My medical history. Appendiceal Cancer: Types, Symptoms, Treatment and Survival

Malignant tumors of the appendix are a fairly rare pathology. By different estimates, appendix cancer occurs in only 1-2 people out of a thousand cancer patients.

The initial stages of the tumor process in the appendix are quite difficult to distinguish from acute inflammation. According to statistics, in approximately 0.9-1% of cases, tumors are found in the removed appendix, which become the cause of a painful attack simulating appendicitis.

Appendiceal cancer is currently treated with surgical and conservative methods. The initial stages of the pathology respond well to conventional treatment surgical removal vermiform appendix. In this case, it is important to inspect the neighboring lymph nodes, since malignant cells can penetrate into them, which threatens relapse in the future.

Today Israel is considered a country with advanced cancer medicine. Excellent world-class specialists work here, using in their practice the latest techniques diagnosis and treatment. Thanks to the introduction of innovative methods, the percentage of recovered patients cancer diseases in the Promised Land is one of the highest in the world. At the same time, according to observations, mortality from cancer in Israel is decreasing from year to year. Even with advanced cases of oncological pathologies, Israeli doctors offer patients treatment that allows them to transfer the disease to the stage of long-term stable remission.

Price for treatment of appendix cancer in Israel

It is impossible to indicate the exact cost of medical services for a diagnosis of appendix cancer, since everything here depends on many components, such as:

• treatment method (surgery or conservative therapy);
• the use of innovative treatment procedures (eg HIPEC);
• specific diagnostic procedures;
• length of stay of the patient in the hospital;
• severity of pathology;
• other factors.

It should be noted that thanks to serious government support, Israeli clinics are able to provide first-class medical services at very reasonable prices. Israel allocates almost 10% of GDP to healthcare. Therefore, treatment in the Promised Land costs foreign patients almost 40% cheaper than in Western European countries, not to mention the USA, where medicine has always been expensive.

Diagnostic protocol in Israeli clinics

When diagnosing diseases, it is important to adhere to modern protocols accepted by the international medical community. All the developed countries(including Israel) diagnose and treat diseases according to established protocols. As for a disease such as appendix cancer, the diagnostic protocol includes the following measures:

• Initial examination by an abdominal surgeon and oncologist.
• Blood tests: general, biochemical, tests for tumor markers.
• Ultrasound diagnostics of internal organs (used to determine the degree of damage to organs and tissues).
• Tomographic studies (CT, MRI, PET-CT). Depending on the picture of the disease, doctors select certain tomographic examinations.
• Biopsy and histological examination of the taken material.

Diagnostics in Moscow are carried out at the Medis-Center representative office. All procedures are performed according to international medical protocols by Israeli and Russian specialists.

Appendiceal cancer: treatment in Israel

Appendiceal cancer is treated with surgery and conservative ways, among which in Israeli clinics the following apply:

• Appendectomy. This is an operation to remove the appendix. It is performed in the early stages, when the tumor does not grow into neighboring tissues. In most countries of the world this therapeutic measures end, but Israel is somewhat different from this approach. Israeli doctors after removal of the appendix, a complete revision of the abdominal area is performed, since there is a possibility of detecting malignant cells. Treatment ends only when it is 100% clear that there are no more atypical cells in the body. This approach eliminates the possibility of developing metastases.
• Right hemicolectomy. During this intervention, the appendix and part of the colon are removed, which prevents relapses.
• Lymphadenectomy. If malignancy also affects nearby lymph nodes, then a decision is made to perform lymphadenectomy - removal of the lymph nodes.
• Chemotherapy. Typically, chemotherapy is prescribed when appendix cancer has metastasized. In a country like Israel, the latest generation of chemotherapy drugs are used.
• HIPEC. This is an innovative chemotherapy method, the essence of which is the use of a heated solution of chemotherapy drugs, which is injected into the abdominal cavity. In some cases, the HIPEC technique is used in combination with surgery to remove the appendix, part of the gallbladder, intestines and the inner lining of the abdominal cavity. Cytoreductive surgery is advisable in cases where the tumor has spread to other tissues and organs.
• Radiation therapy. Modern linear accelerators are used to irradiate the tumor in a strictly given coordinates and radiation doses.

Appendiceal cancer in Moscow at the Medis Center is treated according to Israeli protocols. If necessary, we send the patient to Israel, where he receives qualified care at the highest level. Treatment of appendix cancer in Moscow is performed by invited Israeli and Russian specialists.

Appendiceal cancer: types of disease

According to cytological characteristics, appendix cancer is of the following types:

• Carcinoid- a tumor of epithelial origin that has a predisposition to metastasize. If we're talking about about a primary tumor, its size fluctuates around 1 centimeter in diameter, but such a neoplasm can increase in size.
• Adenocarcinoma- often such a tumor is registered in patients over 40 years of age. In women, metastases can penetrate the ovaries. Clinical picture in in this case often resembles symptoms of acute appendicitis.
• Cystadenocarcinoma mucinous (pseudomyxomatosis)- a benign tumor that secretes mucus, which can lead to the death of the patient.
• Scirrhous carcinoma of the appendix- is very rare, and the tumor feels hard to the touch.
• Poorly differentiated appendix cancer- capable of quickly metastasizing.
• Squamous cell carcinoma of the appendix- a tumor consisting of squamous epithelium.

Appendiceal cancer, like other types of malignant tumors, occurs in 4 stages:

• Zero - atypical cells observed only in the mucous membranes of the appendix.
• The first is that the neoplasm spreads to other layers of the appendix.
• Second - nearby ones are affected The lymph nodes.
• Third, the malignant tumor increases in size and spreads to neighboring organs.
• Fourth, distant metastases are recorded, which are found in the liver, lungs and other organs.

In the early stages the disease responds well complete cure However, appendiceal cancer is rarely detected at this stage.

Appendiceal cancer: causes

Currently, hundreds of studies are being conducted aimed at elucidating the causes of the development of the oncopathological process in the appendix. The cause of malignancy of appendix cells is not fully known, but scientists and doctors were able to find out some factors leading to the appearance of a malignant process:

• infectious pathologies of the gastrointestinal tract;
• disturbances in the functioning of intestinal enterochromaffin cells, which leads to increased secretion of serotonin;
• intestinal pathologies;
• inflammatory vascular diseases;
• slagging and intoxication of the body;
• bad habits, physical inactivity and alcohol abuse.

Tumors of the PR are rare, their frequency among all patients is 0.2-0.3% [M.M. Kuzin, 1987; Yu.M. Paniyrev, 1988].

DO PO includes neuromas, adenomas, fibroids, leiomyomas, lipomas, angiomas, fibromas and polyps. There are adenomatous and villous polyps. 30 include cancer, carcinoid and reticuloblastoma.

The presence of a tumor in the cervical region and its nature are detected only during hysterectomy of the removed appendix. Although tumors do not give any specific manifestations, they can nevertheless contribute to the development of acute or chronic appendicitis.

With cervical cancer, obstruction of its lumen occurs quite quickly, which leads to stagnation of the contents and the development of acute appendicitis, for which patients often undergo surgical intervention. Cervical cancer has the appearance of a polyp and often ulcerates. Histologically, adenocarcinoma is detected. Tumor metastases are rare; relatively often they metastasize to the liver and greater omentum. When cancer is detected in the emergency area, there is a need for repeated surgical intervention—right hemicolectomy.

Of the tumors of the gastrointestinal tract and appendix, the most common (55% of cases) is carcinoid PO, which in its structure resembles cancer. A carcinoid tumor arises from and is rich in enterochromophin cells. These cells secrete serotonin. The tumor has a small gap (1-2 cm). Most often it is located in the area of ​​the apex of the choroid. On the section it has a yellowish-gray color. Metastases of a carcinoid tumor are rarely observed (in 3% of cases). Carcinoid differs from cancer in a more favorable course, although very rarely, unlike other localizations, it gives metastases.

The disease is mainly manifested by sudden cyanosis or redness of the face and upper half of the body, flushing, diarrhea, asthmatic attacks, pellagroid skin changes, mental changes (carcinoid syndrome, or Bjork syndrome). These symptoms are due high level serotonin. With carcinoid, fibrosis of the endocardium with damage to the valves is often observed, which gives the corresponding clinical manifestations. In diagnostics great importance has a determination of serotonin levels in the blood and 5-hydroxyindolyl in the urine acetic acid(a product of serotonin metabolism).

Treatment of tumors in the cerebral region is surgical. For benign tumors and carcinoids that do not extend beyond the appendix, a simple appendectomy is sufficient. For cancer and other cancers in the non-generalized stage, right-sided hemicolectomy is indicated, radical surgical intervention is an appendectomy. As a rule, carcinoid has no other objective manifestations.

True cervical cancer is casuistically rare; no more than 150 observations of such cancer localization are described in the literature [Yu.M. Pantsyrev, 1988]. In terms of structure, it is most often adenocarcinoma, located at the base of the cerebral palsy. In the initial stages of the disease, the tumor does not manifest itself in any way and, as a rule, is discovered by chance during surgery or subsequent hysterectomy.

The exception is lymphosarcoma, when lymphoid tissue PO is involved in the process during its generalization. Metastases of 30 in the cervical region are also rare, with the exception of its superficial lesions in peritoneal carcinomatoea.

As a result of obstruction of the lumen of the choroid or its obliteration in a limited area, cysts may form. Obliteration of the lumen of the process leads to the accumulation of CO secretion in it, resulting in the formation of a closed cavity filled with jelly-like content (mucocele). Rupture of a cyst with the release of its contents into the abdominal cavity can lead to the development of pseudomyxoma peritonei. At the same time, a large number of jelly-like or mucous masses accumulate in the abdominal cavity, formed in the cells of the mucocele implanted on the surface of the peritoneum after mucocele rupture. A chronic granulomatous-cystic inflammatory process develops in the peritoneum. The disease is severe and leads to fatal outcome. In this regard, pseudomyxoma is classified as a malignant process.

Berger first described appendix cancer in 1882. Berger first described appendix cancer in 1882. Neoplasms of the appendix are an extremely rare tumor pathology: the total proportion among all malignant tumors of the colon is 0.5%. Carcinoid tumors of the gastrointestinal tract are most often found in the appendix (45-75%). Adenocarcinoma of the appendix is ​​usually discovered incidentally during an appendectomy performed for acute or chronic appendicitis. Neoplasms of the appendix are an extremely rare tumor pathology: the total proportion among all malignant tumors of the colon is 0.5%. Carcinoid tumors of the gastrointestinal tract are most often found in the appendix (45-75%). Adenocarcinoma of the appendix is ​​usually discovered incidentally during an appendectomy performed for acute or chronic appendicitis.

The relative incidence of appendix cancer does not exceed 0.02%. At appendectomy, 48 tumors were found, including 3 adenocarcinomas, 38 carcinoids, 5 metastatic tumors, 1 fibroma, 2 reticuloblastomas, and 4 polyps. The relative incidence of appendix cancer does not exceed 0.02%. At appendectomy, 48 tumors were found, including 3 adenocarcinomas, 38 carcinoids, 5 metastatic tumors, 1 fibroma, 2 reticuloblastomas, and 4 polyps.

Classification I. Benign tumors: 1. Epithelial 1. Epithelial - villous - villous - polyps - polyps 2. Non-epithelial: 2. Non-epithelial: - lipomas - lipomas - fibromas - fibromas - fibroids - fibroids - neuromas - neuromas - neurofibromas - neurofibromas

II. Malignant: 1. Epithelial 1. Epithelial - squamous cell carcinoma - squamous cell carcinoma - glandular cancer - glandular cancer 2. Non-epithelial 2. Non-epithelial - sarcoma - sarcoma - macrofollicular lymphoblastosis (Brill-Simmers disease) - macrofollicular lymphoblastosis (Brill-Simmers disease) Simmers) III. Metastatic tumors

Tumors of the appendix are most often localized in proximal part shoots, their growth occurs predominantly endophytically. If the tumor is located in the proximal part of the process, it can spread to the wall of the cecum, making it difficult to determine the location primary focus. Tumors of the appendix are most often localized in the proximal part of the appendix, their growth occurs predominantly endophytically. If the tumor is located in the proximal part of the process, it can spread to the wall of the cecum, making it difficult to determine the location of the primary lesion.

Tumors of the appendix quickly infiltrate the serous membrane, metastasize lymphogenously (into the retroperitoneal lymph nodes located at the base of the appendix and in the mesentery of the right half of the colon), implantation (along the pelvic peritoneum), and hematogenously (liver, lungs). In some cases, the significant prevalence of the process significantly complicates the determination of the location of the primary tumor. Tumors of the appendix quickly infiltrate the serous membrane, metastasize lymphogenously (into the retroperitoneal lymph nodes located at the base of the appendix and in the mesentery of the right half of the colon), implantation (along the pelvic peritoneum), and hematogenously (liver, lungs). In some cases, the significant prevalence of the process significantly complicates the determination of the location of the primary tumor.

Carcinoid tumors are most often located distal to the third of the appendix and appear as small, firm, contoured, yellowish-brown lesions. Carcinoid tumors are most often located distal to the third of the appendix and appear as small, firm, contoured, yellowish-brown lesions. Metastatic damage to the appendix is ​​possible when the primary tumor is localized in the stomach, pancreas, ovaries, mammary glands, and lungs. Metastatic damage to the appendix is ​​possible when the primary tumor is localized in the stomach, pancreas, ovaries, mammary glands, and lungs.

We present observations of patients with appendix cancer from 1998 to 2005. We present observations of patients with appendix cancer from 1998 to 2005. We observed 16 patients with appendix cancer, among them 9 men and 7 women aged from 16 to 70 years. The duration of clinical manifestations ranged from 1 month to 2 years. We observed 16 patients with appendix cancer, among them 9 men and 7 women aged from 16 to 70 years. The duration of clinical manifestations ranged from 1 month to 2 years.

In most cases, patients presented complaints that were not characteristic of the given location and nature of the pathology. Basically, these are non-specific complaints, such as lower back pain, radiating to right leg, pain in the right hypochondrium and right iliac region, increased body temperature, pain in the lower abdomen, increased abdominal volume, weakness. In most cases, patients presented complaints that were not characteristic of the given location and nature of the pathology. Basically, these are non-specific complaints, such as pain in the lower back, radiating to the right leg, pain in the right hypochondrium and right iliac region, increased body temperature, pain in the lower abdomen, increased abdominal volume, weakness.

However, such complaints do not make it possible to suspect that the patient has malignant lesion. In 4 cases, the patients' complaints were caused not by the primary tumor, but by metastatic lesions of the liver, ovaries, vagina, and lungs. One observation noted manifestations of severe carcinoid syndrome - weakness, hot flashes, diarrhea, facial flushing. However, such complaints do not make it possible to suspect the presence of a malignant lesion in the patient. In 4 cases, the patients' complaints were caused not by the primary tumor, but by metastatic lesions of the liver, ovaries, vagina, and lungs. In one observation, manifestations of severe carcinoid syndrome were noted: weakness, hot flashes, diarrhea, facial hyperemia.

Appendiceal carcinoid is the most common carcinoid tumor of the gastrointestinal tract. The tumor originates from enterochromaffin cells that secrete serotonin. The tumor is small in size, most often located in the area of ​​the apex of the appendix, and on a section it has a yellowish-gray color. Metastases are rare. Appendiceal carcinoid is the most common carcinoid tumor of the gastrointestinal tract. The tumor originates from enterochromaffin cells that secrete serotonin. The tumor is small in size, most often located in the area of ​​the apex of the appendix, and on a section it has a yellowish-gray color. Metastases are rare.

The main manifestations of the disease are associated with a high level of serotonin in the blood - cyanosis or redness of the face, hot flashes, diarrhea, osmotic attacks (carcinoid syndrome). With carcinoid, there is often endocardial fibrosis with damage to the valves, which gives rise to corresponding clinical manifestations. In diagnosis, the determination of the level of serotonin in the blood and 5-hydroxyindolylacetic acid (a product of serotonin metabolism) in the urine is of great importance. The main manifestations of the disease are associated with a high level of serotonin in the blood - cyanosis or redness of the face, hot flashes, diarrhea, osmotic attacks (carcinoid syndrome). With carcinoid, there is often endocardial fibrosis with damage to the valves, which gives rise to corresponding clinical manifestations. In diagnosis, the determination of the level of serotonin in the blood and 5-hydroxyindolylacetic acid (a product of serotonin metabolism) in the urine is of great importance.

Cancer of the appendix has the appearance of a polypoid tumor, sometimes with ulceration; adenocarcinoma is histologically detected. Tumor metastases (to the liver, greater omentum) are rarely observed due to the fact that with cancer of the appendix, obstruction of its lumen occurs quite quickly, leading to stagnation of the contents and the development of acute appendicitis, for which the patient is operated on. If cancer is detected in the appendix removed due to acute appendicitis, a repeat operation is necessary - right hemicolectomy. Cancer of the appendix has the appearance of a polypoid tumor, sometimes with ulceration; adenocarcinoma is histologically detected. Tumor metastases (to the liver, greater omentum) are rarely observed due to the fact that with cancer of the appendix, obstruction of its lumen occurs quite quickly, leading to stagnation of the contents and the development of acute appendicitis, for which the patient is operated on. If cancer is detected in the appendix removed due to acute appendicitis, a repeat operation is necessary - right hemicolectomy

Macroscopic description of the preparation: Macroscopic description of the preparation: a fragment of the colon 30 cm long, consisting of the cecum with a vermiform appendix approximately 5 cm long, the ascending colon and part of the transverse colon, with fragments ileum 20 cm long and surrounding fiber in a single block. a 30 cm long fragment of the colon, consisting of the cecum with an approximately 5 cm long appendix, the ascending colon and part of the transverse colon, with 20 cm long fragments of the ileum and surrounding tissue in a single block.

At a distance of 13 cm from the proximal edge of the resection, the mucous membrane of the ileum in the area of ​​6.5 x 4.0 cm is granular in appearance, motionless in relation to the muscle layer, with areas of superficial ulceration. On the section, the intestinal wall is unevenly thickened to 1 cm due to strands of whitish dense tissue. The vermiform appendix is ​​opened along its length, the mucous membrane is loose, grayish in color. At a distance of 13 cm from the proximal edge of the resection, the mucous membrane of the ileum in the area of ​​6.5 x 4.0 cm is granular in appearance, motionless in relation to the muscle layer, with areas of superficial ulceration. On the section, the intestinal wall is unevenly thickened to 1 cm due to strands of whitish dense tissue. The vermiform appendix is ​​opened along its length, the mucous membrane is loose, grayish in color

In the distal area there is a cavity with a diameter of 2 cm with hemorrhagic contents. The adjacent fiber is of uneven density due to thin whitish strands. The mucous membrane of the colon is folded throughout its entire length, gray-pink. On the serous membrane of the small intestine there are single millet-like formations of dense consistency, white, with a diameter of up to 0.3 cm. The tissue contains 6 lymph nodes of dense elastic consistency. In the distal area there is a cavity with a diameter of 2 cm with hemorrhagic contents. The adjacent fiber is of uneven density due to thin whitish strands. The mucous membrane of the colon is folded throughout its entire length, gray-pink. On the serous membrane of the small intestine there are single millet-like formations of dense consistency, white, up to 0.3 cm in diameter. The tissue contains 6 lymph nodes of dense elastic consistency.

Due to the fact that there are no characteristic complaints of malignant lesions of the appendix, most patients were referred with various erroneous diagnoses: pelvic extraorgan tumor, gall bladder cancer with metastases in the peritoneum and liver, gastrointestinal cancer, metastases in the ovaries and liver without an identified primary focus, ascites, tumor of the ascending colon with perforation, abscesses of the retroperitoneum, colon tumor with metastases in the lung. Due to the fact that there are no characteristic complaints of malignant lesions of the appendix, most patients were referred with various erroneous diagnoses: pelvic extraorgan tumor, gall bladder cancer with metastases in the peritoneum and liver, gastrointestinal cancer, metastases in the ovaries and liver without an identified primary focus, ascites, tumor of the ascending colon with perforation, retroperitoneal abscesses, colon tumor with metastases to the lung.

THAT. Anamnestic data did not allow a correct diagnosis to be made in any case. Only in patients undergoing emergency surgery was the correct diagnosis made, since during the intraoperative examination a tumor-altered vermiform appendix and metastases were discovered. THAT. Anamnestic data did not allow a correct diagnosis to be made in any case. Only in patients undergoing emergency surgery was the correct diagnosis made, since during the intraoperative examination a tumor-altered vermiform appendix and metastases were discovered.

Based on a physical examination, a tumor of the appendix can be suspected: it is mainly a large palpable formation in the right iliac region, in the projection of the right lateral canal. The tumor nature of the palpable formation may be indicated by its size (up to 30 cm), density, tuberosity, and immobility. Based on a physical examination, a tumor of the appendix can be suspected: it is mainly a large palpable formation in the right iliac region, in the projection of the right lateral canal. The tumor nature of the palpable formation may be indicated by its size (up to 30 cm), density, tuberosity, and immobility.

A retrospective analysis of the results of instrumental examination methods (ultrasound, CT, MRI, colonoscopy, laparoscopy) showed that only in one case were data identified on the basis of which it was possible to suspect tumors of the appendix; during colonoscopy, swelling of the bauhinium valve, infiltration and bleeding of the mucous membrane of the caecum were determined intestines; At the same time, according to ultrasound data, a tumor node associated with the wall of the cecum, as well as multiple metastases to the liver, was diagnosed. A retrospective analysis of the results of instrumental examination methods (ultrasound, CT, MRI, colonoscopy, laparoscopy) showed that only in one case were data identified on the basis of which it was possible to suspect tumors of the appendix; during colonoscopy, swelling of the bauhinium valve, infiltration and bleeding of the mucous membrane of the cecum were determined; Moreover, according to ultrasound data, a tumor node associated with the wall of the cecum was diagnosed, as well as multiple metastases to the liver

Laparoscopy, as one of the most informative diagnostic methods, made it possible to assess the condition of the peritoneum and perform a biopsy, but it was not possible to visualize the appendix in any observation. In most cases, the preoperative diagnosis had discrepancies with the final one established based on the results of the operation. Laparoscopy, as one of the most informative diagnostic methods, made it possible to assess the condition of the peritoneum and perform a biopsy, but it was not possible to visualize the appendix in any observation. In most cases, the preoperative diagnosis had discrepancies with the final one established based on the results of the operation.

The cytological diagnosis also, as a rule, did not coincide with the final histological conclusion. Thus, tumors of the appendix are, as a rule, intraoperative findings. The cytological diagnosis also, as a rule, did not coincide with the final histological conclusion. Thus, appendix tumors are usually intraoperative findings.

The final morphological examination revealed the following forms of malignant tumors: carcinoid, adenocarcinoma with mucus formation, papillary adenocarcinoma, well-differentiated adenocarcinoma, mucinous cystadenocarcinoma, moderately differentiated adenocarcinoma. In some cases, appendix cancer was combined with tumors of other locations: soft tissue sarcoma of the thigh, osteoma frontal bone, ovarian cancer. The final morphological examination revealed the following forms of malignant tumors: carcinoid, adenocarcinoma with mucus formation, papillary adenocarcinoma, well-differentiated adenocarcinoma, mucinous cystadenocarcinoma, moderately differentiated adenocarcinoma. In some cases, appendix cancer was combined with tumors of other locations: soft tissue sarcoma of the thigh, osteoma of the frontal bone, ovarian cancer.

A 60-year-old patient was admitted to diagnostic department in January 2008 with complaints of pain in the right iliac region, the presence of a neoplasm in this area. The duration of the pain syndrome is 4 months. Upon admission, the condition was satisfactory. The abdomen is soft, painless, there is no ascites. On palpation: a tumor up to 12 cm in greatest dimension is palpable in the right iliac region. A 60-year-old patient was admitted to the diagnostic department in January 2008 with complaints of pain in the right iliac region and the presence of a tumor in this area. The duration of the pain syndrome is 4 months. Upon admission, the condition was satisfactory. The abdomen is soft, painless, there is no ascites. On palpation: a tumor up to 12 cm in greatest dimension is palpable in the right iliac region.

Based on the results of ultrasound and CT, a mobile neoplasm with clear, even contours, a heterogeneous structure, and liquid content in the center was diagnosed in the right iliac region. (Formal picture of a tumor of the right ovary.) Laparoscopy did not reveal dissemination in the peritoneum or liver damage. The uterus has myomatous changes, the appendages have no signs of tumor. Based on the results of ultrasound and CT, a mobile neoplasm with clear, even contours, a heterogeneous structure, and liquid content in the center was diagnosed in the right iliac region. (Formal picture of a tumor of the right ovary.) Laparoscopy did not reveal dissemination in the peritoneum or liver damage. The uterus has myomatous changes, the appendages have no signs of tumor.

A tumor up to 13 cm in size with a smooth surface is visualized in the right iliac region. An infero-median laparotomy was performed. During the audit, it was determined that the neoplasm was a vermiform appendix modified by a tumor. A tumor up to 13 cm in size with a smooth surface is visualized in the right iliac region. An infero-median laparotomy was performed. During the audit, it was determined that the neoplasm was a vermiform appendix modified by a tumor.

An appendectomy was performed. In case of urgent histological examination: reactive hyperplasia of the mucous membrane of the appendix with the formation of adenomatous structures, hyperproduction of mucus with foci of angiomatosis. The postoperative period was without complications. An appendectomy was performed. An urgent histological examination revealed reactive hyperplasia of the appendix mucosa with the formation of adenomatous structures, hyperproduction of mucus with foci of angiomatosis. The postoperative period was without complications.

A routine histological examination diagnosed highly differentiated mucus-forming adenocarcinoma of the appendix with the formation of pseudomyxoma fields. A routine histological examination diagnosed highly differentiated mucus-forming adenocarcinoma of the appendix with the formation of pseudomyxoma fields.

Diagnosis at discharge: Mucinous cystadenocarcinoma of the appendix T2N0M0, stage II. Postoperative chemotherapy with Xeloda was prescribed (at a dose of 2 g/m2 on days 1-14 with a 2-week interval; up to 6 courses). Diagnosis at discharge: Mucinous cystadenocarcinoma of the appendix T2N0M0, stage II. Postoperative chemotherapy with Xeloda was prescribed (at a dose of 2 g/m2 on days 1-14 with a 2-week interval; up to 6 courses).

Conclusions Cancer of the appendix is ​​an extremely rare tumor with poor prognosis. Unlike carcinoid, the diagnosis of which can be assumed before surgery based on the clinical picture, cancer of the appendix is ​​an intraoperative diagnosis. Cancer of the appendix is ​​an extremely rare tumor with poor prognosis. Unlike carcinoid, the diagnosis of which can be assumed before surgery based on the clinical picture, cancer of the appendix is ​​an intraoperative diagnosis.

By the time the diagnosis is made, dissemination of the process is often detected, which limits the possibilities of treatment with chemotherapy (radiation) therapy. The optimal extent of the operation is right hemicolectomy. By the time the diagnosis is made, dissemination of the process is often detected, which limits the possibilities of treatment with chemotherapy (radiation) therapy. The optimal extent of the operation is right hemicolectomy.

In case of a disseminated process, systemic therapy is indicated, and in case of peritoneal carcinomatosis, intraperitoneal chemotherapy is possible. Average duration The life of the patients was 27.6 months. For a disseminated process, systemic therapy is indicated, and for peritoneal carcinomatosis, intraperitoneal chemotherapy is possible. The average life expectancy of patients was 27.6 months.

If a tumor of the appendix is ​​suspected, the need for oncological vigilance is obvious, which helps to improve the diagnosis and treatment results of this group of patients. If a tumor of the appendix is ​​suspected, the need for oncological vigilance is obvious, which helps to improve the diagnosis and treatment results of this group of patients.

REFERENCES REFERENCES 1. Shodmonkhodzhaev N.U. Metastasis of malignant tumors. Vol. 2, Dushanbe, 1979; With. 58– Shodmonkhodzhaev N.U. Metastasis of malignant tumors. Vol. 2, Dushanbe, 1979; With. 58– Kalitievsky P.F. Diseases of the appendix. M, Kalitievsky P.F. Diseases of the appendix. M, Kuzin M.I. Surgical diseases. M.: Medicine, Kuzin M.I. Surgical diseases. M.: Medicine, Rottenberg A.L. Arch. anat. 1962; 43(8):96–8. 4. Rottenberg A.L. Arch. anat. 1962; 43(8):96–8. 5. Menon NK. Postgrad Med J 1980, Jun; 56 (656): 448– Menon NK. Postgrad Med J 1980, Jun; 56 (656): 448– Levchenko A.M., Vasechko V.N., Yerusalimsky E.L. Wedge. surgery. 1985; 5:56–7. 6. Levchenko A.M., Vasechko V.N., Yerusalimsky E.L. Wedge. surgery. 1985; 5:56–7.

Anatomy and physiology of the appendix

The first description and sketch of this organ was made by Leonardo da Vinci in 1472.

Andrei Vesalius, in his work “De fabrica humani corporis”, extracts from which we find in the “Epitome”, described its topography: “Further, where the ileum stops, a part of the intestine is visible, very thick and extensive, holding a small appendage, folded and pointed like earthworm, endowed with one opening and therefore called the cecum by famous anatomists."

Subsequently, it received the name vermiform appendix (appendix vermiformis) and is considered a rudimentary continuation of the cecum. It starts from the medial-posterior or medial side of the cecum. To see the base of the appendix, it is necessary to pull the cecum laterally and upward.

At the base of the appendix, three muscle bands of the cecum converge, which pass onto it, forming a continuous longitudinal muscle layer. As a rule, the base of the appendix is ​​located 2-3 cm below the confluence with the cecum of the ileum; the vermiform appendix does not have a fixed position, since, being covered with peritoneum on all sides and having a well-defined mesentery, it has significant mobility.

The following positions of the appendix in the abdominal cavity are described:

1) pelvic, or descending, when the process is directed downward into the pelvic cavity;
2) medial, when the process is located along the terminal part of the ileum;
3) lateral, when the process is located in the right lateral canal;
4) anterior, when the process is located anterior to the cecum;
5) ascending, or subhepatic, when the process is directed with its apex upward, often reaching the subhepatic region;
6) retrocecal, when the process is located behind the cecum.

With the latter location option, the appendix can be located either intraperitoneally or abandoned, retroperitoneally.

The position of the appendage largely depends on the condition of the intestines, in particular, on the filling of the latter with feces and gases. In rare cases of reverse arrangement of abdominal organs, the vermiform appendix, together with the cecum, is located in the left iliac region with all position options that occur on the right.

Happens occasionally abnormal position process, relating not to variants, but to deformities. For example, the vermiform appendix may extend from ascending department colon. Duplications of the cecum and appendix, as well as isolated duplications of the appendix, have been described; agenesis of the appendix is ​​very rare.

The process is suspended, as already mentioned, on its own mesentery, the root of which is attached to the posterior (left) side of the lower part of the mesentery of the small intestine. Several unstable peritoneal pouches are formed between the mesentery, the wall of the cecum, the ileum and the appendix. The mesentery, being a duplicate of the peritoneum, contains adipose tissue, vessels, nerves and several small lymph nodes.

The average length of the appendix of an adult is 8-10 cm. In men, the appendix is ​​on average 6-7 mm longer than in women. Cases of very long, 25-30 cm and even 50 cm, as well as short, up to 1 cm, processes have been described. The average thickness of the appendix is ​​5-6 mm.

In its structure, the wall of the appendix differs little from the intestinal wall. The outer layer of the wall - serous - is a continuation of the common peritoneal layer covering the cecum and mesentery, and has a similar structure.

Beneath the serosa is a layer of loose tissue. The muscular coat is represented by two layers of muscles. The more superficial layer of longitudinal muscles is a continuation of the longitudinal muscle bundles passing into the taenia of the cecum. The second layer is a continuation of the circular layer of the muscles of the cecum.

The boundaries between these layers are unclear, the fibers are often intertwined, which gives some authors grounds to consider the muscular membrane of the appendix to be a single muscle layer formed by muscle fibers located in the longitudinal and transverse directions.

The submucosal layer consists of crosswise intertwined collagen and elastic fibers that penetrate into the intercellular spaces of the inner muscle layer and tightly adhere to it.

The fibers are oriented along the vessels and nerves and around the follicles located in the submucosal layer. The number and size, as well as the activity of the lymphatic follicles of the submucosal layer, vary significantly depending on the age of the person and general condition his lymphatic system.

In adults, the number of follicles per 1 cm2 of the area of ​​the process reaches 70-80, and total for the entire process is 1200-1500 with follicle sizes of 0.5-1.5 mm. The submucosal layer is separated from the mucous membrane by an unevenly developed, discontinuous and rather narrow muscular layer of the mucous membrane.

The mucous membrane is folded and forms rather deep crypts. The entire surface of the mucous membrane, including the crypts, is lined with single-row tall prismatic epithelium with basally located nuclei.

The epithelium is covered with a delicate cuticular border, which is interrupted at the points where the tips of the goblet cells emerge. Deep in the crypts there are Paneth cells. Besides them, at all levels of crypts, and occasionally in superficial epithelium a small number of Kulchitsky cells are found.

Physiological role and the true nature of Kulchitsky cells has not yet been definitively established. They are believed to have an endocrine function, which is confirmed by the detection of serotonin in them.

The epithelium contains a large number of cells in a state of mitotic division. Unlike other parts of the intestine, where cell proliferation occurs mainly in the depths of the crypts, in the vermiform appendix dividing cells are distributed evenly over the entire surface of the mucous membrane.

The blood supply to the appendix is ​​very peculiar. An adult has one appendicular artery, less often two. One or two arteries begin from the posterior ileocecal artery or from one of its branches and pass in the free edge of the mesentery; several branches depart from the main artery of the process. In the mesentery there are two interconnected arteriolar networks. Each of the secondary branches is divided at the site of attachment of the mesentery to the process into two or more branches.

These branches, penetrating the wall of the process, form two main intramural networks - serous and submucosal. Small branches extend from the serous network, feeding the muscular layers of the process. Having reached the submucosal layer, they form a network around the lymphatic follicles and give off terminal branches inside them. Other branches of this network end in the stroma of the mucous membrane.

Venous outflow from the appendix is ​​carried out through the veins accompanying the arteries. The veins merge into 1-2 trunks, flowing into the v.ileocolica or one of its branches.

The nerves of the appendix contain both parasympathetic and sympathetic fibers. As in other parts of the intestine, the appendix has two main plexuses - muscular (Auerbach's) and submucosal (Meissner's). The number of nerve elements per unit surface of the appendix is ​​3 times higher than that in neighboring parts of the intestine.

Lymphatic vessels begin in the mucous membrane of the appendix, located along the crypts in the form of narrow capillaries 30-40 m wide. At the base of the crypts, the first capillary network is formed, which connects to the second, more powerful submucosal network. The latter is interrupted only near the lymphatic follicles, enveloping them in rings.

There is a third network between muscle fibers lymphatic capillaries. Next, the lymph flow is directed to the subserous layer, where there are large lymphatic target spaces that drain lymph into the lymphatic vessels of the mesentery and then through a small number of small nodes into the general lymph flow from the intestine.

The main collectors are two groups of lymph nodes: appendiceal and ileocecal. It should be noted that there are connections along the lymphatic pathways between the appendicular system and the cecal systems, right kidney and perinephric fiber, stomach and duodenum, gall bladder and internal genital organs.

Information about the functions of the appendix and its role in human body meager.

Motor function is determined by the presence of peristaltic movements. The ability to perform peristalsis was established both radiologically and in a human appendage model. The muscles of the appendix react to acetylcholine: longitudinal - with tonic contractions, circular - with periodic contractions.

The mucous membrane of the appendix is ​​capable of producing mucus and a number of enzymes.

An important functional role is played by the lymphatic apparatus of the appendix, which is called the “intestinal tonsil”. The appendix, along with Peyer's patches, is an important element immune system and, therefore, must, to one degree or another, participate in ensuring the body’s natural resistance, immunity, immunological memory, immunological tolerance and respond to specific pathological immune reactions.

The implementation of these functions is possible thanks to the lymphoid apparatus of the appendix, represented by immunocompetent lymphocytes. Lymphocytes are known to be produced by the bone marrow. Proliferation and differentiation of bone marrow stem cells in thymus gland leads to the production of T lymphocytes.

The site of formation of B lymphocytes in humans, which would be an analogue of the Bursa of Fabricius in birds, is unknown. Although the morphology of group lymphatic follicles of the appendix resembles that of the bursa of Fabricius in birds. One way or another, lymphocytes are settled in the appendix, as well as in other secondary lymphoid organs: the spleen, lymph nodes, palatine tonsils, Peyer's patches.

Experimental studies have shown that xenotransplantation of the appendix from a rabbit into thymectomized mice restores immunoglobulin synthesis and effectively affects immunological activity.

Perhaps, due to the developed lymphatic apparatus and the constant presence of microorganisms in it, the appendix, in the absence of inflammation, is the organ responsible for the development of tolerance to intestinal microflora. The development of malignant tumors is accompanied by the formation of various depressive effects on the immune system.

It is possible that appendectomy may contribute to this. On the other hand, these influences can have their source in tumors, including those developing in the appendix. There is no reason to assert that at present these functions of the appendix have been studied sufficiently fully.

Epidemiology and classification of appendix tumors

The increase in their frequency in statistics is due to the fact that the number of tumors includes hypertrophy or hyperplasia of smooth muscle tissue, regarded as leiomyoma, as well as changes in the process with multiple myeloma, reticulose, etc. The frequency of true tumors of the appendix is ​​0.1-0.25%. Statistical data on tumors of the appendix up to the present day can hardly be considered reliable, because there is still no generally accepted classification of them.

There is disagreement about ownership carcinoid tumors and cancer. Different points of view introduce significant confusion into the nomenclature of all groups of tumors. The small number of cases observed by individual authors over many decades using various, often changing, classifications makes it impossible to determine the true frequency various types tumors.

But at the same time, these descriptions make it possible to classify neoplasms of the appendix. Based on an analysis of literature data and our own experience, the following classification seems possible to us.

Classification of appendix tumors

Benign

1. Benign carcinoid
2. Glandular polyp
3. Villous adenoma

Malignant

1. Malignant carcinoid
2. Cancer

II. Tumors of non-epithelial origin

Benign

1. Leiomyoma
2. Angioma
3. Lipoma
4. Fibroma
5. Neuroma

Malignant

1. Lymphosarcoma, reticulosarcoma
2. Myosarcoma
3. Endothelial sarcoma
4. Fibrosarcoma

We observed from 1971 to 1991. 19 patients with various tumors of the appendix, which amounted to 0.3% of all 6500 patients with diseases of this organ. The majority of this group of patients (in 13 cases) was found to have carcinoid, 2 had cancer, 1 patient had lymphosarcoma, 1 patient had tonsillitis, and 2 more patients had fibroids of the appendix.

In the vast majority of cases, tumors were accidentally discovered during the examination of appendices removed for suspected appendicitis. Only in 3 patients with manifestations of carcinoid syndrome, the diagnosis of carcinoid was established before surgery. Another patient was found to have a tumor in the right iliac region, which before surgery was interpreted as cancer of the cecum.

Among the patients there were 8 women and 11 men. The average age was 28 years, ranging from 15 to 57 years.

Appendiceal carcinoids

Among the 6500 patients with diseases of the appendix we observed from 1971 to 1991, carcinoid occurred in 13, which amounted to 0.2%. Among the patients there were 5 women and 8 men. The average age was 28 years, increasing from 19 to 50. In most cases, the tumor was accidentally discovered in patients during the examination of vermiform appendices removed for appendicitis.

Only in 3 patients with manifestations of carcinoid syndrome was the diagnosis established before surgery. Another patient was found to have a tumor that was considered before surgery as a neoplasm of the cecum.

When examining processes affected by carcinoids, signs of acute inflammation or tissue sclerosis, lipomatosis of the internal membranes are often detected. Rarely, cardinoid is found in intact tissue outside the tumor. The tumor itself in most cases is represented by a single node. The node is usually located in the distal part of the process, sometimes at its very apex.

The size of the tumor is usually small (on average 0.5-1 cm), although large formations have also been described. Its consistency is densely elastic. The tumor tissue is clearly demarcated from the surrounding tissue. Its color when cut is grayish with a yellow tint, the surface is matte. Sometimes the clarity of the boundaries of the tumor is lost, there is infiltration and thickening of the wall of the process.

The histological structure of carcinoids does not differ from those in small intestine described above. Tumor cells are located in the form of nests, islands and wide cords surrounded by stroma. Cells usually do not have clear boundaries; their nuclei are compact and stain well. The cytoplasm is pale stained and often vacuolated.

Complexes of tumor cells are often located in the deep layers of the process and invade them up to serous membrane and even the mesentery of the process. Often, groups of tumor cells are found in the lymphatic spaces. Appendiceal carcinoid metastasizes extremely rarely. Morphological characteristics malignant metastatic carcinoid is almost no different from non-metastatic carcinoid.

The same histological picture is found in metastases, only sometimes there is a slightly greater degree of anaplasia and cellular polymorphism, a slightly greater hyperchromicity of the nuclei, and occasionally the appearance of ugly large cells and mitotic figures. Metastases are found in regional lymph nodes, liver and lungs, rarely in bones.

Appendiceal carcinoids, if small in size, do not cause symptoms. But the presence of a tumor often causes concomitant inflammation, which is clinically manifested by signs of acute or chronic appendicitis.

An acute inflammatory process, including destructive forms, was detected in 7 out of 13 patients. All of them were operated on due to the clinical picture of acute appendicitis. Another 2 patients had manifestations of chronic recurrent appendicitis. Histological examination accidentally revealed carcinoids against the background dystrophic changes process.

Only three patients local signs chronic appendicitis (aching pain in the right iliac region, pain on palpation in this area) was accompanied by the above-described manifestations of carcinoid syndrome. This syndrome may therefore be considered the only somewhat specific symptom of appendix carcinoids.

Treatment of appendix carcinoids is surgical. Even in the presence of the invasive nature of the tumor, appendectomy gives completely favorable prognosis diseases. J.S. Stewart and A.L. Taylor (1920) described a case of appendix carcinoid with large metastases to the peritoneum and ovaries.

Alpendentomy and removal of metastases ensured recovery and relapse-free course of the disease for 10 years. Due to the fact that a number of authors consider all carcinoids to be potentially malignant, it is recommended to remove the appendix along with its mesentery. The presence of metastases is not a contraindication to surgery.

In 12 of 13 patients observed by us, appendectomy was performed. Only one patient, with large tumor invasion of the intestinal wall itself, underwent right hemicolentomy. 6 patients were observed in the long term (up to 10 years), none of them showed signs of disease relapse.

Polyps of the appendix

The sizes of appendix polyps range from 1 mm to 5 cm in diameter. They may have a leg and be located on broad base. The surface of the polyps is mostly lobular, in places villous and may have a cauliflower-like appearance. The color of the tumor depends on the degree of vascularization and possible hemorrhages. The consistency is soft.

Polyps large sizes an actively peristaltic appendix can cause its intussusception into the lumen of the cecum. Narrowing and obstruction of the lumen of polyps can lead to the development of a retention cyst of the process.

The histological picture of polyps of the appendix is ​​typical. In large polyps, areas of glandular structure and villous formations can be found. The surface of the polyps is partially or entirely covered with one or more rows of high prismatic epithelium. Beneath the epithelial cover there is a discontinuous layer of muscularis propria.

The base of the polyp is built from loose connective tissue With big amount circulatory and lymphatic vessels. In the stroma of polyps, accumulations of lymphocytes are found, sometimes with the formation of follicles.

Since foci of malignant growth may occur in a benign polyp, it is necessary to examine the polyp in many areas. The criteria for malignancy of appendix polyps are the same as for colon polyps. The initial stage of malignancy is considered to be the appearance of basophilic cells with hyperchromic nuclei, a violation of the polarity of the epithelium, an increase in the number of rows, a decrease in secretory activity, the appearance of numerous mitoses, and structural atypia of the glands. Signs invasive cancer consist in the penetration of tumor complexes and cells beyond the basement membrane.

A peculiar form is the so-called villous tumor, which is often found in the colon and will be described below. This tumor also occurs in the appendix. Villous tumors are more prone to malignant transformation than glandular polyps. They are characterized by copious mucus excretion. Mucus production can be so significant that it leads to protein and electrolyte deficiencies.

In some patients with familial diffuse polyps of the rectum and colon, the formation of polyps can also be observed in the appendix. Polyps in this form have all the signs of glandular tumors, sometimes like a miliary polyp, and in some cases - features of juvenile polyps.

Appendiceal cancer

For benign tumors, as already mentioned, often remain unrecognized. Adenocarcinoma of the appendix was first described in 1882 by A. Berger, and in Russia in 1907 by F.K. Weber. Relative frequency cancerous tumors the vermiform appendix does not exceed hundredths of a percent.

Microscopically, cancer of the appendix is ​​similar to cancer of the cecum. In this case, it can move to the wall of the cecum. In this regard, it can be difficult to reliably resolve the question of where the primary localization of cancer is. In addition, the tumor is often detected in advanced stages.

Macroscopically, cancer of the appendix usually appears as a polypoid, sometimes ulcerating tumor growing into the lumen of the appendix. The process is usually thickened both due to the tumor itself and as a result of concomitant reactive and inflammatory changes. Due to abundant mucus production, the tumor can sometimes have a gelatinous appearance. There may be perforation of the tumor.

Histologically, the tumor most often has the structure of adenocarcinoma, sometimes with significant mucus formation. The number of mucinous and non-mucinated adenocarcinomas is approximately the same. Scirrhous cancer, represented by poorly differentiated cells with abundant development of stroma, has also been described. Isolated cases described squamous cell carcinoma(Ya.A.Naftolyev).

Widespread metastasis of appendix cancer is uncommon. The tumor is often detected at earlier stages. This is due to the fact that it quickly leads to obstruction of the lumen of the appendix, causes its tension, stagnation of the contents, and circulatory disorders. Clinically, this is manifested by signs of acute appendicitis, for which patients undergo surgery. Both patients we observed were operated on due to acute appendicitis.

Metastasis of appendix cancer occurs in the regional lymph nodes of the mesentery and mesentery of the ileum, along the cecum and ascending colon. Next, the path of lymphatic metastasis extends through the mesenteric lymph nodes into the collector, located at the level of the anterior surface of the lower horizontal part of the duodenum. Direct lymphogenous metastasis can occur in the uterine appendages in women. The development of implantation metastases in the peritoneum is possible.

Distant metastases were observed in the liver, trachea, adrenal glands, brain, and greater omentum. With mucinous adenocarcinoma with metastases in the peritoneum, a picture of pseudomyxoma of the abdominal cavity can develop.

If a diagnosis of cancer of the appendix is ​​established, radical surgery is recommended - right hemicolectomy. Usually it is performed as a re-intervention after a histological examination of the appendix removed due to suspected appendicitis, or less often as a primary procedure.

Of our two patients, one had a right-sided hemicolentomy performed 8 days after appendectomy, when a morphologist's report was received. In another patient, who also underwent emergency surgery with a diagnosis of acute appendicitis, cancer of the appendix was suspected during surgery. This suspicion was confirmed by express biopsy. A right hemicolentectomy was performed.

The prognosis for hemicolentomy is relatively favorable. Appendectomy with mandatory removal of the mesentery can be radical surgery Only in rare cases, when there are no complications, the tumor grows into the deep layers of the appendix and is localized in its distal part.

Nonepithelial tumors of the appendix

All three patients with benign non-epithelial tumors we observed were operated on urgently for acute appendicitis. In one of them, already during the operation, a purple-cyanotic formation of 5x6 cm was discovered, located in the distal section and turned out to be an angioma. In the other two, histological examination of the removed process revealed fibroids along with inflammation.

The most common form of malignant nonepithelial tumors is lymphosarcoma. According to summary data, lymphosarcoma is more often localized in the distal parts of the process, occurs predominantly in young men and ranges in size from hazelnut and more. Tumor infiltration of the process wall is observed when various options reticulosis and leukemia.

In addition, spindle cell sarcoma, endothelial sarcoma, myosarcoma, and fibrisorcoma have been described. All types of sarcomas of the appendix occur in young adults. Only isolated cases have been described in people over 50 years of age.

Sarcomas and infiltration of the process in reticulosis and leukemia can give clinical picture appendicitis, for which appendectomy is performed in approximately half of patients. In the other half, the tumor is discovered by chance during operations performed for another reason or during autopsy.

Yaitsky N.A., Sedov V.M.