-occupying lesions in the abdomen and pelvis. 3 Abdominal puncture for the collection of mucinous ascites samples and laparotomy surgery in parallel with histopathology facilitate the diagnosis of PMP. 4 , 5 Carcinoembryonic antigen (CEA) is one of the most widely used tumour serum markers, especially for diagnosing gastrointestinal tumours and for predicting tumour progression or remission.…”

Section: Introductionmentioning

confidence: 99%

Prognostic significance of CEA, Ki67 and p53 in pseudomyxoma peritonei of appendiceal origin

Yan

Shi

et al. 2021

J Int Med Res

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Objective To determine the levels of carcinoembryonic antigen (CEA), proliferating nuclear antigen Ki67 and p53 in pseudomyxoma peritonei (PMP) of appendiceal origin and to correlate the levels with clinicopathological characteristics and overall survival. Methods This retrospective study collected data on clinicopathological features and immunohistochemical staining of CEA, Ki67 and p53 in patients with PMP of appendiceal origin. Overall survival was evaluated using Kaplan–Meier plots. Median survival time was estimated by Log-rank tests. Potential prognostic factors were evaluated by Cox proportional hazards regression models. Results A total of 141 patients with PMP of appendiceal origin were enrolled in the study with a median age of 54 years. Of these, 93 (66.0%) were diagnosed with low-grade mucinous carcinoma, 43 (30.5%) with high-grade mucinous carcinoma and five (3.5%) with high-grade with signet ring cells. CEA exhibited ubiquitous immunopositivity in most cases and was not associated with overall survival. Ki67 labelling index (LI) and p53 status were related to histological grade and overall survival. The main pathological indicators affecting survival included histological grade, lymph node involvement, angiolymphatic invasion, Ki67 LI and p53. Conclusion Combined analysis of high Ki67 LI and aberrant p53 may provide the basis for evaluating the biological behaviour of PMP and predicting clinical outcome.

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“…Syndrome of progressive intraperitoneal accumulation of mucinous ascites related to a mucin-producing neoplasm is called pseudomyxoma peritonei. The mucinous deposits follow routes of normal peritoneal fluid flow, spreading along pelvis, paracolic gutters, liver capsule and momentum [11]. 39-year-old man was admitted to the hospital for further diagnostics of pancreatic lesion (pancreatic infiltration of unclear etiology) described in outpatient USG.…”

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confidence: 99%