A 34-year-old woman undergoes appendicectomy for presumed acute appendicitis. Histopathology reveals a well-differentiated neuroendocrine tumour (carcinoid) of the appendix measuring 2.5 cm, located at the tip, completely excised, with lymphovascular invasion present. What is the appropriate next step?

• A No further treatment, routine follow-up only
• B Somatostatin receptor scintigraphy followed by octreotide therapy
• C Completion subtotal colectomy
• D Completion right hemicolectomy ✓

Explanation

Appendiceal neuroendocrine tumours larger than 2 cm carry a substantial risk of nodal metastasis and warrant completion right hemicolectomy, as does tumour at the base of the appendix or a goblet cell carcinoma regardless of size. Tumours under 1 cm treated by simple appendicectomy need nothing further. Octreotide and somatostatin analogue therapy are palliative measures for functioning metastatic disease, not adjuvant steps after a potentially curable localised lesion.

Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.