23 February 2021: Articles
A Low-Grade Appendiceal Mucinous Neoplasia and Neuroendocrine Appendiceal Collision Tumor: A Case Report and Review of the Literature
Rare coexistence of disease or pathology
Massimo Villa A , Daniele Sforza A* , Leandro Siragusa A , Andrea Martina Guida B , Matteo Ciancio Manuelli A , Brunella Maria Pirozzi A , Marco Pocci C , Giampiero Palmieri C , Michele Grande ADOI: 10.12659/AJCR.927876
Am J Case Rep 2021; 22:e927876
Table 1. Cases of collision ANET and LAMN.
| Authors and year | Sex | Age (years) | Presentation | Histology | Surgical treatment | Follow-up |
|---|---|---|---|---|---|---|
| Baena-del- Valle et al 2015 []14 | F | 49 | Acellular mucin during epigastric hernia repair | Appendiceal perforation, PCI 27 + LAMN (cytokeratin 20 and CDX-2 +, cytokeratin 7 –) and NET (CgA and synaptophysin +) | First appendectomy + CRS + HIPEC | Not available |
| F | 45 | Epigastric hernia and free abdominal fluid | Multiple abdominal mucinous implants + tumor-like lesion on the tip of the appendix + LAMN (cytokeratin 20 and CDX-2 +, cytokeratin 7 –) and NET (CgA and synaptophysin +) | First diagnostic laparoscopic appendectomy + omentectomy + CRS + HIPEC | One year later: progression of disease with perihepatic and pleural recurrences | |
| Tan et al 2015 []13 | M | 52 | Elevated CEA trend | LAMN (3.5–5 cm diameter) without involvement of either the appendiceal base nor the surrounding structures + absence of peritoneal disease + carcinoid 3 mm | Appendectomy | Regular CT scan at 6 months after the surgery |
| Hajjar et al 2018 []11 | M | 50 | Abdominal pain | 5.5 cm LAMN + perforation with PMP + 1.6 cm well-differentiated NET, infiltrating muscularis propria and mesoappendix, ki67 3%, grade of G2/3 + perineural invasion, no vascular invasion, free resection margins, no lymph nodes | First appendectomy, second right hemicolectomy, omentectomy, cholecystectomy, peritoneal stripping, CRS, and HIPEC | DFS at 20 months after surgery |
| Ekinci et al 2018 []2 | M | 60 | Abdominal discomfort, RIF pain, mild anemia, elevated WBC, elevated CEA | LAMN + NET WHO grade 1, infiltrating the entire thickness of the appendiceal wall, ki67 | First appendectomy, second right hemicolectomy indicated but refused by the patient | DFS at 6 months after surgery |
| Sholi et al 2019 []12 | F | 23 | Constipation and abdominal fullness | LAMN + well-differentiated NET | First appendectomy, second right hemicolectomy | DFS at 24 months after surgery |
| Sugarbaker et al 2020 []7 | F | 39 | Right iliac fossa pain | Ruptured LAMN with extrusion of mucin + foci of mucin and epithelial cells on the surface of the small bowel, but no involvement of the lymph nodes (pT3N0M1) +1.7 cm pT1BN0 NET | First appendectomy + right hemicolectomy, second greater omentectomy, lesser omentectomy, cholecystectomy, hysterectomy, and bilateral salpingo-oophorectomy + HIPEC | DFS 5 years after surgery |
| M | 32 | Mucin fluid during left inguinal hernia repair | LAMN pT3N0M1a + well-differentiated NET G2T2N1MX (ki67 5%) | Right hemicolectomy, greater omentectomy, lesser omentectomy and cholecystectomy + HIPEC | Follow-up scheduled every 3 months, DFS 1 year after surgery | |
| Cafaro et al 2020 []16 | F | 35 | Epigastric pain with migration to right iliac fossa + >WBC | LAMN + well-differentiated NET | Appendectomy | DFS at 15 months after surgery |
| LAMN – low-grade appendiceal mucinous neoplasia; ANET – appendiceal neuroendocrine tumor; NET – neuroendocrine tumor; CRS – colorectal surgery; HIPEC – hyperthermic intraperitoneal chemotherapy; CEA – carcinoembryonic antigen; CT – computed tomography; DFS – disease-free survival; WBC – white blood cell; CgA – chromogranin-A. | ||||||