Appendiceal Tumors Guide: Mucocele, Adenocarcinoma, Cystadenocarcinoma & Carcinoid
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Tumors of appendix and management
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Appendiceal Tumors Guide: Mucocele, Adenocarcinoma, Cystadenocarcinoma & Carcinoid
- 1. Tumors Of Appendix BY: DR. WAQAR HUSSAIN
- 2. Outlines Review of anatomy of appendix Tumors Of Appendix Investigations Management
- 3. Review Of Apppendix Anatomy
- 4. Tumors Of Appendix Mucocele Primary Adenocarcinoma Of Appendix Cystadenocarcinoma Carcinoid
- 5. Mucocele Occurs when proximal end of the lumen of appendix gets slowly and completely occluded, usually by a fibrous stricture causing collection of sterile fluid (mucus) in the lumen. It is a retention cyst. Can be non-neoplastic or neoplastic. Appendix is grossly enlarged with features of sub-acute appendicitis. Mucocele can get infected leading to empyema of appendix. Rupture of mucocele can lead to pseudomyxoma peritonei. Neoplastic type causes generalized pseudomyxoma peritonei; non-neoplastic type causes localized pseudomyxoma peritonei. (Other cause for pseudomyxoma peritonei is ruptured mucinous carcinoma of ovary).
- 6. Pseudomyxoma peritonei Jelly like mucoid yellowish-brown substance accumulates in peritoneal cavity Due to ruptured adenocarcinoma appendix/mucocele or mucinous carcinoma of ovary Common in females Painless progressive distension of abdomen with intestinal obstruction occurs eventually Shifting dullness is absent Surgical debulking, oophorectomy, appendicectomy, omentectomy are often done
- 7. Primary Adenocarcinoma Extremely Rare. Can be mucinous type or can be colonic. Mucinous type has better prognosis Can present as acute appendicitis in colonic type
- 8. Cystadenocarcinoma Is rare. Presentation often delayed until the patient has gross abdominal distension as a result of pseudomyxoma peritoneii, which may mimic ascites.
- 9. Carcinoid Most common appendicular tumor. Usually found 1 in 4oo appendices. Not aggressive. Usual site is distal third of appendix. Is asymptomatic, usually found incidentally intraoperatively
- 10. Investigation U/s Of Abdomen CT Scan, MRI. Most of times appendicular tumors are found intraoperatively because, they are mostly asymptomatic and rare and mimic signs and symptoms of acute appendicitis. Diagnosis is confirmed by histopathology.
- 11. Management All primary tumors of appendix should be treated by doing right hemicolectomy irrespective of their size and locations except in case of carcinoid and mucocele. If carcinoid is found in tip of appendix and is <2cm, only appendicectomy can give good prognosis. If it is in base of appendix and size is >2cm then go for right hemicolectomy. In case of simple mucocele, simple appendicectomy should be done.
- 13. Carcinoid tumour in two different patients. If it is in the tip or away from the base, then appendicectomy is sufficient. If it is in the base or extending into the caecum then right hemicolectomy is needed.
- 15. Thanks….