Appendicular Tumors Research Articles

Discrepancies between preoperative diagnosis of tumors and the right uterine appendage and intraoperative data. Appendiculare mucocele, which manifests itself in the form of an appendage formation. Clinical case

Tumor formations of the tubes, hydrosalpinxes, pyosalpixes have a number of discrepancies in outpatient service examinations and intraoperative clinical diagnosis. Purpose - to report a unique case with discrepancies between the preoperative diagnosis (pyosalpinx, hydrosalpinx) and the intraoperative and postoperative definitive findings (appendicular tumor, mucocele). Clinical case. A 50-year-old woman, a 3-year-old Mirena IUD wearer, applied for examination for pain in the right iliac region and a slight rise in temperature to 37-37.5 over the past 10 days. The examination showed the movement of the tumor on the right up to 7-4 cm, sensitive on palpation, uterine fibroids, and appendices on the left without features. Other history, physical examination, and laboratory tests were not remarkable, and there was no leukocytosis as in inflammatory processes. Ultrasound and MRI showed neoplasms of the right appendages of 7-5-4 cm, avascular and uterine fibroids - 3 subserosal nodes of 10-5 mm each. Intraoperatively Intact 2 fallopian tubes were detected, a tumor formation of the appendix 3-2-3 cm without adhesions was isolated. Laparoscopic appendectomy was performed along with conservative myomectomy and bilateral salpingectomy. Histopathology showed mucocele without atypia, myomas nodules, and fallopian tubes without features. Conclusions. In the formation of the right appendages of the uterus, a thorough preoperative diagnosis is required, which does not always give a definitive answer to the clinical diagnosis. Diagnostic laparoscopy, visual and operational clinical experience of the surgeon, cytological and histological examination of intra- and postoperative results make it possible to carry out adequate surgical treatment. Patients should be informed about doubts between outpatient and intraoperative diagnosis, possible changes in the intraoperative surgical plan. Prompt care should be provided in institutions with appropriate teams and equipment. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Treatment and Outcomes of Radiation-Induced Soft Tissue Sarcomas of the Extremities and Trunk—A Systematic Review of the Literature

Introduction: Radiation-induced soft tissue sarcomas (RISs) are rare secondary malignancies with a dire prognosis. The literature on the management of these tumors remains scarce due to their low incidence. Our systematic review sought to assess the treatment alternatives and outcomes of patients with RIS. Methods: A systematic review was conducted following the PRISMA guidelines. Our study was registered in PROSPERO (ID: CRD42023438415). Quality assessment was performed using the STROBE checklist. Weighted means for both continuous and categorical values were calculated. Results: Twenty-one studies comprising 1371 patients with RIS were included. The mean latency period from radiation to RIS diagnosis was 14 years, and the mean radiation dose delivered to the primary malignancy was 29.2 Gy. The most common histological type was undifferentiated pleomorphic sarcoma (42.2%), and 64% of all tumors were high-grade. The trunk was the most common location (59%), followed by extremities (21%) and pelvis (11%). Surgery was performed in 68% of patients and, among those with an appendicular tumor, the majority (74%) underwent limb-salvage surgery. Negative margins were attained in 58% of patients. Chemotherapy and radiotherapy were administered in 29% and 15% of patients, respectively. The mean 5-year overall survival was 45%, and the local recurrence and metastasis rates were 39% and 27%, respectively. Conclusions: In our study, the most common treatment was surgical resection, with RT and chemotherapy being administered in less than one third of patients. Patients with RIS exhibited poor oncologic outcomes. Future studies should compare RIS with de novo STS while controlling for confounders.

Retrospective Clinico-pathological and Morphological Analysis of Appendicular Tumors on Appendectomy Specimens for Acute Appendicitis

Background and Study Aims: Appendiceal Tumors are rare. Difficult to diagnose, these tumors are often accidentally discovered following acute appendicitis. The aim of this study is to describe the clinical, pathological and morphologic characteristics of these tumors in order to define an appropriate management. Patients and Methods: From a pathological database, all appendiceal tumors found on appendectomy specimens performed between January 2017 and July 2019 were retrospectively analysed. Results: Among the 1480 appendectomies performed, 15 cases of appendiceal tumors were collected (1.01%). The mean age was estimated at 44.7 ± 21.5 years (17-80). Pain in the right iliac fossa was present in all patients. Abdominal ultrasonography coupled with computed tomography (CT) scan led to the diagnosis of appendiceal tumors in 40% of cases (6/15). All patients underwent emergency surgery. An appendectomy was performed in 13 patients (86%). A mucinous tumor was found in 9 patients (60%). In 40% of the cases (6/15), it was a neuroendocrine tumor. Conclusion: Appendiceal tumors are often discovered incidentally on appendectomy specimens for acute appendicitis. They can be seen at any age and their diagnosis is not easy, even with the support of imaging. Ideally, the diagnosis of these tumors should be made preoperatively; this can change the surgical approach and avoid the need for additional surgery. All appendectomy specimens should be examined in histopathology.

Characterization of denosumab treatment response in giant cell tumors of bone with dynamic contrast-enhanced MRI

Rationale and objectivesDenosumab is a monoclonal antibody used neo-adjuvantly in giant cell tumor of bone (GCTB) to facilitate surgery, or long term for axial tumors where surgery comes with high morbidity. Time intervals for treatment effects to occur are unclear and monitoring tools are limited, complicating optimal drug dose titration. We assessed changes in time intensity curve (TIC) - derived perfusion features on DCE-MRI in GCTB during denosumab treatment and evaluated the duration of treatment effects on tumor perfusion. Materials and methodsPatients with GCTB who underwent dynamic contrast enhanced (DCE) MRI before (t = 0) and after 3 (t = 3), 6 (t = 6) or 12 (t = 12) months of denosumab treatment were retrospectively included in a single center. Regions of interest were placed on tumor compartments with visually most intense enhancement and TICs were created. Time-to-enhancement (TTE), wash-in rate (WIR), maximal relative enhancement (MRE), and area-under-the-curve (AUC) were calculated. Differences in perfusion features were calculated with the Wilcoxon signed-rank test. ResultsIn all 24 patients decreased perfusion on DCE-MRI after start of denosumab treatment was seen. TTE increased between t = 0 and t = 3 (p < 0.001). WIR, MRE and AUC decreased between t = 0 and t = 3 (p < 0.001, p = 0.01 and p = 0.02, respectively). No significant differences in features were found between t = 3 and t = 6 or t = 6 and t = 12. No significant perfusion differences in primary versus recurrent, or axial versus appendicular tumors, were found. ConclusionMRI perfusion significantly changed in GCTB within 3 months of denosumab treatment compared to baseline. No further significant change occurred between 3 and 6, and 6 and 12 months of treatment. These findings suggest that evaluation of treatment response and subsequent consideration of maintenance with lower doses of denosumab, may already be indicated after 3 months. In cases where long term denosumab is the preferred therapy, monitoring change in tumor characteristics on DCE-MRI may aid optimal drug dose titration, minimizing side effects.

Risk factors for 30-day soft tissue complications after pelvic sarcoma surgery: A National Surgical Quality Improvement Program study.

Soft tissue (ST) complications after resection of bone and ST sarcomas of the pelvis occur more frequently than in appendicular tumors. We sought to identify risk factors for complications within 30 days of surgery. The National Surgical Quality Improvement Program database was used for this study. Patients with sarcomas of bone and ST of the pelvis were retrieved using Current Procedural Terminology and International Classification of Diseases codes. Outcomes assessed were ST complications, overall complication rates, 30-day reoperation, and mortality. A total of 770 patients with pelvic bone and ST sarcoma were included. The ST complication rate was 12.6%, including 4.9% superficial and 4.7% deep surgical site infections. Higher ST complication rates were seen in patients >30 years, with partially dependent health status, hematocrit <30%, bone tumors, tumor >5 cm, amputation procedures, and longer operative times. ST complication rates were 1.5 and 3 times higher in pelvic sarcoma surgeries than in the lower and upper extremities, respectively. Age >30 years (odds ratio [OR] = 5.07), hematocrit <30% (OR = 1.84), operative time 1-3 h (OR = 2.97), and >3 h (OR = 4.89) were risk factors for ST complications. One in nine patients with pelvic sarcoma surgery will develop ST complications within 30 days. Risk factors for ST complications were age >30, hematocrit <30%, and longer operative time.

Appendicular mucocele mimicking a right adnexal mass – a case report and literature review

The correct diagnostic of a cystic lesion at the level of the right iliac fossa in women can be hard to be established in certain cases, different pathological lesions having similar imagistic aspects and being associated with similar biological modifications. In such cases the final diagnostic is established intraoperatively and the type of surgery can be significantly modified. The aim of the current paper is to report a 63 year old woman with preoperative diagnostic of right ovarian mass who was submitted to surgery in order to have a total hysterectomy and bilateral adnexectomy; however intraoperatively the cystic lesion developed at the level of the right iliac fossa proved to be an appendicular tumor and was successfully resected by performing a radical right hemicolectomy.

P-269 Malignant tumors of the appendix: A retrospective study

Malignant tumors of the appendix are a rare group of tumors often found fortuitously during surgical removal of the appendix, representing approximately 2% of appendectomy specimens. Our objective was to describe the clinico-pathological characteristics of appendicular tumors, the therapeutic modalities proposed and patient’s evolution after treatment. We conducted a retrospective review of 52 patients diagnosed with malignant tumors in the Medical Oncology department at Mohamed VI University Hospital, Marrakech, Morocco between 2012 and 2021. The clinical, biological, radiological, therapeutic and evolution data were collected. The median age was 50 years. The sex ratio was 0.7. Right lower quadrant pain was a constant complaint, followed by constipation, abdominal bloating and/or distension and vomiting. The diagnostic was based on ultrasound and/or abdominal scan. A complementary colonoscopy was proposed for 4 patients. An appendicectomy for performed on all patients after suspecting an acute appendicitis, an appendicular mucocele or for a diagnostic exploration. 42% (22 cases) were found to have a low-grade appendicular mucinous tumor, 34% a mucinous adenocarcinoma (including 5 patients with pseudomyxoma peritonei) and 24% (12 cases) an neuroendocrine tumor. 36% had localized only in the appendix while 64% were already metastatic. The therapeutic management was based on an additional surgical revision by right hemi-colectomy with ileocecal resection and lymph node dissection in 32% (17 cases), while 3% (2 cases) had undergone cytoreductive surgery with intravenous chemotherapy-peritoneal. Adjuvant chemotherapy was indicated to patients with a localized tumor with R0 and positive lymph node dissection which is the case in 7 patients. Palliative chemotherapy was proposed for metastatic patients with an unresectable tumor 26% (14 cases). 55% were under medical surveillance and screening, and 24% of patients relapsed. 21% (11 cases) were lost to follow-up. Appendicular malignant tumors represent a wide histological spectrum with various clinical subtypes, early diagnosis conditioning its management. Multidisciplinary molecular tumor boards are recommended.

Appendicular Volvulus without Necrosis on Appendicular Tumor: A Rare Case Report

We report a case of volvulus of the appendix on appendicular tumor without necrosis. Pathological examination confirmed a bilharzian granuloma. We retained the preoperative diagnosis of an appendicular abscess. Our aim is to draw the attention of surgeons to the existence of other rare anatomopathological forms of appendicitis.

Assessment of treatment response after Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) for appendicular peritoneal metastases

Background: Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is a new treatment with promising safety profile and early response rates for peritoneal metastases (PM) of various origins. We aimed to analyse oncological outcomes after PIPAC for appendicular tumours.

A Pilot Study of Cancer-Induced Bone Pain Using Validated Owner Questionnaires, Serum N-Telopeptide Concentration, Kinetic Analysis, and PET/CT.

Cancer-induced bone pain, despite its frequency and severity, is a poorly understood phenomenon in people and animals. Despite excitement regarding translational osteosarcoma studies, there is a lack of attention toward examining cancer pain in dogs. In this pilot study, we used a multimodal pain assessment methodology to evaluate pain relief after therapeutic intervention in dogs with primary bone cancer. We hypothesized that intervention would cause objective evidence of pain relief. Evaluations of 8 dogs with primary bone cancer included 18F-FDG PET/CT scans, kinetic analysis, validated owner questionnaires (Canine Brief Pain Inventory, canine BPI), and serum N-telopeptide (NTx) concentration. Dogs were routinely staged and had 18F-FDG PET/CT scans prior to treatment with day 0, 7, 14, and 28 canine BPI, serum NTx, orthopedic exam, and kinetic analysis. Dogs treated with zoledronate and radiation underwent day 28 18F-FDG PET scans. All clinical trial work was approved by the University of Missouri IACUC. Four dogs underwent amputation (AMP) for their appendicular bone tumors; four received neoadjuvant zoledronate and hypofractionated radiation therapy (ZOL+RT). Canine BPI revealed significant improvements in pain severity and pain interference scores compared to baseline for all dogs. Positive changes in peak vertical force (+16.7%) and vertical impulse (+29.1%) were noted at day 28 in ZOL+RT dogs. Dogs receiving ZOL+RT had a significant (at least 30%) reduction in serum NTx from baseline compared to amputated dogs (p = 0.029). SUVmax (p = 0.11) and intensity (p = 0.013) values from PET scans decreased while tumor uniformity (p = 0.017) significantly increased in ZOL+RT-treated tumors; gross tumor volume did not change (p = 0.78). Owner questionnaires, kinetic analysis, and 18F-FDG PET/CT scans showed improved pain relief in dogs receiving ZOL+RT. Serum NTx levels likely do not directly measure pain, but rather the degree of systemic osteoclastic activity. Larger, prospective studies are warranted to identify the ideal objective indicator of pain relief; however, use of multiple assessors is presumably best. With improved assessment of pain severity and relief in dogs with cancer, we can better evaluate the efficacy of our interventions. This could directly benefit people with cancer pain, potentially decreasing the amount of subtherapeutic novel drugs entering human clinical trials.

Appendiceal Mucocele in Sikasso Hospital: Report of A Case

Appendicular mucocele is a rare appendicular tumor characterized by dilation of the appendicular lumen with linear changes in the mucosa and hypersecretion of mucus. We report a case of appendicular mucocele in a 73-year-old patient. Clinically, there was pain in the right iliac fossa, nausea, sometimes vomiting, and a poorly defined mass palpated in the right iliac fossa. The abdominal ultrasound found an appendicular plastron and the complete blood count showed leukocytosis. The patient underwent an appendectomy and the operative consequences were simple, the pathological examination of the operative specimen concluded that there was a mucinous cystadenoma of the appendix.

Compromiso del apéndice cecal por linfoma folicular grado 2. Reporte de un caso de presentación clínica atípica

The involvement of the appendix by lymphomas, both primarily or secondarily, is extremely rare; primary lymphomas account for less than 0.02% of gastrointestinal neoplasm. We present the rare case of a patient who debuts with low gastrointestinal bleeding as the main symptom. Colonoscopy found an extra mucosal tumour on the posterior aspect of the ceccum and bleeding from the appendicular orifice. Primary appendicular tumour is confirmed on multislice computed tomography and laparoscopic right hemicolectomy is performed. The patient had an uneventful postoperative course and was discharged on the 6th postoperative day. The pathology report shows a infiltration of the cecal appendix by grade 2 follicular lymphoma.

Derivation and validation of risk groups in patients with osteosarcoma utilizing regression tree analysis.

For patients with osteosarcoma, apart from stage and primary site, we lack reliable prognostic factors for risk stratification at diagnosis. There is a need for further defined, discrete prognostic groups using presenting clinical features. We analyzed a cohort of 3069 patients less than 50years of age, diagnosed with primary osteosarcoma of the bone between 1986 and 2013 from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly split into test and validation cohorts. Optimal cut points for age, tumor size, and grade were identified using classification and regression tree analysis. Manual recursive partitioning was used to identify discrete prognostic groups within the test cohort. These groups were applied to the validation cohort, and overall survival was analyzed using Cox models, Kaplan Meier methods, and log-rank tests. After applying recursive partitioning to the test cohort, our initial model included six groups. Application of these groups to the validation cohort resulted in four final groups. Key risk factors included presence of metastases, tumor site, tumor grade, age, and tumor size. Patients with localized axial tumors were identified as having similar outcomes to patients with metastases. Age and tumor size were only prognostically important in patients with extremity tumors when assessed in the validation cohort. This analysis supports prior reports that patients with axial tumors are a high-risk group, and demonstrates the importance of age and tumor size in patients with appendicular tumors. Biologic and genetic markers are needed to further define subgroups in osteosarcoma.

Neuroendocrine tumors of the appendix

The aim. The aim of our study was to analyze the available data from literature sources concerning the issues of epidemiology, pathology, clinic, diagnosis, and features of surgical treatment of neuroendocrine tumors of the vermiform process. Materials and methods. We conducted a retrospective analysis of foreign and domestic literature sources that contain upto-date information about the state of the problem of neuroendocrine tumors of the vermiform process Results. Appendicular neuroendocrine tumors (ANEO) account for up to 16.7% of all neuroendocrine tumors of the gastrointestinal tract. In 54% of cases, ANEO show themselves for the fi rst time with a picture of an acute abdomen that resembles that of acute appendicitis. The main method of treatment is surgical. So far, there are no clinical guidelines that specify clear criteria for performing an appendectomy or right-sided hemicolectomy. Although gastrointestinal neuroendocrine tumors are less sensitive to it, there is evidence of a good response to temozolomide therapy (CAPTEM scheme: temozolomide+capecitabine). Octreotide can also be eff ective, especially in the group of functionally active ANIOS. The 5-year survival rate of patients with ANEO is 94% for tumors up to 1 cm in diameter, 70.5% for tumors larger than 2 cm, and 33.7% for distant metastases at the time of diagnosis. Conclusion. Treatment of patients with ANEO gives rise to the following confl ict situation: on the one hand, the risk of recurrence of the disease in the long term is quite low, but if it occurs, it signifi cantly worsens the prognosis and, consequently, signifi cantly affects the overall survival. We emphasize the need to further study the biological properties of ANIO, the importance of generalizing all available data, which is possible only with close international contact of scientists around the world.

Rare Case of Acute Peritonitis by Perforation of an Appendicular Schistosomiasis at the CHU BSS in Kati

Perforation of a pseudo appendicular tumor of bilharzial origin (bilharzia) is a rare etiology of acute peritonitis. His diagnosis is histopathological. The existence of comorbid malaria and surgical pathology is frequent in having a positive thick drop with Schistosoma mansoni eggs in his stool. After 3 months, the patient is doing well. In conclusion, we recommend the histopathological analysis of the surgical specimen after appendectomy and the detection of haematozoa for malaria in any case of fever in a surgical environment.

Mucocele Apendicular como causa infrecuente de abdomen agudo

Introducción: Los tumores apendiculares tienen una baja incidencia y constituyen un pequeño grupo dentro de la patología de este órgano, en el que predominan ampliamente los procesos inflamatorios. Se diagnostica un tumor apendicular primario en 0.9 a 0.14% de las apendicectomías. Entre los tumores benignos los más frecuentes son el cistodenoma mucinoso; el tumor mucoso, que es el más común del apéndice y se asocia con cistodenomas de ovario y tumores colónicos. Otro tumor benigno es el mucocele simple.&#x0D; Objetivo: Describir un caso clínico enfocado en el mucocele apendicular, como causa infrecuente de abdomen agudo.&#x0D; Material y métodos: Estudio descriptivo retrospectivo, presentación de caso clínico en el Hospital Básico “IESS Latacunga”, caso que fue tratado en el Servicio de Cirugía General del hospital. &#x0D; Resultados: Paciente de 59 años que por cuadro de dolor abdominal de 4 días de evolución, de localización difusa, 15 horas antes de su ingreso el dolor se localiza en fosa iliaca derecha, a tipo cólico, de moderada intensidad, se acompañaba de nauseas que llegan al vómito en dos ocasiones, alza térmica y anorexia. Al examen físico: signos vitales dentro de parámetros normales, abdomen tenso, depresible, doloroso a la palpación superficial y profunda en fosa iliaca derecha, con presencia de masa de aproximadamente 7 cm x 5 cm de diámetro, puntos apendiculares positivos. Los exámenes de laboratorio mostraron: leucocitosis más neutrofilia. Ecografía abdominal: apéndice cecal no visible, no se observa líquido libre en cavidad abdominal.&#x0D; Se realizó laparotomía exploratoria, donde se identificó masa compleja conformada por ciego, epiplón mayor íleon terminal y un apéndice quístico de aproximadamente 10 cm de diámetro mayor; para lo cual se realizó hemicolectomia derecha más íleo transverso anastomosis termino terminal. Paciente con evolución favorable, es dada de alta al quinto día. El estudio anatomopatológico dio como resultado una Neoplasia quística mucinosa de bajo grado (cistodenoma mucinoso) y adenoma tubular con displasia de bajo grado.&#x0D; Conclusiones: El mucocele apendicular es el tumor benigno más común del apéndice. El diagnóstico definitivo se lo realiza posterior a intervención quirúrgica, como un hallazgo y con el reporte del histopatológico como en el caso descrito. Los estudios de imagen son de gran utilidad para su identificación.; debe considerarse en el diagnóstico diferencial de una masa pélvica derecha, porque clínica y radiológicamente es fácil de confundir con una apendicitis complicada

Appendicitis as a manifestation of colon cancer: should we image the colon after appendicectomy in patients over the age of 40years?

Appendicitis can be secondary to caecal pathology (polyp or cancer). Increasing age is a risk factor for malignancy coexisting with appendicitis. There is an increased coexistence of cancer post-appendicectomy in patients aged 50-54years. This study investigates whether post-appendicectomy patients aged over 40years should receive further colorectal imaging and follow-up. Retrospective data were collected for 1633 patients aged 40years and over who underwent appendicectomy in a 10-year period (1st January 2004-31st December 2014). Data were analysed for patients with histological confirmation of acute appendicitis. Incidental appendicular tumours were excluded. One thousand fifty-five (64%) patients had histological confirmation of acute appendicitis (median age 52years; range 40-96years). Six hundred three patients (57%) were aged 40-54years; 452 patients (43%) were aged 55years or over. Twenty-six (2.5%) patients were investigated post-appendicectomy. Three (11.5%) had caecal pathology: 2 adenocarcinoma, 1 benign caecal polyp. Ten (2.2%) patients aged 55years or over had caecal pathology. Seven (1.6%) were diagnosed with caecal cancer. No patients below age 54years were diagnosed with caecal cancer. The incidence of caecal cancer in the study population was 0.66% (40-54.9years 0%; 55years and over 1.6%). Patients aged 55years or over were more likely to develop caecal pathology than patients aged 40-54years (p = 0.006). The odds ratio of developing caecal pathology was 6.8 times greater (95% CI 1.49-31.29) in people aged 55years and over. Patients aged 55years or over who have undergone appendicectomy should be offered colonoscopy to exclude coexistent caecal pathology.

Unusual Findings in Appendectomy: Experience in a Third Level Hospital with More than 1000 Specimens

Introduction and Aims: Acute appendicitis is a commonly established diagnosis in the approach of abdominal pain. It is usually due to an acute inflammatory process in the appendix. Nevertheless, there is a small percentage of cases due to non-frequent etiologies that are only identifiable based on histopathological analysis. The aim of this study was to determine the prevalence and characterization of these unusual findings. Materials and Methods: The present study was a cross-sectional study in a third-level hospital in Mexico City. Clinical information was collected from unusual findings in the histopathological analysis of 1018 appendectomy specimens between January 2012 and April 2017. Results: In total, 1018 appendectomy specimens were included. In 11 of those appendices (1.08%), unusual findings compatible with appendicular tumors were identified. Carcinoid tumor found in the tip of the appendix was the most frequently reported finding. The muscular layer was affected in most cases; up to 25% of regional ganglia were invaded. Most of the patients presented with abdominal pain and clinical signs suggestive of acute appendicitis. The preferred approach for surgical treatment was laparoscopic. Discussion and Conclusion: The prevalence of unusual findings in our population was 1.08%, with carcinoid tumors the most frequently established diagnosis among those (0.58%), according to previously reported literature data.

Prognostic factors in an 85 patient series of digestive neuroendocrine tumours with surgery or endoscopic resection.

Background: The aim of this study is to analyze prognostic factors for survival and recurrence in patients with diagnosis of digestive neuroendocrine tumours (DNT) and underwent a surgery and/or endoscopic resection Methods: Medical records of 85 patients with DNT were retrospectively reviewed since 1990- 2016. The variables studied were: age, sex, form of presentation, localization, metastasis, treatment, type of surgery and state of tumour, including WHO classification (2010). Results: From 85 patients, 51.8% were male, with a median age of 61 years (29-81). By location, the most frequent tumour was small bowel DNT (27.1%) and appendix (25.9%). Appendicular tumours presents in youngest patients (39 years; 8-78) vs colon (67years; 36-83) (p=0.004). Regarding the mode of presentation, it was sporadic (36.5%) and appendicitis (21.2%). Surgery was the most common treatment of primary tumour (73.5%) and endoscopic resection was enough in the 8.2%. There was synchronous metastasis in 37.6% (hepatic location 32.9%) and this presents association with location (small bowel and stomach; p<0.001). The 1, 3 and 5-years survival was 89.3%, 75% and 58.4%. Univariate and multivariate survival analysis showed that location, presentation clinic, WHO classification and presence of metastasis are independent predictor factors. Conclusion: In our experience, location, presentation clinic, WHO classification and presence of metastasis were an independent prognostic factors in DNT survival.

Functional outcome in reconstructions with fibula autograft in tumors of appendicular skeleton

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Resection by a limb-sparing surgery and restoration of bone and soft tissues makes a successful limb salvage. Several reconstructive procedures that maintain limb length and provide acceptable cosmetic and functional results include endoprosthetic reconstruction, use of allografts and/or autografts like vascular or avascular fibula graft. The objective of the study was to assess and compare the preoperative and postoperative functional and radiological outcome in patients treated with wide resection of tumors of the appendicular skeleton followed by reconstruction with fibula graft.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This retrospective and prospective comparative study was conducted in 17 patients in Amrita Institute of Medical Sciences, Kerala. The patients were followed up for a minimum of 9 months ranging to 65 months. Functional and radiological assessments were done. Wilcoxon signed ranks test was done to assess significant differences between preoperative and postoperative functional scores. The SPSS software was used to analyze the data collected.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There was statistical significance as well as improvement in the postoperative functional scores (p=0.004) when compared to the preoperative status. There was no significance (2 tailed test) in postoperative functional scores between vascular and avascular fibula graft (p=1.000).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Fibula grafting after resection of appendicular tumors offers a wonderful technique in filling bony defects. It provides good functional outcome and better bony union. Even though the postoperative outcome is significant, there is no significant difference between vascularized and avascular fibula in terms of functional outcome, bony union and graft hypertrophy.&lt;/p&gt;