Acute appendicitis (AA) is one of the most common causes of acute abdominal pain, which can progress to perforation of the appendix and peritonitis. Recently, AA has been classified into uncomplicated (nonperforated, no phlegmon) or complicated (abscess, perforation, phlegmon) appendicitis, for an appropriate initial treatment. With respect to surgical treatment of AA, laparoscopic surgery has been widely accepted worldwide as a safe and feasible first-line treatment. Over the last decade, non-operative treatment has been proposed as an alternative to surgery in uncomplicated AA, and has also played an important role in the management of complicated AA. AA is also the most common cause for abdominal surgery during pregnancy, though an accurate diagnosis of AA during pregnancy is challenging. In this review, the topics being discussed include: 1) Non-operative management for uncomplicated AA, 2) Management for AA in pregnancy, 3) Management for complicated appendicitis (especially immediate laparoscopic surgery for appendiceal abscess), 4) Appendiceal neoplasms related to complicated AA.
Abdominal Pain ; Appendiceal Neoplasms ; Appendicitis ; Appendix ; Diagnosis ; Laparoscopy ; Peritonitis ; Pregnancy

Abdominal actinomycosis is a rare and chronic progressive disease, especially in children. Clinically, it has non-specific symptoms and diagnostic findings as well as low prevalence, making it very difficult to diagnose prior to intraoperative pathological confirmation. For this reason, abdominal actinomycosis is commonly misdiagnosed as appendicitis. After the histopathological diagnosis of abdominal actinomycosis is made, patients should be administered an appropriate antibiotic such as penicillin. Here we describe a case of appendiceal actinomycosis in an 18-year-old girl who was initially diagnosed with acute appendicitis.
Actinomycosis* ; Adolescent ; Appendiceal Neoplasms ; Appendicitis* ; Child ; Diagnosis ; Female ; Humans ; Penicillins ; Prevalence

OBJECTIVEThe clinicopathologic and immunohistochemical features of 11 pseudomyxoma peritonei (PMP) cases were studied to determine pathologic diagnosis, site of origin and prognosis.

METHODSClinical files of 11 cases of PMP were reviewed with follow up. The changes in mucinous tumors of peritoneum and primary tumors under microscope and immunostaining were reviewed.

RESULTSEleven cases (8 women, 3 men) are reported. The patients age ranged from 36 to 76 (average 56). One died 2 years after operation, and one case was lost. The remaining 8 cases were alive 1 to 60 months postoperatively. Of the 11 cases, 8 cases had appendiceal mucinous neoplasm of the 11 cases, and 5 women had synchronous ovarian mucinous tumors; colon mucinous adenocarcinoma was present in one case with synchronous ovarian mucinous tumor; simple ovarian mucinous tumors were present in two cases. Immunostainings were consistent on mucinous tumors of appendix, ovary and peritoneum in the same case.

CONCLUSIONSTo diagnose the PMP, the type of tumor should be considered whether it is benign, low malignant or malignant. The appendix neoplasm is closely related to PMP. The prognosis depends greatly on the growth speed of the mucinous neoplasm.

Adult ; Aged ; Appendiceal Neoplasms ; diagnosis ; pathology ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Ovarian Neoplasms ; diagnosis ; pathology ; Peritoneal Neoplasms ; diagnosis ; pathology ; Prognosis ; Pseudomyxoma Peritonei ; diagnosis ; pathology

Aged ; Appendiceal Neoplasms ; diagnostic imaging ; Calcinosis ; diagnostic imaging ; Cystadenoma, Mucinous ; diagnostic imaging ; Diagnosis, Differential ; Female ; Humans ; Radiography, Abdominal ; Rupture, Spontaneous

OBJECTIVETo explore the ultrasound characteristics of mucinous cystadenoma of the appendix and evaluate its diagnostic value.

METHODSFourteen cases of mucinous cystadenoma of the appendix were diagnosed by ultrasonic examination and confirmed by surgery and pathology. The ultrasound findings and distribution of color Doppler flow signals were observed and analyzed in comparison with the surgical and pathological results.

RESULTSUltrasound revealed a unilocular or multilocular cystic mass located in the right lower quadrant area with clear boarders, smooth and thick wall, and inconsistent internal echogenicity. The maximal outer diameter of the mass was 2 cm or greater in attachment to the cecum, lacking of periileal inflammatory changes such as in the periileal lymph nodes and echogenic periappendiceal epiploon.

CONCLUSIONUltrasound is of high value in the diagnosis of mucinous cystadenoma of the appendix.

Adult ; Aged ; Appendiceal Neoplasms ; diagnostic imaging ; Cystadenoma, Mucinous ; diagnostic imaging ; Diagnosis, Differential ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Ultrasonography

Immunoglobulin G4 (IgG4)-related disease is an autoimmune disease that forms tumorous lesions. Several cases involving various organs are reported, however, IgG4-related disease involving appendix has not been reported yet. In this report, we presented a case of IgG4-related disease of appendix, which raised a suspicion of appendiceal tumor or usual appendicitis and, therefore, led to unnecessary surgical resection. IgG4-related disease should be considered in the differential diagnosis for a mass-like swelling of the appendix, in order to avoid unnecessary surgery.
Appendiceal Neoplasms/*diagnosis ; Appendicitis/*diagnosis ; Appendix/immunology/*pathology ; Autoimmune Diseases/*diagnosis/immunology ; Diagnosis, Differential ; Humans ; Immunoglobulin G/*immunology ; Male ; Middle Aged ; Neoplasms

OBJECTIVETo investigate clinicopathological features and prognostic factors of appendiceal neuroendocrine neoplasms(a-NEN).

METHODSClinical data of 20 patients diagnosed with a-NEN at Zhongshan Hospital of Fudan University between January 2000 and December 2016 were retrospectively analyzed. Pathological diagnosis was based on the WHO classification criteria of digestive system tumors (2010 edition). Based on the mitotic count and Ki-67 index, a-NENs were divided into grade 1 neuroendocrine tumor (NET G1), grade 2(G2) NET G2) and grade 3 (neuroendocrine carcinoma, NEC). Some special types of a-NEN (e.g. goblet cell carcinoid) and mixed adenoneuroendocrine neoplasms were classified as mixed adenoneuroendocrine carcinoma (MANEC). Follow-up was conducted by telephone or return visits. Univariate analysis was carried out using the Kaplan-Meier method, and the log-rank test was used to draw survival curves.

RESULTSOf 20 patients, 14 were male and 6 were female with median age of 54 years. Seventeen cases presented acute right lower quadrant abdominal pain, 1 chronic right lower quadrant abdominal pain, 1 persistent abdominal discomfort with outburst whole abdominal pain and 1 was found during body check without symptoms. Twenty cases comprised 8 G1 patients, 4 G2 patients, 3 G3 patients, and 5 MANEC patients. When diagnosed, there was 1 patient with liver metastasis, 1 patient with abdominal and pelvic metastases, and 2 patients with postoperative pathological findings of lymph node metastasis. Six patients underwent appendectomy, 12 underwent right hemicolectomy, 1 underwent right hemicolectomy plus small intestine resection, and 1 underwent partial hepatectomy plus right hemicolectomy. The follow-up time was 7-187 months(average, 36 months). The total 1- and 3-year survival rates were 94.7% and 60.2%, respectively. Univariate analysis showed that age >50 years (χ=7.036, P=0.008), pathology grade as MANEC (χ=5.297, P=0.021), and metastasis (χ=6.558, P=0.010) indicated lower 5-year survival rate.

CONCLUSIONSMost a-NEN patients have no typical symptoms, and the main complaint at consultation is acute right lower quadrant abdominal pain. Prognosis is poor for patients with age >50 years, MANEC pathology grade and metastasis.

Appendiceal Neoplasms ; complications ; diagnosis ; surgery ; Carcinoma, Neuroendocrine ; complications ; diagnosis ; therapy ; Female ; Gastrointestinal Neoplasms ; Humans ; Male ; Middle Aged ; Neuroendocrine Tumors ; complications ; diagnosis ; surgery ; Prognosis ; Retrospective Studies

Local recurrence after endoscopic piecemeal mucosal resection (EPMR) for colorectal tumors is a crucial issue. However, such recurrence is usually detected within one year and cured with additional endoscopic treatment, which makes EPMR acceptable. Herein, we report a rare case of repeatedly recurrent colon cancer involving the appendiceal orifice after EPMR, which was not cured with additional endoscopic treatments. A 67-year-old man was referred to us for endoscopic treatment of a 25 mm cecal tumor spreading to the appendiceal orifice in May 2002. The tumor was resected with EPMR, showing well differentiated intramucosal adenocarcinoma with a positive lateral cut margin of tubular adenoma. Endoscopic surveillance was conducted and the first local recurrence was detected in August 2006. Although we resected it endoscopically, the second local recurrence was found in September 2007 and we removed it with endoscopic resection again. However, the third local recurrence was detected in March 2008. Although endoscopic resection was performed also for the third recurrence, curative resection was not achieved. In February 2009, laparoscopic assisted colectomy was performed and histopathological examination showed well differentiated adenocarcinoma with deep submucosal invasion. This case is important in considering indication for endoscopic resection in colorectal tumors involving the appendiceal orifice.
Adenocarcinoma/*diagnosis/pathology/surgery ; Aged ; Appendiceal Neoplasms/complications ; Colectomy ; Colonic Neoplasms/*diagnosis/pathology/surgery ; Colonoscopy ; Humans ; Intestinal Mucosa/pathology ; Male ; Neoplasm Recurrence, Local ; Recurrence

Neuroendocrine tumor (NET) is a cancer-like tumor that occurs mostly in the gastrointestinal system. Within the gastrointestinal tract, NET most commonly occurs in the rectum whereas appendix is very rarely involved. In most cases of appendiceal NET, it is found at a relatively early stage compared to other NETs because appendiceal NET frequently presents with acute appendicitis because appendiceal NET frequently presents with acute appendicitis even when the size is smaller than 1 cm. Therefore, it is very rare for lymph node metastasis to occur in a young adult. Herein, we report a rare case of grade 1 appendiceal NET with lymph node metastasis which developed in a teenage male.
Adolescent ; Appendiceal Neoplasms/*diagnosis/pathology/surgery ; Carcinoid Tumor/diagnosis/pathology ; Colectomy ; Colonoscopy ; Humans ; Lymphatic Metastasis ; Male ; Neuroendocrine Tumors/*diagnosis/pathology ; Tomography, X-Ray Computed

OBJECTIVETo investigate the clinicopathological and immunohistochemical features of primary malignant tumor of the appendix.

METHODSThe clinical data were reviewed; and histopathological and immunohistochemical features were analyzed in 22 cases with primary malignant tumor of the appendix.

RESULTIn 22 cases of primary malignant tumor of the appendix, 19 cases were carcinoid and 3 were adenocarcinoma. Immunohistochemistry showed that the carcinoid was positively reacted to the neuroendocrine markers, and the adenocarcinoma was negatively reacted to the neuroendocrine markers.

CONCLUSIONImmunohistochemistry is useful in diagnosis of primary malignant tumor of the appendix, a rare type of cancer.

Adenocarcinoma ; diagnosis ; pathology ; surgery ; Adolescent ; Adult ; Aged ; Appendiceal Neoplasms ; diagnosis ; pathology ; surgery ; Carcinoid Tumor ; diagnosis ; pathology ; surgery ; Female ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Young Adult