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Case 9A+B - Kathrin Glatz · Prof. Dr. med. P. Komminoth STZH Zürich, Switzerland Prof. Dr. med....
Transcript of Case 9A+B - Kathrin Glatz · Prof. Dr. med. P. Komminoth STZH Zürich, Switzerland Prof. Dr. med....
![Page 1: Case 9A+B - Kathrin Glatz · Prof. Dr. med. P. Komminoth STZH Zürich, Switzerland Prof. Dr. med. A. Perren Uni Bern, Switzerland Appendical NENs TNM 7.ed ENETS Tis Intraepithelial/L.](https://reader036.fdocuments.net/reader036/viewer/2022081614/5fc1a1d8fcb72006073ae92e/html5/thumbnails/1.jpg)
Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
Case 9A+B Prof. Dr. med. Paul KOMMINOTH
Institute of Pathology
City Hospital Triemli
Birmensdorferstrasse 497
CH-8063 Zürich, Switzerland
www.triemli.ch/pathologie
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
• Patients with symptoms of acute
appendicitis
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
![Page 4: Case 9A+B - Kathrin Glatz · Prof. Dr. med. P. Komminoth STZH Zürich, Switzerland Prof. Dr. med. A. Perren Uni Bern, Switzerland Appendical NENs TNM 7.ed ENETS Tis Intraepithelial/L.](https://reader036.fdocuments.net/reader036/viewer/2022081614/5fc1a1d8fcb72006073ae92e/html5/thumbnails/4.jpg)
Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
![Page 5: Case 9A+B - Kathrin Glatz · Prof. Dr. med. P. Komminoth STZH Zürich, Switzerland Prof. Dr. med. A. Perren Uni Bern, Switzerland Appendical NENs TNM 7.ed ENETS Tis Intraepithelial/L.](https://reader036.fdocuments.net/reader036/viewer/2022081614/5fc1a1d8fcb72006073ae92e/html5/thumbnails/5.jpg)
Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
![Page 6: Case 9A+B - Kathrin Glatz · Prof. Dr. med. P. Komminoth STZH Zürich, Switzerland Prof. Dr. med. A. Perren Uni Bern, Switzerland Appendical NENs TNM 7.ed ENETS Tis Intraepithelial/L.](https://reader036.fdocuments.net/reader036/viewer/2022081614/5fc1a1d8fcb72006073ae92e/html5/thumbnails/6.jpg)
Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland CgA
1 mm
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
• NET G1 of the appendical tip Dm 0.9
cm with minimal invasion (< 3mm) of
the mesoappendix, fully removed
• NET G1 of the appendical tip Dm 1.3
cm with deep invasion (> 3mm) of the
mesoappendix, fully removed
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
Appendical NENs
TNM 7.ed ENETS
Tis Intraepithelial/L. propria
T1 T1a: < 1cm
T1b: > 1 - 2 cm
< 1 cm; invasion of muscularis
propria
T2 > 2 – 4 cm; or invasion of
coecum
< 2 cm; < 3 mm invasion
of subserosa/ mesoapp
T3 > 4 cm; or invasion of ileum > 2 cm; > 3 mm invasion of
subserosa/ mesoapp
T4 invasion of peritoneum/ other
organs
invasion of peritoneum/ other
organs
Virchows Arch 2006;449:395 Virchows Arch 2007;451:757
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
1 cm
TNM 7.ed
2 cm 1 cm
pT1b pT1a
1 cm
2 cm
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
1 cm
ENETS
pT1 pT3
<3mm
>3mm
1 cm
1 cm 2 cm
2 cm
pT2
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
ENETS and AJCC/UICC TNM are different for
appendiceal and pancreatic NENs
use both in your report
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
• NET G1 of the appendical tip Dm 0.9 cm with
minimal invasion (< 3mm) of the mesoappendix,
fully removed
TNM: pT1a G1; ENETS TNM: pT2 G1
• NET G1 of the appendical tip Dm 1.3 cm with
deep invasion (> 3mm) of the mesoappendix,
fully removed
TNM: pT1b G1; ENETS TNM: pT3 G1
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
• mostly detected incidentically
• 50-70% tip, 5-21% middle, 7-10% base
• 80% <1cm, 14% 1-2cm, 6% >2cm
• small tumors may not be seen macroscopically
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
A
B 1/100 – 1/300
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
• <1 cm hardly ever metastasize
• >2cm have a risk for regional metastases (21-44%)
• Moertel et al. 1987: 150 patients
127 with < 2cm -> no LN mets
3/14 with 2-3 cm -> LN mets (21%)
4/9 with > 3cm -> LN mets (44%)
• Anderson and Wilson 1985: 147 patients with <2cm
2/147 with < 2cm -> LN mets (1.3%)
• Syracuse et al. 1979: 92 patients with <1cm
2/92 with < 1cm -> LN mets (2.1%)
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
Landry et al. Arch Surg 2008
143 (7): 664-670
TNM: USA proposal
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
• Meso invasion 30-40% children
10-20% adults
• Risk of LN mets in Tu < 2cm: 3.5% with
versus 0.3% without meso invasion
• 47/1248 with LN mets (3.8%) 2/3 > 2cm
and 1/3 < 2cm
• Secondary hemicolectomy 69/574:
83% T0N0, 11% Tu rest, 22% N1
Dralle H. Chirurg 2011, 82:598-606
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
LN + 10 yrs/survival
LN +
< 1 cm 15% (4/27) 100%
> 1cm - < 2cm 47% (16/34) 92%
> 2cm 86% (24/28) 91%
Appendical NET
Mullen & Savarese. J Surg Oncol 2011;104:41-44
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
Appendical NENs: Therapy
3
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
• NEN of the appendix are often detected incidentically
• Adequate dissection -> 1/100 – 1/300
• Two TNM classifications
• Lymph node metastases more frequent than previously thought (also in tumors < 2cm: 1-2%)
• Look for mesoappendical and subserosal invasion
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Prof. Dr. med. P. Komminoth
STZH Zürich, Switzerland
Prof. Dr. med. A. Perren
Uni Bern, Switzerland
NET G1 tubular type
Questions ?