Primary Lesions of the Appendix in Patients Undergoing Surgery for Gynecological Tumors

Appendiceal neoplasms are an incidental finding in <1% of all appendicectomy specimens. Their incidence rates are largely based on appendectomies performed for appendicitis. Appendicectomy is often performed as part of cytoreductive surgery for gynecological malignancies. This is to reduce the risk of occult metastatic disease and to mitigate the morbidity of acute appendicitis in patients undergoing chemotherapy for cancers. The objective of this study was to investigate the incidence of primary lesions of the appendix in 2 cohorts of patients who underwent appendicectomy: patients who had surgery for mucinous neoplasms of the ovary and patients who had cytoreductive surgery for gynecological malignancies. This study looked at the histopathology reports of 581 patients covering both cohorts. Appendicectomy in the setting of mucinous neoplasms of the ovary was done in 187 patients and as part of cytoreductive surgery for gynecological malignancies in 182 patients. We used the updated 2019 WHO nomenclature to classify the appendiceal lesions. The 2 cohorts had an incidence of 13% (25/187) and 7% (12/182) of appendiceal lesions. The appendix was noted to be the frequent primary site of extraovarian mucinous tumor metastasis to the ovary with a frequency of 56% (14/25) in patients with mucinous ovarian tumors; the highest cited in literature to date. We also noted poor correlation between gross and microscopic confirmation of appendiceal lesions with 7% of all macroscopically normal appendices harboring an appendiceal pathology. The study highlights the importance of appendicectomy during surgery for ovarian mucinous neoplasms and as part of cytoreductive surgery for gynecological malignancies. It also signifies the importance of microscopic examination of the whole appendix, especially when no gross abnormality is detected.