Cacinoid Tumour of the Appendix

Hi,
I was originally diagnosed with a borderline tumour of the ovary. This was removed and I had a total hysterectomy. Everything removed during this surgery (ommentum, ovaries, uterus and tubes showed clear apart from the borderline cyst on the one ovary) During this surgery the surgeon also removed my appendix. They found a carcinoid tumour at the tip. It was 11mm in size and infiltrated the mesoappendix by 3mm. Does this mean it is mallignant? I'm waiting for a CT scan next week to check if there is any other tumours lurking around. I've been reading around but am confused at the difference in oppinion on whether more surgery would be required based on the tumour being over 10mm and the fact it infiltrates into the mesoappendix. Do you think I will need more surgery based on the pathology results below? :

At the tip of the appendix there is a grade 1 well differentiated neuroendocrine tumour (classical carcinoid tumour) which infiltrates into the mesoappendix up to 3mm (pT2). The maximum tumour size is 11mm. The tumour expresses CD56, Chromogranin and Synaptophysin. Ki67 labelling is less than 1 percent. No tumour cells are seen on the peritoneum. Excision is complete. Distance to margin is 12mm.

Any information would be gratefully received.
Many thanks.

[Kamal S Saini, MD, MRCP (UK), DM]

Hi,
The standard approach to malignant carcinoid tumors of the appendix is as follows:

For tumors less than 10 mm, appendicectomy is enough.

For tumors between 10 and 20 mm, there is controversy, with one school of thought favoring a conservative approach with appendicectomy or limited colectomy, while another feels it may be better to be more radical and perform a full hemicolectomy.

For tumors larger than 20 mm, right hemicolectomy is needed.

One point in your favor is that you have a well differentiated Grade 1 carcinoid, and additionally, it is localized to appendix tip and mesoappendix.

A PET-CT may be more informative than a CT in your case.

Pl keep me posted about your progress.

All the best, and God Bless!

[bluebean]

Hi, sorry. I should add that I am 34 years old. I haven't met the consultant or had any other tests yet for the carcinoid as they are awaiting the results of the CT scan before meeting with me.
Many thanks.