Appendiceal Neuroendocrine Tumor with Lymph Node Metastasis in a Teenager

Keun Young Kim; Won Cheol Park

doi:10.4166/kjg.2015.65.2.127

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Kim and Park: Appendiceal Neuroendocrine Tumor with Lymph Node Metastasis in a Teenager

Case Report

Korean J Gastroenterol 2015;65(2):127-131.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.65.2.127

Appendiceal Neuroendocrine Tumor with Lymph Node Metastasis in a Teenager

Keun Young Kim, Won Cheol Park

Department of Surgery, Wonkwang University School of Medicine, Iksan, Korea

Correspondence to: Won Cheol Park, Department of Surgery, Institute of Medical Science, Wonkwang University School of Medicine, 895 Muwang-ro, Iksan 570-711, Korea. Tel: +82-63-859-1496, Fax: +82-63-855-2386, E-mail: parkwc@wonkwang.ac.kr

Received 20 November 201412 December 2014 Accepted 9 January 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Neuroendocrine tumor (NET) is a cancer-like tumor that occurs mostly in the gastrointestinal system. Within the gastrointestinal tract, NET most commonly occurs in the rectum whereas appendix is very rarely involved. In most cases of appendiceal NET, it is found at a relatively early stage compared to other NETs because appendiceal NET frequently presents with acute appendicitis because appendiceal NET frequently presents with acute appendicitis even when the size is smaller than 1 cm. Therefore, it is very rare for lymph node metastasis to occur in a young adult. Herein, we report a rare case of grade 1 appendiceal NET with lymph node metastasis which developed in a teenage male.

Keywords: Appendiceal neoplasms, Neuroendocrine tumor, Carcinoid tumor

References

1. Kang BS, Kim JW. Gastrointestinal carcinoid tumor: clinical review of 36 cases. J Korean Surg Soc. 2009; 76:1–6.

2. Lee MH, Shin SJ, Jeon SJ, et al. Clinical characteristics of gastrointestinal carcinoid tumors. Korean J Gastrointest Endosc. 2010; 40:347–351.

3. Eggenberger JC. Carcinoid and other neuroendocrine tumors of the colon and rectum. Clin Colon Rectal Surg. 2011; 24:129–134.

4. Heo SC, Ahn YJ, Jung IM, et al. Appendiceal carcinoids detected in patients with symptoms of acute appendicitis. J Korean Surg Soc. 2004; 67:146–151.

5. Song SK, Choi ST, Kim KK, et al. Clinical review of appendiceal tumors (retrospective study of 3,744 appendectomies or right hemicolectomies). J Korean Surg Soc. 2007; 73:42–47.

6. Shin HD. Diagnosis and treatment of rectal neuroendocrine tumor. Korean J Med. 2014; 87:415–423.

7. Kim GU, Ye BD, Byeon JS, et al. Endoscopic resection for rectal carcinoid tumor: efficacy and clinical results of follow-up. Intest Res. 2011; 9:217–224.

8. Park CH, Cheon JH, Kim JO, et al. Criteria for decision making after endoscopic resection of well-differentiated rectal carcinoids with regard to potential lymphatic spread. Endoscopy. 2011; 43:790–795.

9. Lee DH, Chin HM, Kim JG, Lee YB, Park WB, Chun CS. Clinical analysis of carcinoid tumors. J Korean Surg Soc. 1997; 53:315–323.

10. Chang NS, Sung KC, Pyeon YJ, et al. Clinical reviews of patients with carcinoid tumor. Korean J Gastroenterol. 1997; 30:179–186.

Fig. 1.

CT shows dilated appendix, which measures up to 2 cm in diameter (arrow), with proximal appendicolith.

Fig. 2.

Gross findings of the resected appendix. No definite tumor is observed on the specimen.

Fig. 3.

Microscopic findings. On histologic examination, the appendiceal lesion is a Grade 1 neuroendocrine tumor with no lymphova-scular invasion or cellular atypism. Mitotic count is lower than 2/10 HPF (H&E, ×100).

Fig. 4.

Colonoscopy finding shows a normal appearing appendiceal orifice except for mild mucosal inflammation.

Fig. 5.

Gross specimen obtained after right hemicolectomy.

Fig. 6.

Microcopic finding of lymph node (H&E,×200).

Table 1.

Appendiceal Neuroendocrine Tumor (NET): Clinical and Pathological Data in Korea

Reference	Case (n)	Prevalence of NET at appendectomy	Tumor size (mm)	Additional operation	Combined with appendicitis	Lymph node metastasis (n)	Recurrence	Follow-up (mo)
Kang and Kim¹	4	0.1% (4/4,189)	7.8 (1–13) ^a	ND	2/4	NA	None	11.4
2009
Heo et al.⁴	6	0.24% (6/2,477)	9.1 (2–20) ^a	IC (1)	5/6	1	None	NA
2004				RHC (1)		18 mm, Si(+)
Song et al.⁵	9	0.24% (9/3,744)	8.5 (3–16) ^a	RHC (1)	8/9	NA	None	31.8
2007
Lee et al.⁹	5	NA	<10 (4) ^b ^b	ND	2/5	1	None	NA
1997			>30 (1) ^b			30 mm, P(+)
Chang et al.¹⁰	5	NA	ND	ND	2/5	NA	NA	NA
1997

IC, ileocectomy; RHC, right hemicolectomy; Si, serosa invasion; P, perforation; NA, not available; ND, not detected.^{a b}

^a Median size (range).

^b Mean size (n of patients).

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