INCIDENCE OF NEUROENDOCRINE TUMOR OF THE APPENDIX IN LAPAROSCOPIC APPENDECTOMIES IN PATIENTS WITH INTESTINAL ENDOMETRIOSIS: A CASE SERIES

Introduction and Objectives Appendiceal endometriosis is uncommon, accounting for only about 1% of all cases of endometriosis. However, endometriosis is found in the appendix in approximately 8-13% of patients with deep endometriosis, and it is particularly common in patients with severe forms of deep endometriosis. Neuroendocrine tumors (NETs) are the most common neoplasms of the appendix and may be misdiagnosed when there are multiple endometriosis lesions in the pelvis. The aim of this study was to analyze the incidence of NETs in patients with deep endometriosis involving the intestines.

Methods This was a retrospective study using electronically recorded data prospectively. All laparoscopic appendectomies performed in patients with deep endometriosis involving the intestines between April 2012 and April 2024 were evaluated, along with the results of the pathological examinations.

Results A total of 78 laparoscopic appendectomies were performed, with 6 cases (7.7%) of NETs. Based on the pathological findings of the surgical specimen (well-differentiated NET at the tip of the appendix, measuring 1.3 cm, with free margins but infiltration of the appendiceal adipose tissue and positive angiolymphatic invasion), the patient was advised to undergo a complementary colectomy, but she refused. The average age of the patients at the time of surgery was 35.2 years (24-51 years). The main surgery performed was segmental resection in 46 patients, disc resection in 22 cases, shaving nodulectomy in 12 patients, and enterectomy in 5 patients. Laparoscopic hysterectomy was associated in 10 patients. The average hospital stay was 1.5 days (1-3 days), and the surgical time was 125 minutes (45-300). There were no signs of NET recurrence in a mean follow-up period of more than 2 years.

Conclusion In our study, the frequency of appendiceal neoplasms was 1 in every 12 appendectomies in patients with intestinal endometriosis. This case series reinforces the need for careful management of these lesions and supports the recommendation for appendectomy when the appendix is affected by endometriosis. Although the most likely diagnosis is appendiceal endometriosis, NETs cannot be excluded by imaging studies, and both conditions can occur in the same patients.

Publication History

Article published online:
25 April 2025