a 4-cm mass is found in the midportion of the appendix

Discussion in 'MRCS Forum' started by Joseph., May 31, 2008.

  1. Joseph.

    Joseph. Guest

    During an appendectomy for acute appendicitis, a 4-cm mass is found in the midportion of the appendix. Frozen section reveals this lesion to be a carcinoid tumor. Which of the following statements is true?

    a- No further surgery is indicated
    b- A right hemicolectomy should be performed
    c- There is about a 50% chance that this patient will develop the carcinoid syndrome
    d- Carcinoid tumors arise from islet cells
    e- Carcinoid syndrome can occur only in the presence of liver metastases
  2. Joseph.

    Joseph. Guest

    Answer: b. (Schwartz, 7/e, pp 1244-1246) Carcinoid tumors arise from enterochromaffin cells in the crypts of Lieberuhn. When they are encountered in the appendix and are less than 2 cm in size, simple appendectomy is the procedure of choice. When the tumors are larger than 2 cm, a right hemicolectomy should be performed. Carcinoid syndrome (hepatomegaly, diarrhea, cutaneous flushing, right heart valvular disease, and asthma) usually occurs in the presence of liver metastases but can also be seen when there are metastases to sites drained by systemic (as opposed to portal) veins or from primary carcinoids outside the portal system. Carcinoid syndrome is rare in patients with carcinoid of the appendix because the tumors are usually discovered before metastases occur.

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