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Appendiceal neoplasms and histological involvement of the mesoappendix: A case series
Jaideep Singh Rait1,2,3, Joshua McGillicuddy2, Jirayr Ajzajian2
1William Harvey Hospital, East Kent NHS Trust, Kennington Rd, Willesborough, Ashford TN24 0LZ, United Kingdom.
Introduction:
Acute appendicitis is a common presentation to surgical departments, typically resulting in appendicectomy. Appendiceal tumours may not be visible intraoperatively, and are present in roughly 0.5-1% of specimens. Routine resection of the mesoappendix is not universally practiced, despite the mesoappendix being commonly involved in appendiceal tumours.This is a case series of the histological findings of 21 patients with appendiceal tumours, with consideration to tumour within the resected mesoappendix.
Methods:
We reviewed the histology of 1344 patients undergoing laparoscopic appendicectomy over a 6-year period assessing for the presence of appendiceal tumours and resected mesoappendix.
Results:
Twenty-one patients were found to have appendiceal tumours, with a mean maximum tumour dimension of 7.2 mm. Sixteen of these patients had simultaneous mesoappendix resection, of whom six (38%) were found to have direct or indirect tumour tissue within the mesoappendix.
Conclusion:
Further evidence for routine removal of the mesoappendix, and the need for larger prospective studies to investigate for any survival benefit. We note the worrying trend of conservative management of acute appendicitis.
Insights
Routine mesoappendix resection during appendicectomy is recommended, as 38% of appendiceal tumor cases showed tumor tissue in the mesoappendix. Further studies are needed to confirm survival benefits.
Area of Science:
- Surgical Pathology
- Gastrointestinal Oncology
Background:
- Appendiceal tumors are incidentally found in 0.5-1% of appendectomy specimens.
- The mesoappendix, often involved in appendiceal tumors, is not always resected.
- Conservative management of acute appendicitis is a concerning trend.
Purpose of the Study:
- To evaluate the incidence of appendiceal tumors.
- To assess the involvement of the mesoappendix in appendiceal tumors.
- To determine the significance of mesoappendix resection in appendiceal tumor cases.
Main Methods:
- A 6-year retrospective review of 1344 laparoscopic appendicectomy cases.
- Histological analysis for appendiceal tumors and mesoappendix resection.
- Assessment of tumor presence within the resected mesoappendix.
Main Results:
- Twenty-one patients (1.6%) had appendiceal tumors (mean size 7.2 mm).
- Mesoappendix resection was performed in 16 of these patients.
- Tumor tissue was found in the mesoappendix of 6 patients (38%) who underwent resection.
Conclusions:
- Routine mesoappendix resection during appendicectomy is suggested for appendiceal tumors.
- Further prospective studies are needed to investigate survival benefits.
- The findings support enhanced pathological evaluation of appendectomy specimens.
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