The appendix is the most common location for carcinoid tumors and establishing the diagnosis incidentally following appendectomy for acute appendicitis is reported from 0.4-1.13 % (1, 2). The most common anatomic locations for intestinal tuberculosis (TB) are the ileo-caecal valve and caecum and due to its nonspecific features poses diagnostic challenges (3). Following a laparoscopic appendectomy performed in a 18-year old female patient for acute appendicitis the pathology report additionally revealed a carcinoid tumor staged as NET-G1, Pt4Nx L0 V1 Pn0 (Fig. 1). Immunohistochemistry assay revealed intense positive synaptophisin (Fig. 2). Neuroendocrine markers were within normal limits: chromogranin A-57 ug/L (N: 27-94) serotonin-318ug/L (N:80-400), 5-HIAA-5,4MG/24h(N:2-9). Subsequently, a right hemicolectomy was performed and the macroscopical examination of the specimen revealed an ulceration of the ileo-caecal valve (Fig. 3). The final pathology report described multiple tuberculous (TB) granulomas with a tendency for coalescence and central caseation necrosis of the ileo-caecal valve (Fig. 4). The postoperative course was uneventful and antiTB therapy was started. The follow-up at 6 months revealed a patient in excellent condition without clinical, biological or imagistical criteria for recurrence of both NET and TB. The association between carcinoid tumor and ileo-caecal TB is extremely rare and requires an interdisciplinary team management and a long term follow-up.
Figure 1.
Acute appendicitis and carcinoid tumor nests.
Figure 2.
Immunohistochemistry assay revealed intense positive synaptophisin, anti-synaptophisin, X10.
Figure 3.
Ulceration of the caecum measuring 1.3 cm with red hemorrhagic and irregular border.
Figure 4.
Tuberculous granulomas with a tendency for coalescence and central caseation necrosis of the ileo-caecal valve.
Conflict of interest
The authors declare that they have no conflict of interest concerning this article.
References
- 1.In’t Hof KH, van der Wal HC, Kazemier G, Lange JF. Carcinoid tumor of the Appendix: An Analysis of 1,485 consecutive Emergency Appendectomies. Gastrointest Surg. 2008;12(8):1436–1438. doi: 10.1007/s11605-008-0545-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Ozer MT, Demirbas S, Celik E, Safali M, Harlak A, Coskun K, Ersoz N, Uzar AI. Natural behaviour and surgical treatment of appendiceal carcinoids: an analysis of 2,376 consecutive emergency appendectomies. Bratisl Lek Listy. 2011;112(11):619–622. [PubMed] [Google Scholar]
- 3.Gan H, Mely M, Zhao J, Zhu L. An Analysis of the Clinical, Endoscopic, and Pathologic Features of Intestinal Tuberculosis. J Clin Gastroenterol. 2016;50(6):470–475. doi: 10.1097/MCG.0000000000000514. [DOI] [PubMed] [Google Scholar]