APPENDICEAL TUMORS - RETROSPECTIVE CLINICOPATHOLOGICAL ANALYSIS OF APPENDICEAL TUMORS FROM 7,970 APPENDECTOMIES

BACKGROUND: Appendiceal tumors are rare and often unexpectedly discove red in an acute situation, in which decision-making is difficult. To h elp define the most appropriate management, a retrospective analysis w as undertaken to describe the clinicopathologic behavior of appendicea l tumors, and the literature was reviewed of the management of the dif ferent types of appendiceal tumors. METHOD: From a single center, a hi stopathologic database of 7,970 appendectomies, all appendiceal tumors , were identified and case notes reviewed. Analysis of clinical presen tation, histopathology, operation, and outcome is presented. RESULTS: During a 16-year period (7,970 appendectomies), 74 patients (0.9 perce nt) with appendiceal tumors were identified: 42 carcinoid, 12 benign, and 20 malignant. Acute appendicitis was the most common presentation (49 percent), and 9.5 percent were incidental findings. Primary malign ant tumors of the appendix were found in 0.1 percent of all appendecto mies. Secondary malignant disease was identified in the appendix of 11 patients, most commonly (55 percent) from patients with primary color ectal disease. There was a high incidence of synchronous and metachron ous colorectal cancer in all appendiceal tumors: carcinoids, 10 percen t; benign tumors, 33 percent; secondary malignancies, 55 percent; prim ary malignancies, 89 percent. CONCLUSION: Appendiceal tumors are uncom mon and most often present as appendicitis. Most are benign and can be managed by appendectomy, except adenocarcinomas and carcinoids larger than 2 cm, which are most appropriately managed by right hemicolectom y. A suggested management algorithm is provided. Controversy exists ov er the management of carcinoids 1 to 2 cm in size and adenocarcinoids. All types of appendiceal tumors have a high incidence of synchronous and metachronous colorectal cancer.