Tumours Of Appendix😍

Tumours Of Appendix

Neuroendocrine Tumour (NET) of Appendix

  • m/c tumour of appendix (AKA carcinoid of appendix).
  • m/c site: Tip of appendix.
  • C/F:
    • Pain & appendicitis.
    • May be detected incidentally.
  • Mx:
    • Close to the base & >2 cm: Right hemicolectomy.
    • Close to the tip & <2 cm: Simple appendicectomy.

Epithelial Tumours

  1. Non-mucinous:
    1. Adenocarcinoma
      1. Mx: Same as colorectal cancer
  1. Mucinous:
    1. Gives rise to pseudomyxoma peritonei.
        • Mucinous deposits in the peritoneum → Obstruction, distention.
        • Mx: Cytoreductive Sx → HIPEC.
          • Hyperthermic intraperitoneal chemotherapy.
          • With Paclitaxel/Mitomycin-C at 41-44°C.
            • Pack (Paclitaxel) my tummy (Mitomycin C)
        • Seen in appendicular, ovarian & peritoneal tumours.

Carcinoids

Types

Type
Site
Metastases
Argentaffin
Serotonin
Carcinoid Syndrome
Foregut
Bronchial/
Stomach/
Duodenal
Lungs (m/c)
(-)
(-)
Uncommon
Midgut
Appendix/
Ileum/
Jejunum
Liver
(+)
(+)
If liver metastasis (-)
No Carcinoid because serotonin produced will be metabolised in liver

If liver metastasis (+)
Carcinoid syndrome (+) → D/t ↓↓ metabolism of serotonin
Hindgut
Colon/Rectum
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‘’
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Carcinoid Syndrome

  • Carcinoids are tumors of neuroendocrine cells
    • Argentaffin cells / Kulchitsky cells of crypts of Leiberkuhn
    • Present in
      • Intestine
      • Brain
      • Platelets
  • ↑↑ Serotonin → ↓Niacin
  • Most common site
    • Ileum > appendix (Tip) > jejunum
    • Most common tumor of the appendix
  • If liver metastasis (+) in Carcinoid tumor
    • ⇒ ↓↓ metabolism of serotonin
    • ⇒ Carcinoid syndrome (+)
  • Clinical Features
    • Serotonin enters circulation → Bronchospasm.
    • Features of pellagra
    • Intermittent diarrhea
    • Cutaneous flushing (m/c symptom)
      • go to bathroom and repeated flush (Cutaneous flushing)
    • Sweating
    • Abdominal pain, sweating.
    • Right heart valve involved:
      • Tricuspid Valve (m/c).
  • Investigations
    • 24-hr urinary 5-HIAA ↑ (5-Hydroxy indole acetic acid)
    • Blood: Serum chromogranin.
    • Imaging:
      • CECT
      • Serotonin receptor Scintigraphy (localise tumour)
  • Management
    • Ki67: Proliferation Index marker.
    • Sx f/b Ki67 → ↑ levels:
      • Malignant NET → Require Chemo Rx.

Appendicular carcinoid mx

  • < 2 cm, away from base:
    • Simple appendicectomy.
  • 2 cm, close to base:
    • Right hemicolectomy.