Neuroendocrine appendiceal tumor and endometriosis of the appendix: a case report
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(2020) 14:152
CASE REPORT
Open Access
Neuroendocrine appendiceal tumor and endometriosis of the appendix: a case report Rogério Serafim Parra1,2* , Marley Ribeiro Feitosa1,2, Giovana Bachega Badiale Biagi3, Daniel Ferracioli Brandão3, Margarida Maria Fernandes da Silva Moraes3, Liliane Silvestre4, José Vitor Cabral Zanardi5, Nelson Hitamo Sato Junior5, Omar Féres1,2 and José Joaquim Ribeiro da Rocha1,2
Abstract Introduction: Endometriosis of the appendix is very uncommon, accounting for only about 1% of all cases of endometriosis. However, endometriosis is found in the appendix in approximately 8–13% of patients with deep infiltrating endometriosis and is particularly common in patients with severe forms of deep infiltrating endometriosis. Neuroendocrine tumors are the most common neoplasms of the appendix and may be misdiagnosed when there are multiple endometriosis lesions in the pelvis. Case presentation: We describe a case of a Caucasian patient with deep infiltrating endometriosis with rectal involvement, retrocervical lesions, and a right ovarian endometrioma with no suspected lesions in the appendix. She underwent laparoscopy and, after a systematic intraoperative evaluation, suspected involvement of the appendix was observed. The patient underwent ovarian cystectomy, excision of the pelvic endometriosis lesions, appendectomy, and anterior stapler discoid resection. Histopathological analysis of the appendix revealed endometriosis and a well-differentiated neuroendocrine carcinoma at the appendix tip. Discussion: Our patient’s case emphasizes the need to approach these lesions carefully and strengthens the indication for appendectomy when the appendix is affected in the setting of endometriosis. Despite the more likely diagnosis of appendiceal endometriosis, neuroendocrine tumors cannot be ruled out by imaging examinations, and both conditions can occur in the same patient. Keywords: Appendiceal neoplasm, Appendix, Neuroendocrine tumor, Endometriosis, Deep infiltrating endometriosis
Introduction Endometriosis is a common benign disease that affects approximately 10% of women of reproductive age and is associated with chronic pelvic pain, dyspareunia, and infertility [1]. Deep infiltrating endometriosis (DIE) is the * Correspondence: [email protected] 1 Proctogastroclinic, Eliseu Guilherme St, 09, Ribeirão Preto, SP, Brazil 2 Department of Surgery and Anatomy, School of Medicine of Ribeirão Preto, University of São Paulo, Sao Paulo, Brazil Full list of author information is available at the end of the article
most severe type and often affects the bowel (up to 25% of cases), particularly the rectosigmoid colon, and occasionally may be found in the ileum, cecum, and appendix [2, 3]. Surgery is indicated in patients with pelvic pain who do not respond to medical therapy and/or in patients with ileal involvement, owing to the risk of intestinal obstruction, and in those with appendiceal involvement, owing to the higher risk of neoplasia in these cases [2, 4]. Previous studies have suggested that appendic
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