Abstract
Aim: Primary appendiceal neoplasms are rare, with carcinoid being more common than carcinoma. Pre-operative diagnosis is infrequent. We report a series of 24 primary appendiceal neoplasms treated over a five year period.
Method: All primary appendiceal neoplasms diagnosed in a University teaching hospital between April 2003-June 2008 were identified from the prospective histopathology database. Patient records were reviewed for clinical, operative and pathological data.
Results: 14 carcinomas and 10 carcinoids were identified in the five-year period. The former presented at median age 55.8 years with median symptom duration of 35 days compared with 48 years and 3 days for carcinoids. An abdominal mass was commoner in carcinomas (8/14 versus 1/10). Six carcinomas underwent appendicectomy followed by completion right-hemicolectomy, two of which had residual disease, seven underwent primary right-hemicolectomy and one had abscess drainage. Five patients with appendiceal carcinoma died of the disease during a median follow-up of 633 [256-1158) days. Six patients underwent appendicectomy for acute appendicitis, one had a primary right-hemicolectomy for a caecal mass. Three had a subsequent right-hemicolectomy for a high-risk carcinoid. An appendiceal carcinoid was an incidental finding in three right-hemicolectomy specimens removed for other indications. No metastases or deaths were recorded at median follow-up 451 (51-975) days.
Conclusion: Appendiceal carcinomas follow a more protracted clinical course than carcinoids, which usually present as acute appendicitis. Caution is needed when diagnosing simple appendicitis in older patients with longer symptom duration, particularly if a mass is present. Patients with appendiceal carcinoma should be offered completion right-hemicolectomy. Carcinoma has a poor prognosis.
© 2012 The Authors Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland
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