Carcinoid tumors of the appendix: Report of thirty-five cases

Abstract

Summary Thirty-five carcinoid tumors of the appendix seen in a period of twenty-eight years have been reviewed. There are no pathognomonic signs or symptoms leading to the diagnosis of carcinoid tumors of the appendix. The appendix is most frequently removed during abdominal section for some other disease and the argentaffin tumor is recognized. Gynecologic procedures and biliary tract operations yielded most of the appendiceal carcinoids reported herein. Acute appendicitis was the clinical indication for operation in nine patients (24 per cent) in whom the carcinoid tumor was also discovered. Appendectomy alone would have been curative in thirty-three of thirty-four surgically treated patients. One tumor was discovered incidentally at postmortem examination. Two patients had right colectomy after the pathologist reported that tumor cells were seen proximal to the line of amputation. It was significant that after colectomy no recurrence of tumor was seen in the ascending colon or its mesentery. Another patient was reported to have tumor proximal to the line of section but did not undergo further resection; she has been followed up for seventeen years without evidence of recurrent tumor. The only patient in this study with metastatic carcinoid tumor, presumably of appendiceal origin, was transferred to our facility after having had appendectomy and omental biopsy elsewhere. The pathologist reported that the tumor was a malignant carcinoid tumor. The possibility that this tumor was of multicentric origin had never been positively ruled out. In our experience, carcinoid tumors of the appendix are characteristically benign. A careful study of confirmed malignant tumors will often reveal a multicentric origin. An orderly plan of management of appendiceal carcinoids is presented. Further study of malignant appendiceal carcinoids and careful documentation of their pathologic behavior are necessary. Long-term postoperative follow-up study is mandatory if worthwhile conclusions regarding their malignant potential are to be reached.