Appendiceal Neoplasms
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Malignancy- A 56-year-old woman presents for evaluation of increasing abdominal girth, fullness, and abdominal pain. On examination, her abdomen is distended and she has had progressive weight loss of 50 lbs over the last 1 year. Computed tomography is performed (Figure). Her gynecologic examination and transvaginal ultrasonography findings are normal. Findings of colonoscopy are unremarkable. What is the best step in management?
- A 45-year-old woman presents with abdominal pain. Computed tomography of the abdomen and pelvis showed an inflamed appendix with periappendiceal stranding. A laparoscopic appendectomy is performed. The pathology report reveals a 1.5-cm goblet cell carcinoid of the midappendix with lymphovascular invasion. What is the most appropriate next step?
- A 50-year-old woman is found to have a 7-mm submucosal yellow lesion in the distal rectum on screening colonoscopy. There is no pillow sign. What is the most likely diagnosis?
- You are consulted by the emergency department about a patient with a large bowel obstruction caused by an obstructing right colonic mass. On exploration, you note that she has peritoneal carcinomatosis in the right lower quadrant, with a normal-appearing liver and ovaries. You perform a right colectomy with primary anastomosis, and a biopsy of her metastatic disease. Final pathology report is consistent with metastatic appendiceal mucinous neoplasm. Staging shows no evidence of distant metastatic disease aside from her known isolated peritoneal lesions. What is the best treatment option to improve her overall survival?