Adenocarcinoma of the appendix with extra-appendicular spread: Clinico-surgical and histologic analysis of 27 cases

Abstract

Background and objectives

Appendiceal neoplasms with extra-appendiceal spread may show different clinical patterns with pseudomyxoma peritonei (PMP) being one of them. We analyse the results in a series of patients treated in our centre.

Material and methods

Retrospective study of patients operated on for appendiceal peritoneal carcinomatosis from January 2012 to May 2015.

Results

Twenty-seven consecutive patients were included. Median age 63 years (26–73); 14 were men. Peritoneal carcinomatosis index = 16 ± 8 (3–31). The suspected preoperative origins were appendix in 23, ovary in 3 and urothelial in one. Postoperative mortality in 2 patients (7.4%). The remaining 36% presented morbidity. Major morbidity (Clavien-Dindo grades 3 and 4) occurred in 3 patients (12%).

Conclusions

Mucinous adenocarcinomas with extra-appendiceal spread may present as PMP with mucinous ascites, jelly-nodular carcinomatosis without ascites, nodular or desmoplasic plates carcinomatosis without jelly mass/nodules. Histology is not correlated to clinical picture. Preoperative diagnosis of mucinous ovarian cancer in peritoneal carcinomatosis scenario may increase the doubt of their ovarian origin and force an appendiceal origin to be ruled out.

Resumen

Fundamento y objetivos

La neoplasia apendicular con extensión extraapendicular puede mostrarse con diferentes patrones clínicos, entre ellos el pseudomixoma peritoneal (PMP). Analizamos los resultados de una serie clínica tratada en nuestro centro.

Material y métodos

Estudio retrospectivo de pacientes con carcinomatosis peritoneal apendicular (desde enero de 2012 hasta mayo de 2015).

Resultados

Veintisiete pacientes consecutivos. Edad mediana 63 años (26-73), 14 varones. Índice de carcinomatosis peritoneal = 16 ± 8 (3-31). El origen tumoral supuesto preoperatoriamente fue el apéndice en 23, el ovario en 3 y urotelial en uno. Mortalidad postoperatoria 2 pacientes (7,4%). El 36% de los restantes presentó morbilidad. Morbilidad mayor (Clavien-Dindo grados 3 y 4) en 3 pacientes (12%).

Conclusiones

Los adenocarcinomas mucinosos extraapendiculares pueden manifiestarse como PMP con ascitis mucinosa, carcinomatosis nodular gelatinosa sin ascitis, carcinomatosis nodular o placas desmoplásicas sin masas/nódulos gelatinosos. La histología no se correlaciona con la forma de presentación. La sospecha preoperatoria de cáncer de ovario mucinoso en el contexto de carcinomatosis peritoneal obliga a descartar que se trate de metástasis ováricas apendiculares.