Hidden hazard in appendix in children: Carcinoid tumors

Abstract

Introduction: Carcinoid tumors (CT) are the most common tumors of the appendix. The incidence of CT of the appendix is generally 1–2 in every 1000 appendectomy material. Objectives: The objectives of the study were to discuss the follow-up and treatment of CT of the appendix in the specimen of patients who underwent an appendectomy. Materials and Methods: This retrospective study enrolled the patients who were diagnosed with CT of the appendix as a result of an examination of the appendix specimen after the patients underwent an appendectomy. All the patients, who underwent appendectomy in the pediatric surgery clinic of our hospital between November 2015 and November 2018, were included in the study. Patients’ demographic characteristics, clinical findings, pre-operative laboratory and imaging results, location, diameter and size of the tumor, mesoappendix invasion status, mitotic index and Ki-67 elevation, hospital stay duration, surgical types and complications, and results of laboratory and imaging tests were evaluated. Findings: Eight of the 621 patients (1.2%) who underwent an appendectomy were diagnosed with CT of the appendix. The median age of the patients was 13 years (range, 11–16 years). Of the eight patients, five (62.5%) were female and three (37.5%) were male. All patients presented to our clinic with abdominal pain. No surgical complications were observed during the operation and in the early post-operative period. The mean hospital stay was 2.7 days (2–5 days). In all the patients, the tumor size was <2 cm, the surgical margins were clean, the mitotic index was <2%, the Ki-67 index was below 1%, and the tumor had not spread to the mesoappendix. Only in one of the patients, the CT was located in the appendix radix; in the other seven patients, the tumor was in the middle and end of the appendix. Conclusion: CT of the appendix are clinically similar to acute appendicitis but may be found incidentally during other surgical procedures other than an appendectomy. Diagnosis is made after the pathological specimen diagnosed with CT is histopathologically evaluated. The size, diameter, and depth of the tumor, mesoappendix invasion, mitotic index, and Ki-67 elevation are used in the evaluation and treatment of the tumor.