M Kleppe1, J Bruls2, T Van Gorp3, L Massuger2, B F M Slangen3, K K Van de Vijver4, A J Kruse3, R F P M Kruitwagen5. 1. Maastricht University Medical Centre, Department of Obstetrics and Gynecology, Maastricht, The Netherlands. 2. Radboud University Nijmegen Medical Centre, Department of Obstetrics and Gynecology, Nijmegen, The Netherlands. 3. Maastricht University Medical Centre, Department of Obstetrics and Gynecology, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands. 4. GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands; Maastricht University Medical Centre, Department of Pathology, Maastricht, The Netherlands. 5. Maastricht University Medical Centre, Department of Obstetrics and Gynecology, Maastricht, The Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands. Electronic address: r.kruitwagen@mumc.nl.
Abstract
OBJECTIVES: Appendectomy is often recommended in patients with mucinous borderline ovarian tumours (mBOTs) based on studies suggesting that metastatic disease from a primary appendiceal tumour can mimic mBOT. The present study assessed the incidence of mucinous neoplasms in the appendix associated with the presence of mBOT. METHODS: A retrospective cohort study was performed in two university hospitals in the Netherlands between 1990 and 2011. All patients with mBOT and/or a mucinous appendiceal tumour were included. RESULTS: Of 127 patients included, 98 had a primary mBOT and 29 had a primary mucinous appendiceal tumour. In patients with a mBOT, the appendix was either removed at prior surgery (4%), resected as part of the staging procedure showing no pathological abnormalities (13%), described as normal and not resected (58%), or not described and not resected (25%). During a median follow-up period of 5 years (range 2-23), two patients developed a recurrence in which the appendix was not involved. In all patients with a primary mucinous tumour of the appendix, the appendix appeared abnormal at the time of surgery. Eight of these patients (28%) were diagnosed with invasive ovarian metastases. A review of the literature including the cases from this study identified 510 mucinous ovarian tumours with borderline features and 214 associated appendectomies, of which 4 (1.9%) contained a primary appendiceal malignancy. CONCLUSIONS: A thorough inspection of the appendix should be performed in patients with a mucinous ovarian tumour with borderline features. An appendectomy should only be performed when the appendix is macroscopically abnormal.
OBJECTIVES: Appendectomy is often recommended in patients with mucinous borderline ovarian tumours (mBOTs) based on studies suggesting that metastatic disease from a primary appendiceal tumour can mimic mBOT. The present study assessed the incidence of mucinous neoplasms in the appendix associated with the presence of mBOT. METHODS: A retrospective cohort study was performed in two university hospitals in the Netherlands between 1990 and 2011. All patients with mBOT and/or a mucinous appendiceal tumour were included. RESULTS: Of 127 patients included, 98 had a primary mBOT and 29 had a primary mucinous appendiceal tumour. In patients with a mBOT, the appendix was either removed at prior surgery (4%), resected as part of the staging procedure showing no pathological abnormalities (13%), described as normal and not resected (58%), or not described and not resected (25%). During a median follow-up period of 5 years (range 2-23), two patients developed a recurrence in which the appendix was not involved. In all patients with a primary mucinous tumour of the appendix, the appendix appeared abnormal at the time of surgery. Eight of these patients (28%) were diagnosed with invasive ovarian metastases. A review of the literature including the cases from this study identified 510 mucinous ovarian tumours with borderline features and 214 associated appendectomies, of which 4 (1.9%) contained a primary appendiceal malignancy. CONCLUSIONS: A thorough inspection of the appendix should be performed in patients with a mucinous ovarian tumour with borderline features. An appendectomy should only be performed when the appendix is macroscopically abnormal.
Authors: Jaimin S Shah; Michael Mackelvie; David M Gershenson; Preetha Ramalingam; Marylee M Kott; Jubilee Brown; Polly Gauthier; Elizabeth Nugent; Lois M Ramondetta; Michael Frumovitz Journal: J Minim Invasive Gynecol Date: 2018-04-19 Impact factor: 4.137