Incidental neuroendocrine tumor of the appendiceal base less than20 mm in diameter: is appendectomy enough?
Landolsi Sana, Mannai Saber
The Pan African Medical Journal. 2015;22:102. doi:10.11604/pamj.2015.22.102.6548

Create an account  |  Sign in
Healthcare India 2017 Supplement 2 Supplement
"Better health through knowledge sharing and information dissemination "

Case series

Incidental neuroendocrine tumor of the appendiceal base less than20 mm in diameter: is appendectomy enough?

Cite this: The Pan African Medical Journal. 2015;22:102. doi:10.11604/pamj.2015.22.102.6548

Received: 13/03/2015 - Accepted: 18/04/2015 - Published: 06/10/2015

Key words: Neuroendocrine tumors, appendix, treatment

© Landolsi Sana et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available online at: http://www.panafrican-med-journal.com/content/article/22/102/full

Corresponding author: Landolsi Sana, Department of Surgery, Jendouba’s Hospital, University of Medicine Tunis El Manar, Tunisia (sanachirurgie@yahoo.fr)


Incidental neuroendocrine tumor of the appendiceal base less than20 mm in diameter: is appendectomy enough?

 

Landolsi Sana1,&, Mannai Saber2

 

1Department of Surgery, Jendouba’s Hospital, University of Medicine Tunis El Manar, Tunisia, 2Department of Surgery, Mahmoud El Matri Hospital, University of Medicine Tunis El Manar, Tunisia

 

 

&Corresponding author
Landolsi Sana, Department of Surgery, Jendouba’s Hospital, University of Medicine Tunis El Manar, Tunisia

 

 

Abstract

The appendixis the second primary site for neuroendocrine tumors. The management of incidentelly discovered neuroendocrine tumor of the appendiceal base less than 20 mm in diameter is still controversal. The aim of this study was to discuss the management of such tumors. Three patients were operated on for acute appendicitis. Histopathologic examination of surgery specimens revealed neuroendocrine tumors of the appendiceal base less than 20 mm in diameter. Since no one presented with poor prognostic factors, no complementary right hemicolectomy was performed. No recurrence was observed. The existence of poorprognostic factors at histopathologic examination should indicate complementary right hemicolectomy for incidental neuroendocrine tumor of the appendiceal base less than 20 mm in diameter.

 

 

Introduction

The appendix counts for the second primary site of neuroendocrine tumors occuring in 25 to 30% of the cases [1,2].These tumors are located in the base of the appendix in only 10% of the cases. They are discovered incidentally after appendectomy for acute appendicitis [3]. The management following appendectomy still controversial especially for tumours of less than 20 mm in diameter. The aim of this study was to discuss the management for incidentally histopathologic discovered neuroendocrine tumors of the appendiceal base with a diameter lessthan 20mm.

 

 

Methods

The case series included three patients, two females and one male. The ages at diagnosis were 38 years, 42 years, and 45 years. All three patients were admitted for acute appendicitis. None suffered from the carcinoid syndrome. Appendectomy was performed laparoscopically in two cases and by elective laparotomy in one patient. Per operatively, The macroscopic aspects of the appendix were gangrenous in one patient and phlegmonous in two cases. Appendectomy was performed with uneventfull course. The histological analysis of the surgical specimens revealed the neuroendocrine tumors.

 

 

Results

The three tumors were located at the base of the appendix, well-differentiated, without cellular necrosisnor vascular invasion. The tumor sizes were 5mm, 7mm, and 15 mm. Mitotic figures were 2 mitosis per 10 high-power fields in one patient, 3 in one case, and 4 in the other one. Proliferative activity Ki-67 was nil in two cases and 2% in one patient. Microscopic invasion was limited to the submucosa, the musculosa, and the subserosa in one case each. The surgical margins were negative for tumor cells. No mesoappendiceal involvement was found. Postoperative computerized tomography of the abdomen didn´t demonstrate metastases. The somatostatin receptor scintigraphy was normal. The secretion of 5-Hydroxy-Inndole-Acetic Acid measured after a 24-hour collection of urine was normal in all patients.No poor prognostic factors were found in our patients thus complementaryright hemicolectomy wasn´t carried out.No relapse was diagnosed after a follow up of 12 months.

 

 

Discussion

As for our patients, appendectomy seems enough for neuroendocrine tumors of the appendiceal base less than 20 mm in diameter unless poor prognostic factors are present. Our results are in agreement with the litterature. The appendiceal neroendocrine tumors are discovered at a younger age than the othersites with a mean age of 42 years [4] as in our cases. It may be secondary to incidental diagnosis during appendectomy thatoccurs more frequently in younger patients. They are more frequent in women with a sex-ratio of 0,5 [5-7]. No specific clinical presentation is described [8]. Abdominal pain represents the most common complaint [5,9]. Association with a carcinoid syndrome occurs in only 1% of cases [6]. Several factors are taken into account before deciding to perform complementary surgery. The most considered factor is the tumor size [2]. Since tumors greater than 20 mm in diameter increase the incidence of metastatic spread ranging from 20% to 85% [10,11], they should be managed with a formal right hemicolectomy [2]. For those with a diameter less than 20 mm, appendectomy is enough unless an other poor prognostic factor is found. The indications for a complementary surgery include histological evidence of mesoappendiceal extension [12], tumor at the base of the appendix with positive margins or involvement of the caecum [13], high-grade malignant carcinoid tumor with a raised tumor prognostic index as measured by mitotic index and Ki-67 levels [12], lymph node involvement, and cellular pleomorphism with a high mitotic index [14]. The appendiceal neuroendocrine tumors have a good prognosis with 90,3% 5-year disease-specific survival [9].

 

 

Conclusion

Appendectomy is enough for incidental neuroendocrine tumor of the appendiceal base less than 20 mm in diameter unless poor prognostic factors at histopathologic examination are present.

 

 

Competing interests

The authors declare no competing interests.

 

 

Authors’ contributions

All authors have read and agreed to the final version of this manuscript and have equally contributed to its content and to the management of the case.

 

 

References

  1. Niederle MB, Hackl M, Kaserer K, Niederle B. Gastroenteropancreatic neuroendocrine tumours: the current incidence and staging based on the WHO and European Neuroendocrine Tumour Society classification: an analysis based on prospectively collected parameters. Endocrine-Related Cancer. 2010;17(4):909-918. PubMed | Google Scholar

  2. Deschamps L, Couvelard A. Endocrine Tumors of the Appendix A Pathologic Review. Arch Pathol Lab Med. 2010;134(6):871-875. PubMed | Google Scholar

  3. Sandor A, Modlin IM. A retrospective analysis of 1570 appendiceal carcinoids. Am J Gastroenterol. 1998;93(3):422-428. PubMed | Google Scholar

  4. Modlin IM, Sandor A. An analysis of 8305 cases of carcinoid tumors. Cancer. 1997;79(4: 813-829. PubMed | Google Scholar

  5. Estrozi B, Bacchi CE. Neuroendocrine tumors involving the gastroenteropancreatic tract: a clinico pathological evaluation of 773 cases. Clinics. 2011;66(10):1671-1675. PubMed | Google Scholar

  6. Plöckinger U, Couvelard A, Falconi M et al. Consensus guidelines for the management of patients with digestive neuroendocrine tumours: well-differentiated tumour/carcinoma of the appendix and goblet cell carcinoma. Neuroendocrinology. 2008;87(1):20-30. PubMed | Google Scholar

  7. Yao JC, Hassan M, Phan A et al. One hundred years after "carcinoid": epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26(18):3063-3072. PubMed | Google Scholar

  8. In't Hof KH, van der Wal HC, Kazemier G, Lange JF. Carcinoid tumour of the appendix: an analysis of 1,485 consecutive emergency appendectomies. J Gastrointest Surg. 2008;12(8):1436-1438. PubMed | Google Scholar

  9. Tsikitis TL, Wertheim BC, Guerrero MA. Trends of incidence and survival of gastrointestinal neuroendocrine tumors in the United States: A seer analysis. Journal of Cancer. 2012;3:292-302. PubMed | Google Scholar

  10. Thompson GB, van Heerden JA, Martin JK Jr, Schutt AJ, Ilstrup DM, Carney JA. Carcinoid tumors of the gastrointestinal tract: presentation, management, and prognosis. Surgery. 1985;98(6):1054-1063. PubMed | Google Scholar

  11. Mac Gillivray DC, Heaton RB, Rushin JM, Cruess DF. Distant metastasis from a carcinoid tumor of the appendix less than one centimeter in size. Surgery. 1992;111(4):466-471. PubMed | Google Scholar

  12. Goede AC, Caplin ME, Winslet MC. Carcinoid tumour of the appendix. Br J Surg. 2003;90(11):1317-1322. PubMed | Google Scholar

  13. Safioleas MC, Moulakakis KG, Kontzoglou K et al. Carcinoid tumors of the appendix. Prognostic factors and evaluation of indications for right hemicolectomy. Hepatogastroenterology. 2005;52(61):123-127. PubMed | Google Scholar

  14. Fornaro R, Frascio M, Sticchi C et al. Appendectomy or right hemicolectomy in the treatment of appendiceal carcinoid tumors? Tumori. 2007;93(6):587-590. Google Scholar

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


The Pan African Medical Journal articles are archived on Pubmed Central. Access PAMJ archives on PMC here

Volume 28 (September - December 2017)

Article tools

This article authors

On Pubmed
On Google Scholar

Rate this article

Altmetric

PAMJ is a member of the Committee on Publication Ethics
Next abstract

PAMJ is published in collaboration with the African Field Epidemiology Network (AFENET)
Currently tracked by: DOAJ, AIM, Google Scholar, AJOL, EBSCO, Scopus, Embase, IC, HINARI, Global Health, PubMed Central, PubMed/Medline, Ulrichsweb, More to come . Member of COPE.

ISSN: 1937-8688. © 2017 - Pan African Medical Journal. All rights reserved