Retroperitoneal lymphadenopathy, appendicitis - Forum

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Old surgeon

Retroperitoneal lymphadenopathy, appendicitis - Ärzteforum

Post#1 »

How is it we are suddenly talking about lymphoma and
Crohn's? You have your answer in the path report--you have an
adenocarcinoma of the appendix!!! Do you really think this is a case
of two or three different things happening at the same time? Patient
needs to go back now for a formal cancer operation--a right
hemicolectomy--it seems we are losing sight of the forest for the
trees! Do your patient a favor and forget you ever saw the CT scan
that was unnecessary to begin with! Proceed...


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Alalo

Re: Retroperitoneal lymphadenopathy, appendicitis - Ärzteforum

Post#2 »

I reread your post--I misunderstood and see it was only a
cystadenoma--belay my last! Still, I would ignore the CT
findings--but--weren't you just in there? Isn't what you actually saw more
reliable than what you see on CT?

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Old surgeon

Re: Retroperitoneal lymphadenopathy, appendicitis - Ärzteforum

Post#3 »

The path report identifies it as a mucinous cystadenoma. Is this not benign disease?

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Old surgeon

Re: Retroperitoneal lymphadenopathy, appendicitis - Ärzteforum

Post#4 »

At time of surgery, all I saw was a hyperemic
lymph node in the ileocecal fat pad. I actually thought of biopsy at that
time, but didn't because I thought I was dealing with a simple appendicitis.
What is the chance of malignant degeneration? My pathologist is reviewing
the slides and sending out the specimen for second and third opinions.
My question I guess, is would you treat empirically for Crohn's and
follow her with CT?

Noro

Re: Retroperitoneal lymphadenopathy, appendicitis - Ärzteforum

Post#5 »

The problem is not what he saw but what he didn't look at. When doing an
appendectomy, especially when it appears to be inflamed, the exploration is
not extensive, and it is easy to miss surrounding pathology, if it is not
immediately near the appendix, such as enlarged para-aortic or pelvic lymph
nodes.
Even though CT is just an imaging modality, it is unwise to ignore its
results, especially if similar in two subsequent studies.

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