A neuroendocrine tumor in a macroscopically unchanged appendix
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District Hospital in Biskupiec, Poland
Submission date: 2023-11-30
Final revision date: 2024-01-08
Acceptance date: 2024-01-09
Online publication date: 2024-02-27
Corresponding author
Wojciech Całka   

District Hospital in Biskupiec, Armii Krajowej 8, 11-300 Biskupiec, Poland
Pol. Ann. Med. 2024;31(1):59-62
The intraoperative failure to find a macroscopically visible pathological condition within the appendix or other abnormalities of abdominal organs that could explain clinical symptoms in patients eligible for appendectomy does not prejudge the absence of underlying disease in an apparently healthy appendix.

The aim of the study is to highlight the problem of possible hidden pathological conditions in a macroscopically unchanged appendix in patients scheduled for appendectomy.

Case study:
In this article, we present a case of female patient who was qualified to laparoscopic appendectomy due to symptoms of acute appendicitis. Although intra-operatively appendix did not show any pathological signs, histopathological examination revealed neuroendocrine tumor in the organ.

Results and discussion:
This publication describes a case of the removal of a macroscopically unchanged appendix in a patient with clinical and laboratory signs of acute appendicitis. A neuroendocrine neoplasm was histopathologically revealed in the removed appendix. The correct eligibility for appendectomy can present great difficulties even for experienced surgeons. Failure to identify visible abnormalities in the appendix after ruling out other possible causes of clinical symptoms does not prejudge the absence of pathological conditions in this organ.

This clinical case shows that the removal of a morphologically normal appendix in a patient eligible for appendectomy, in the absence of other intra-abdominal pathological conditions explaining the clinical signs, is not necessarily a mistake.

This study has no funding.
The author declares that he has no conflict of interest.
Jaschinski T, Mosch CG, Eikermann M, Neugebauer EA, Sauerland S. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev. 2018;11(11):CD001546.
Mahajan P, Basu T, Pai Ch-W, et al. Factors associated with potentially missed diagnosis of appendicitis in the emergency department. JAMA Netw Open. 2020;3(3):e200612.
Konsek-Komorowska SJ, Kolasińska-Ćwikła AD, Cichocki A, et al. Value of somatostatin receptor scintigraphy in patients with appendiceal neuroendocrine neoplasms based on clinical follow-ups. Pol Ann Med. 2021;28(2):116–121.
Zingone F, Sultan AA, Humes DJ, West J. Risk of acute appendicitis in and around pregnancy: a population-based cohort study from England. Ann Surg. 2015;261(2):332–337.
Cuschieri J, Florence M, Flum DR, et al. Negative appendectomy and imaging accuracy in the Washington State Surgical Care and Outcomes Assessment Program. Ann Surg. 2008;248(4):557–563.
Salminen P, Paajanen H, Rautio T, et al. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: The APPAC Randomized Clinical Trial. JAMA. 2015;313(23):2340–2348.
Benito J, Acedo Y, Medrano L, Barcena E, Garay RP, Arri EA. Usefulness of new and traditional serum biomarkers in children with suspected appendicitis. Am J Emerg Med. 2016;34(5):871–876.
Snyder MJ, Guthrie M, Cagle S. Acute appendicitis: Efficient diagnosis and management. Am Fam Physician. 2018;98(1):25–33.
Alexandraki KI, Kaltsas GA, Grozinsky-Glasberg S, Chatzellis E, Grossman AB. Appendiceal neuroendocrine neoplasms: diagnosis and management. Endocr Relat Cancer. 2016;23(1):R27–41.
Lundqvist M, Wilander E. Subepithelial neuroendocrine cells and carcinoid tumours of the human small intestine and appendix. A comparative immunohistochemical study with regard to serotonin, neuron-specific enolase and S-100 protein reactivity. J Pathol. 1986;148(2):141–147.
Jakobsen AM, Andersson P, Saglik G, et al. Differential expression of vesicular monoamine transporter (VMAT) 1 and 2 in gastrointestinal endocrine tumours. J Pathol. 2001;195(4):463–472.
van Dalen R, Bagshaw PF, Dobbs BR, Robertson GM, Lynch A C, Frizelle FA. The utility of laparoscopy in the diagnosis of acute appendicitis in women of reproductive age. Surg Endosc. 2003;17(8):1311–1313.
Teixeira PGR, Demetriades D. Appendicitis: Changing perspectives. Adv Surg. 2013;47:119–140.
Kayumov MR, Kiryanov NA, Musaev RR, Styazhkina SN. Appendiceal cancer [in Russian]. Khirurgiia (Mosk). 2022;(2):79–81.
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