Case of the Month: July, 2011, Page 4

Answer: C. Carcinoid.

The patient was taken to the operating room. Upon entering the peritoneal cavity, serous fluid without purulence was encountered. The appendix was found to have a very inflamed bulbous tip. Surgical pathology described a vermiform appendix measuring 1 cm in diameter with a spherical tip measuring 2 cm.

Histology revealed a well differentiated endocrine neoplasm consistent with carcinoid. Invasion of the mesoappendix, lymphovascular invasion and perineural spread were present. Additionally, there was an acute periappendiceal abscess which was most likely related to gangrenous perforation of the appendiceal tip neoplasm.

Subsequently, laparoscopic ileocecetomy and lymph node dissection was performed, which revealed no residual or metastatic tumor. Two years later the patient remained tumor free.

True or False?

One third of appendiceal carcinoid tumors are associated with carcinoid syndrome.


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