Department of Pathology, University of California San Diego, La Jolla, CA, United States of America; Health Sciences International, University of California San Diego, La Jolla, CA, United States of America.
Department of Pathology, University of California San Diego, La Jolla, CA, United States of America.
Ann Diagn Pathol. 2022 Aug;59:151950. doi: 10.1016/j.anndiagpath.2022.151950. Epub 2022 Apr 9.
Appendectomies are not uncommonly performed following an intraoperative diagnosis of a mucinous ovarian neoplasm, although the evidentiary basis for the practice is relatively limited. The current study is a contemporary re-examination of the issue, based on an analysis of a large single institutional cohort. We assessed whether there are any composite of factors that may be associated with the finding of significant disease in the appendix in this setting following intraoperative consultation (IOC) diagnosis of a mucinous neoplasm on an ovary-based mass. Records for 460 consecutive patients whose ovarian tumors were classified as "mucinous" on IOC (n = 246) and/or permanents (n = 214) were reviewed. The distribution of IOC diagnoses on the 246 tumors were as follows: cystadenoma (114), borderline (55), carcinoma (21), mucinous neoplasm or tumor without definitive classification (53), and probable metastases (3). Appendectomies were performed on 82 (33%) of the 246 cases. In 30 (36%) of these 82 cases, the appendix was grossly normal, the ovarian tumor was unilateral, and there was no intraabdominal/peritoneal disease. Microscopic examination of the appendices in these 30 cases showed no mucinous neoplasms therein, but one case had a grossly inapparent, 4 mm well-differentiated carcinoid. In contrast, among the remaining 52 cases (i.e. those with at least one of the "key abnormal features": intra-abddominal/peritoneal disease and/or appendiceal gross abnormality and/or ovarian tumor bilaterality), 12 neoplasms (23%) were microscopically identified in the appendix (4 adenocarcinomas; 7 LAMN; 1 carcinoid) [p = 0.0256]. Of these 12, a grossly abnormal appendix, intraabdominal/peritoneal disease, and ovarian tumor bilaterality was the sole key abnormal feature in 10, 8 and 4 cases respectively, meaning that requiring that any one feature be present to justify the appendectomy would have missed 17%, 33% and 67% of cases respectively. Only 33% (3/12) cases had all 3 features. Our findings support the emerging body of work that indicates that appendectomies should not be routinely performed during the primary surgery for suspected or confirmed mucinous tumors that involve the ovary, unless there is a specific indication. In our cohort, all identified mucinous appendiceal neoplasms were associated with at least one key abnormal feature (gross abnormalities of the appendix, intraabdominal/peritoneal disease, ovarian tumor bilaterality), which suggests that only in patients that meet these criteria would appendectomies most likely be beneficial.
阑尾切除术在术中诊断为黏液性卵巢肿瘤后并不少见，尽管该操作的证据基础相对有限。本研究基于对大型单一机构队列的分析，重新审视了这一问题。我们评估了在术中咨询（IOC）诊断卵巢肿块上的黏液性肿瘤后，在这种情况下，阑尾中是否存在任何可能与显著疾病相关的复合因素。对 460 名连续患者的记录进行了回顾，这些患者的卵巢肿瘤在 IOC（n=246）和/或永久（n=214）中被分类为“黏液性”。在 246 个肿瘤中，IOC 诊断的分布如下：囊腺瘤（114）、交界性（55）、癌（21）、黏液性肿瘤或无明确分类的肿瘤（53）和可能的转移（3）。在 246 例病例中，82 例（33%）进行了阑尾切除术。在这 82 例中的 30 例（36%）中，阑尾大体正常，卵巢肿瘤为单侧，且无腹腔/腹膜疾病。在这 30 例中，阑尾的显微镜检查未显示出黏液性肿瘤，但有 1 例有大体上不明显的 4 毫米分化良好的类癌。相比之下，在其余 52 例（即至少有一个“关键异常特征”：腹腔/腹膜疾病和/或阑尾大体异常和/或卵巢肿瘤双侧性）中，在阑尾中发现了 12 个肿瘤（23%）（4 个腺癌；7 个 LAMN；1 个类癌）[p=0.0256]。在这 12 个病例中，10 例、8 例和 4 例的唯一关键异常特征分别为阑尾大体异常、腹腔/腹膜疾病和卵巢肿瘤双侧性，这意味着如果要求任何一个特征存在才能证明阑尾切除术合理，那么分别会遗漏 17%、33%和 67%的病例。只有 33%（3/12）的病例具有所有 3 个特征。我们的发现支持越来越多的工作表明，对于疑似或确诊涉及卵巢的黏液性肿瘤，除非有特定的指征，否则不应在初次手术期间常规行阑尾切除术。在我们的队列中，所有确定的阑尾黏液性肿瘤均与至少一个关键异常特征（阑尾大体异常、腹腔/腹膜疾病、卵巢肿瘤双侧性）相关，这表明只有符合这些标准的患者行阑尾切除术才可能有益。
