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Tumors Of Appendix
BY: DR. WAQAR HUSSAIN
Outlines
 Review of anatomy of appendix
 Tumors Of Appendix
 Investigations
 Management
Review Of Apppendix Anatomy
Tumors Of Appendix
 Mucocele
 Primary Adenocarcinoma Of Appendix
 Cystadenocarcinoma
 Carcinoid
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).
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
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
Cystadenocarcinoma
 Is rare.
 Presentation often delayed until the patient has gross abdominal distension as a
result of pseudomyxoma peritoneii, which may mimic ascites.
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
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.
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.
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.
Pseudomyxoma peritoneii
Thanks….

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Tumors of appendix

  • 1. Tumors Of Appendix BY: DR. WAQAR HUSSAIN
  • 2. Outlines  Review of anatomy of appendix  Tumors Of Appendix  Investigations  Management
  • 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.
  • 12.
  • 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.