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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2017

01-07-2017 | Gastrointestinal Oncology

Computed Tomography Follow-Up Assessment of Patients with Low-Grade Appendiceal Mucinous Neoplasms: Evaluation of Risk for Pseudomyxoma Peritonei

Authors: Catarina Tiselius, MD, PhD, Csaba Kindler, MD, Jayant Shetye, MD, PhD, Henry Letocha, MD, PhD, Kenneth Smedh, MD, PhD, FRCS

Published in: Annals of Surgical Oncology | Issue 7/2017

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Abstract

Background

Low-grade appendiceal mucinous neoplasms are rare. Both classification and management vary. This study aimed to follow up on patients with a diagnosis of LAMN after primary surgery with computer tomography (CT) scans to examine the risk for the development of pseudomyxoma peritonei (PMP).

Methods

This population-based prospective study investigated patients who underwent appendectomy between 2007 and 2013 and had histology results demonstrating the presence of LAMN. The patients were followed up with a CT scan every 6 months for 2 years, until December 2015.

Results

The study investigated 41 patients (20 females) with a median age of 65 years (range 20–87 years). The entire appendix was processed and examined, with results showing that 12 were perforated, and 3 had a positive margin. Extra-appendiceal mucin on the surface of the appendix was found in ten cases, and in two cases, extra-mucinous epithelial cells were detected. During a median follow-up period of 5.1 years (range 2–8.6 years), none of the patients experienced the development of PMP.

Conclusions

These data suggest that for patients with LAMN confined to the appendix, involvement of the appendectomy margin or perforation with mucin locally, even with epithelial cells, did not predict the development of PMP, and a conservative approach seems justified. No reoperation was needed, and regular follow-up evaluation with CT scans was sufficient.
Literature
1.
Connor SJ, Hanna GB, Frizelle FA. Appendiceal tumors: retrospective clinicopathologic analysis of appendiceal tumors from 7970 appendectomies. Dis Colon Rectum. 1998;41:75–80.CrossRefPubMed
2.
3.
4.
Tirumani SH, Fraser-Hill M, Auer R, Shabana W, et al. Mucinous neoplasms of the appendix: a current comprehensive clinicopathologic and imaging review. Cancer Imaging. 2013;13:14–25.CrossRefPubMedPubMedCentral
5.
6.
Misdraji J, Young RH. Primary epithelial neoplasms and other epithelial lesions of the appendix (excluding carcinoid tumors) (review). Semin Diagn Pathol. 2004;21:120–33.CrossRefPubMed
7.
Szych C, Staebler A, Connolly DC, et al. Molecular genetic evidence supporting the clonality and appendiceal origin of pseudomyxoma peritonei in women. Am J Pathol. 1999;154:1849–55.CrossRefPubMedPubMedCentral
8.
Misdraji J. Appendiceal mucinous neoplasms: controversial issues (review). Arch Pathol Lab Med. 2010;134:864–70.PubMed
9.
Panarelli NC, Yantiss RK. Mucinous neoplasms of the appendix and peritoneum. Arch Pathol Lab Med. 2011;135:1261–8.CrossRefPubMed
10.
Murphy EM, Farquharson SM, Moran BJ. Management of an unexpected appendiceal neoplasm (review). Br J Surg. 2006;93:783–92.CrossRefPubMed
11.
González-Moreno S, Sugarbaker PH. Right hemicolectomy does not confer a survival advantage in patients with mucinous carcinoma of the appendix and peritoneal seeding. Br J Surg. 2004;91:304–11.CrossRefPubMed
12.
Foster JM, Gupta PK, Carreau JH, et al. Right hemicolectomy is not routinely indicated in pseudomyxoma peritonei. Am Surg. 2012;78:171–7.PubMed
13.
Arnason T, Kamionek M, Yang M, Yantiss RK, Misdraji J. Significance of proximal margin involvement in low-grade appendiceal mucinous neoplasms. Arch Pathol Lab Med. 2015;139:518–21.CrossRefPubMed
14.
Zih FS, Wong-Chong N, Hummel C, et al. Mucinous tumor of the appendix with limited peritoneal spread: is there a role for expectant observation? Ann Surg Oncol. 2014;21:225–31.CrossRefPubMed
15.
McDonald JR, O’Dwyer ST, Rout S, et al. Classification of and cytoreductive surgery for low-grade appendiceal mucinous neoplasms. Br J Surg. 2012;99:987–92.CrossRefPubMed
16.
Yantiss RK, Shia J, Klimstra DS, Hahn HP, Odze RD, Misdraji J. Prognostic significance of localized extra-appendiceal mucin deposition in appendiceal mucinous neoplasms. Am J Surg Pathol. 2009;33:248–55.CrossRefPubMed
17.
Enblad M, Birgisson H, Wanders A, et al. Importance of absent neoplastic epithelium in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2016;23:1149–56.CrossRefPubMed
18.
Misdraji J, Yantiss RK, Graeme-Cook FM, et al. Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases. Am J Surg Pathol. 2003;27:1089–103.CrossRefPubMed
19.
Pai RK, Beck AH, Norton JA, Longacre TA. Appendiceal mucinous neoplasms: clinicopathologic study of 116 cases with analysis of factors predicting recurrence. Am J Surg Pathol. 2009;33:1425–39.CrossRefPubMed
20.
Stocchi L, Wolff BG, Larson DR, Harrington JR. Surgical treatment of appendiceal mucocele. Arch Surg. 2003;138:585–9.CrossRefPubMed
21.
Davison JM, Choudry HA, Pingpank JF, et al. Clinicopathologic and molecular analysis of disseminated appendiceal mucinous neoplasms: identification of factors predicting survival and proposed criteria for a three-tiered assessment of tumor grade. Mod Pathol. 2014;27:1521–39.CrossRefPubMed
22.
Smeenk RM, van Velthuysen ML, Verwaal VJ, Zoetmulder FA. Appendiceal neoplasms and pseudomyxoma peritonei: a population-based study. Eur J Surg Oncol. 2008;34:196–201.CrossRefPubMed
23.
Nitecki SS, Wolff BG, Schlinkert R, Sarr MG. The natural history of surgically treated primary adenocarcinoma of the appendix. Ann Surg. 1994;219:51–7.CrossRefPubMedPubMedCentral
Metadata
Title
Computed Tomography Follow-Up Assessment of Patients with Low-Grade Appendiceal Mucinous Neoplasms: Evaluation of Risk for Pseudomyxoma Peritonei
Authors
Catarina Tiselius, MD, PhD
Csaba Kindler, MD
Jayant Shetye, MD, PhD
Henry Letocha, MD, PhD
Kenneth Smedh, MD, PhD, FRCS
Publication date
01-07-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 7/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5623-3

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