Retrospective review of appendicitis cases with an underlying tumour to correlate with known CT features: ten years at a single teaching hospital

Abstract

Purpose Appendiceal neoplasms are rare and often present as acute appendicitis, although this is usually only apparent at surgery or histology. Pickhardt et al (Radiology 2002) identified indicators of underlying neoplasm in cases with acute appendicitis on preoperative computed tomography (CT). We review our cases over a ten year period against these indicators. Methods and materials Patients with an appendiceal neoplasm from 2004–2014 were identified on a pathology database. Of these, 94 patients were identified and all reviewed for clinical and radiological data. Cases with a preoperative CT scan suggesting acute appendicitis were analysed in consensus by two gastrointestinal (GI) radiologists. The appendix was evaluated for the following morphological parameters: maximal diameter, cystic dilatation, tissue mass and presence of calcification. Results Thirteen (13.8%) patients with symptoms of acute appendicitis had a preoperative CT scan. The age range was 21–89 with a mean age of 62.6 years. The appendix was not visualised in three patients. CT demonstrated increased appendiceal diameter, cystic dilatation, tissue mass and calcification in five (38.5%), five (38.5%), 1 (7.7 %) and three (23.1%) respectively. Conclusion CT remains useful in identifying underlying appendiceal tumours in patients with acute appendicitis although a significant proportion of our case series did not demonstrate features to suggest underlying tumour. Appendiceal neoplasms are rare and often present as acute appendicitis, although this is usually only apparent at surgery or histology. Pickhardt et al (Radiology 2002) identified indicators of underlying neoplasm in cases with acute appendicitis on preoperative computed tomography (CT). We review our cases over a ten year period against these indicators. Patients with an appendiceal neoplasm from 2004–2014 were identified on a pathology database. Of these, 94 patients were identified and all reviewed for clinical and radiological data. Cases with a preoperative CT scan suggesting acute appendicitis were analysed in consensus by two gastrointestinal (GI) radiologists. The appendix was evaluated for the following morphological parameters: maximal diameter, cystic dilatation, tissue mass and presence of calcification. Thirteen (13.8%) patients with symptoms of acute appendicitis had a preoperative CT scan. The age range was 21–89 with a mean age of 62.6 years. The appendix was not visualised in three patients. CT demonstrated increased appendiceal diameter, cystic dilatation, tissue mass and calcification in five (38.5%), five (38.5%), 1 (7.7 %) and three (23.1%) respectively. CT remains useful in identifying underlying appendiceal tumours in patients with acute appendicitis although a significant proportion of our case series did not demonstrate features to suggest underlying tumour.