ADENOCARCINOMA OF THE APPENDIX MIMICKING COMPLICATED APPENDICITIS IN THE ELDERLY--A REPORT OF TWO CASES/ADENOKARCINOM APENDIKSA KOJI IMITIRA KOMPLIKOVANI APENDICITIS KOD STARIJIH PACIJENATA--PRIKAZ DVA SLUCAJA

Citation metadata

From: Medicinski Pregled(Vol. 71, Issue 11-12)
Publisher: Drustvo Lekara Vojvodine
Document Type: Article
Length: 2,204 words
Lexile Measure: 1200L

Document controls

Main content

Abstract :

Introduction. Primary appendiceal adenocarcinoma is a very rare malignancy which accounts for 0.1% of all appendectomy specimens. In both patients presented in this paper, appendectomy was performed due to suspected acute complicated appendicitis. Case Reports. The first patient, a 77-year-old man, presented with a low grade colonic-type pT3 adenocarcinoma of the appendix, diagnosed by histopathological examination of the resected appendix delivered in a fixative. A month after appendectomy, the patient underwent right hemicolectomy of a tumor at the edge of the resection. Due to a cardiovascular disease, adjuvant chemotherapy was not indicated. The second patient, a 74-year-old female, presented with a low grade mucinous adenocarcinoma of the appendix with subserous infiltration, diagnosed by histopathological analysis of the resected appendix. Eight months after appendectomy, the patient developed a recurrent tumor in the cecal area. After radical surgical excision of the recurrent tumor, the patient received adjuvant chemotherapy. Both patients had a 5-year survival without relapse. Conclusion. Preoperative diagnosis of appendiceal adenocarcinoma is a challenge due to overlapping symptoms of complicated acute appendicitis. Our results suggest that in elderly patients with symptoms of complicated acute appendicitis, appendectomy should be done with intraoperative histopathological frozen section consultation. In advanced stages of adenocarcinoma, right hemicolectomy is a better choice than appendectomy. Key words: Adenocarcinoma; Appendiceal Neoplasms; Appendectomy; Diagnosis; Acute Disease; Appendicitis; Morphological and Microscopic Findings Uvod. Primarni adenokarcinom apendiksa je veoma redak maligni tumor sa ucestaloscu 0,1% u ukupnom broju hirurski odstranjenih apendiksa. Kod oba pacijenta prikazana u nasem radu apendektomija je uradena zbog sumnje na akutni komplikovani apendicitis. Prikaz dva slucaja. Prvi pacijent je muskarac starosti 77 godina sa adenokarcinomom apendiksa, kolonicni tip, niskog gradusa, u stadijumu pT3, dijagnostikovan patohistoloskim pregledom reseciranog apendiksa dostavljenog u fiksativu. Tumor je bio prisutan na rubu resekcije. Desna hemikolektomija je uradena mesec dana nakon apendektomije. Zbog bolesti kardiovaskularnog sistema, pacijent nije lecen adjuvantnom hemioterapijom. Drugi pacijent je 74-godisnja zena kod koje je patohistoloskom analizom reseciranog apendiksa postavljena dijagnoza mucinoznog adenokarcinoma niskog gradusa s infiltracijom supseroze. Prvobitno je uradena samo apendektomija. Osam meseci nakon prve operacije pacijentkinja je imala rekurentni tumor u predelu cekuma. Nakon radikalne hirurske operacije rekurentnog tumora, pacijentkinji je ordinirana adjuvantna terapija. Oba pacijenta su prezivela pet godina bez relapsa bolesti. Zakljucak. Preoperativna dijagnoza adenokarcinoma apendiksa je izazov zbog preklapanja simptoma sa komplikovanim akutnim apendicitisom. Nasi rezultati ukazuju na to da apendektomiju kod starijih pacijenata sa slikom komplikovanog akutnog apendicitisa treba raditi sa intraoperativnom patohistoloskom konsultacijom na zaledenim rezovima. Desna hemikolektomija je bolja metoda od apendektomije kod pacijenata sa adenokarcinomom apendiksa u uznapredovalom stadijumu tumorske bolesti. Kljucne reci: adenokarcinom; neoplazme apendiksa; apendektomija; dijagnoza; akutna bolest; apendicitis; morfoloski i mikroskopski nalazi Abbreviations AA--appendiceal adenocarcinoma WBC--white blood cell LA--laparoscopic appendectomy

Source Citation

Source Citation   

Gale Document Number: GALE|A582098606