Alexandre C Stanescu, MD, Marius Nedelcu, MD, Annamaria Nedelcu, MD, Liana M Ples, MD, Bernhard Egger, Professor, of, Surgery. HFR Fribourg-Cantonal Hospital Switzerland,CHU Montpellier France, HUG Geneve-Switzerland, Sf. Ioan University Hospital, Bucharest.
Introduction : Neuroendocrine tumors (NET) of the appendix (formally known as “carcinoids”) are rare and usually found incidentally at appendectomy.Appendicular carcinoid tumors are among the most frequent malignant neoplasms of the appendix and are detected at the intervention or at histological examination, in 0.3% of the patients undergoing appendectomy.
Case reports: We report here 2 cases of patients, a 14 years old man and a 41 years old woman, presenting with typical signs of appendicitis, which has been confirmed by CT-scan. Both underwent laparoscopic appendectomy with an uneventful postoperative follow-up and with discharge 24 and 48 hours after the intervention, respectively. Histology revealed in both a neuroendocrine tumour of the appendix, classified as a T1a and T2 stade, respectively. Both cases have been presented at our interdisciplinary tumorboard in order to propose these patients an adequate follow-up: The young boy with the early lesion underwent CT-Scan every 6 months for the first two years and then once a year. The woman with the T2 –lesion underwent a right oncological hemicolectomy 3 month after appendectomy followed by the same controls by CT-scan. Both patients are in complete remission, 5 and 6 years after detection of the neuroendocrine lesions, respectively.
Conclusion: Appendicular carcinoid or neuroendocrine tumors are rare (prevalence of 0.3% in patients undergoing appendectomy) and patients present most often with the symptoms of an acute appendicitis. However, in some cases the clinical presentation is non-conclusive and only advanced lesion might be detected by CT-scan. Frequently, the tumor has been only diagnosed at histopathological examination. In order to achieve a high percentage of a successful curative treatment, oncological right hemicolectomy should be performed, especially when the lesion has been classified as T1b or higher. T1a lesions confined to the mucosa and submucosa may be followed-up by CT-scan only.