Snapshot quiz 19/9
Authors: Dunphy LM and Raja MH
Low-grade appendiceal neoplasm. This 78-year-old man presented with CT confirmed appendicitis. Intra-operatively, a grossly dilated appendix was observed and removed. Microscopic examination showed replacement of the normal appendiceal epithelium by mucin-producing, columnar glandular epithelium, with no serosal extension. His carcinoembryonic antigen was 1; his staging CT and colonoscopy were unremarkable. Therefore, no further management was required. Tumours of the appendix are rare, occurring in less than 2 per cent of all appendicectomies. Low-grade mucinous neoplasms known previously as mucinous cystadenomas are rare mucinous tumours of the appendix, usually with low-grade cytological atypia. Follow-up CT, ultrasonography or colonoscopy are recommended. Patients with negative margins and normal tumour markers have a lower risk of recurrence. Elevated tumour markers or serosal involvement signify an increased risk of recurrence. Therefore, close monitoring or surgical intervention such as a right hemicolectomy may be needed.