Appendix cancer pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Pathophysiology

Gross Pathology

The most common tumor of the appendix is carcinoid, but not all appendiceal carcinoids are malignant. Malignant features include size over 1 to 2 cm, presence in lymph nodes, or invasion of tissues adjacent to the appendix.

Microscopic Pathology

Adenocarcinomas are more common primary malignancies of the appendix than carcinoids. Even so, adenocarcinoma originating in the appendix is rare, and usually resembles colonic adenocarcinoma microscopically. The signet ring cell carcinoma form carries a worse prognosis. Most mucinous tumors of the appendix are benign mucinous cystadenomas. The rare malignant form, mucinous cystadenocarcinoma is identified by invasion through the wall of the appendix or epithelial cells in mucus found in the peritoneum. Appendiceal tumors can present with peritoneal seeding, resulting in peritoneal carcinomatosis or pseudomyxoma peritonei (PMP).

Gastrointestinal stromal tumors are rare tumors with malignant potential. Primary lymphomas can occur in the appendix. Breast cancer, colon cancer, and tumors of the female genital tract may metastasize to the appendix.