CASE REPORTS   

Chirurgia 2008 December;21(6):359-61

Copyright © 2008 EDIZIONI MINERVA MEDICA

language: English

Pitfalls in the follow up for appendiceal carcinoid in a girl. A case report

Gasparella M. ¹, Dall’Igna P. ¹, Bisogno G. ², Zucchetta P. ³, Unterkalmsteiner I. ⁴, Andriolo P. ⁴, Alaggio R. ⁵, Cecchetto G. ¹

¹ Pediatric Surgery Clinic, Pediatrics Department University of Padova, Padova, Italy 2 Division of Pediatric Ematology-Oncology Pediatrics Dipartment, University of Padova, Padova, Italy 3 Department of Nuclear Medicine I University-Hospital of Padova, Padova, Italy 4 Division of Pediatric Surgery Hospital of Bolzano, Bolzano, Italy 5 Oncologic Sciences Institute, Dipartment of Pathology University of Padova, Padova, Italy

Carcinoid of the appendix is the most common gastro-intestinal epithelial tumors in childhood, and is always found accidentally.The behaviour of this tumor in children is less aggressive comparing with adults. The clinical-therapeutic approach still represents a challenge due to its rarity and the evidence in literature of only few complicated cases. We report a case of a 15 year old girl, who presented with hepatic nodules simulating metastatic lesions at three years follow-up after appendectomy. The tumor, which measured 3 mm, was localized on the tip of the appendix and did not show any invasion of the serosa and periappendix fat. At three years follow-up, an abdominal ultrasound showed a solid nodule of 15 mm in diameter in the first segment of the liver. An Octreotide scintiscan was performed and other two hepatic lesions were found, in the V° and VIII° hepatic segments.
This result suggested a possible metastatic lesions therefore a surgical exploration was performed. The first hepatic segment lesion was removed; the two others could not be identified even with intraoperative ultrasound. The histological diagnosis was focal nodular hyperplasia. The patient continued the follow-up; another Octreotide scintiscan, two years after, confirmed the nodules sites in the V° and VIII° segments, but showed less intensive captation. This article describes an unusual case: the clinical findings were in contrast with the asymptomatic patient. At present after 6 years of follow up, the girl remains asymptomatic.