The Excised Appendix Tip-To Send or not to Send, That is the Question

Area of Science:

• Pediatric Surgery
• Surgical Pathology
• Gastrointestinal Oncology

Background:

• A 9-year-old boy with a history of anorectal malformation and neuropathic bladder and bowel underwent reconstructive surgery.
• The procedure included ileocystoplasty, Monti-Mitrofanoff channel creation, and antegrade colonic enema using the appendix.

Observation:

• The appendix tip, appearing macroscopically normal, was submitted for routine histopathology.
• Microscopic examination revealed a 5-mm, well-differentiated neuroendocrine tumor invading the muscularis propria.
• The Ki-67 proliferation index was less than 2%.

Findings:

• Positive margins necessitated re-excision of the appendix conduit and surrounding skin.
• A subsequent tube cecostomy was performed via a separate incision.
• Histopathology of the re-excised specimen showed no residual neuroendocrine tumor.

Implications:

• This case highlights the importance of routine histopathological examination of appendices used in reconstructive surgery, even when appearing normal.
• It demonstrates the successful management of an incidentally discovered appendiceal neuroendocrine tumor in a pediatric patient.
• Complete surgical excision was curative, avoiding the need for adjuvant therapy.