ORIGINAL ARTICLE
The relationship between diverticula and low-grade mucinous neoplasm of the appendix. Does the diverticulum play a role in the development of periappendicular mucin deposition or pseudomyxoma peritonei?
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Submission date: 2016-03-20
Final revision date: 2016-07-03
Acceptance date: 2016-07-18
Publication date: 2016-11-28
Pol J Pathol 2016;67(4):376-383
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ABSTRACT
Prevalences of diverticulum and low-grade mucinous neoplasm (LGMN) were reported as 0.04-2% and less than 1% in the appendix. In this study, the frequency of diverticulum in LGMN cases, the relationship between diverticula and periappendicular mucin, and the possible role of diverticula in pseudomyxoma peritonei pathogenesis were researched.
Through systematic review and targeted search, 38 LGMN and 96 diverticula were identified, frequencies and relationship between diverticulum and LGMN were analysed.
Diverticulum and LGMN were determined in 4.8% and 1.04%, respectively, of 1922 appendectomy materials specifically grossed by the same pathologist. The prevalence of diverticulum was higher in our study than literature. The difference may be due to detailed macroscopic examination. Diverticulum was detected in 60% of LGMN cases. The rate of diverticulum was found to be significantly higher in LGMNs than non-neoplastic diverticulum (p < 0.001). Periappendicular mucin deposition was significantly more frequent in LGMN cases with diverticulum than in other groups (p < 0.05). Follow-ups were available in 18 patients; none of them had mucin deposition in the peritoneal cavity.
We detected that periappendicular mucin was highly associated with diverticula in LGMN cases. Periappendicular acellular mucin deposition may not give rise to pseudomyxoma peritonei. We may think that mucin could move out of the appendix through the diverticulum rather than neoplastic spread in some of these cases.
REFERENCES (24)
1.
Lam-Himlin D, Montgomery E, Torbenson M. Nonneoplastic and neoplastic disorders of the appendix. In: Gastrointestinal and Liver Pathology. Iacobuzio-Donahue CA, Montgomery E (eds.). 2nd ed. Elsevier, Philadelphia 2012; 257-296.
2.
Qizilbash AH. Mucoceles of the appendix. Their relationship to hyperplastic polyps, mucinous cystadenomas, and cystadenocarcinomas. Arch Pathol Lab Med 1975; 99: 750-755.
3.
Ronnet BM, Kurman RJ, Zahn CM, et al. Pseudomyxoma peritonei in women: a clinicopathologic analysis of 30 cases with emphasis on site of origin, prognosis, and relationship to ovarian mucinous tumors of low malignant potential. Hum Pathol 1995; 26: 509-524.
4.
Carr NJ, Sobin LH. Unusual tumors of the appendix and pseudomyxoma peritonei. Semin Diagn Pathol 1996; 13: 314-325.
5.
Edge SB, Byrd DR, Compton CC, et al. (eds.). AJCC Cancer Staging Manual. (Appendix) Springer, New York, 2010; 133-141.
6.
Carr NJ, Sobin LH. Adenocarcinoma of the appendix. In: WHO Classification of Tumors of the Digestive System. Bosman FT, Carneiro F, Hruban RH, N.D. Theise (eds.), 4th ed. WHO press, Lyon 2010; 122-125.
7.
Käser SA, Willi N, Maurer CA. Prevalence and clinical implications of diverticulosis of the vermiform appendix. J Int Med Res 2013; 41: 1350-1356.
8.
Marudanayagam R, Williams GT, Rees BI. Review of the pathologic results of 2660 appendectomy specimens. J Gastroenterol 2006; 41: 745-749.
9.
Abdullgaffar B. Diverticulosis and diverticulitis of the appendix. Int J S Pathol 2009; 17: 231-237.
10.
Wetzig NR. Diverticulosis of the vermiform appendix. Med J Aust 1986; 145: 464-465.
11.
Everts-Suare EA, Noteboom B. Congenital diverticula of the appendix: review of the world’s literature and report of a case. Penn Med J 1961; 64: 1454-1458.
12.
Hsu M, Young RH, Misdraji J. Ruptured appendiceal diverticula mimicking low-grade appendiceal mucinous neoplasms. Am J Surg Pathol 2009; 33: 1515-1521.
13.
Panarelli NC, Yantiss RK. Mucinous neoplasms of the appendix and peritoneum. Arch Pathol Lab Med 2011; 135: 1261-1268.
14.
Misdraji J. Mucinous epithelial neoplasms of the appendix and pseudomyxoma peritonei. Mod Pathol 2015; 28 Suppl 1: 67-79.
15.
Misdraji J. Epithelial neoplasms of the Appendix In: Odze RD, Goldblum JR, editors. Surgical Pathology of the GI Tract, Liver, Biliary Tract and Pancreas. 2nd ed. Philadelphia, 2015: 779-801.
16.
Dupre MP, Jadavji I, Matshes E, et al. Diverticular disease of the vermiform appendix: a diagnostic clue to underlying appendiceal neoplasm. Hum Pathol 2008; 39: 1823-1826.
17.
Place RJ, Simmang CL, Huber PJ Jr. Appendiceal diverticulitis. South Med J 2000; 93: 76-79.
18.
Medlicott SAC, Urbanski SJ. Acquired diverticulosis of the vermiform appendix. A disease of multiple etiologies. Int J Surg Pathol; 6: 23-26.
19.
Lipton S, Estrin J, Glasser I. Diverticular disease of the appendix. Surg Gynecol Obstet 1986; 168: 13-16.
20.
Lamps LW, Gray GF, Dilday BR, et al. The coexistence of low-grade mucinous neoplasms of the appendix and appendiceal diverticula: A possible role in the pathogenesis of pseudomyxoma peritonei. Mod Pathol 2000; 13: 495-501.
21.
Pai RK, Beck AH, Norton JA, et al. Appendiceal mucinous neoplasms. Clinicopathologic study of 116 cases with analysis of factors predicting recurrence. Am J Surg Pathol 2009; 33: 1425-1439.
22.
Yantiss RK, Shia J, Klimstra DS, et al. Prognostic siginificance of localized extra-appendiceal mucin deposition in appendiceal mucinous neoplasms. Am J Surg Pathol 2009; 33: 248-255.
23.
Kim SH, Lim HK, Lee WJ, et al. Mucocele of the appendix: ultrasonographic and CT findings. Abdom Imaging 1998; 23: 292-296.
24.
Wakui N, Fujita M, Yamauchi Y, et al. Mucinous cystadenocarcinoma of the appendix in which contrast-enhanced ultrasonography was useful for assessing blood flow in a focal nodular lesion in the tumor cavity: A case report. Exp Ther Med 2013; 6: 3-8.