Frozen cells indicate when to remove both appendix and ovaries

Ovarian pathology diagnosed by frozen section is the best indicator of which women undergoing oophorectomy for suspected cancer also may require removal of a diseased appendix, researchers from the University of Virginia Health System, Charlottesville, report.

Retrospective analysis of data on 191 patients who underwent both oophorectomy and appendectomy during the same procedure between 1992 and 2007 found high rates of appendiceal disease-94.4% of grossly abnormal and 35.3% of normal appendices-associated with serous ovarian cancers. Ovarian tumors of suspected primary gastrointestinal origin were linked to high rates of appendiceal mucinous neoplasms (82.8% of grossly abnormal and 60% of normal appendices).

The authors of the study, published in Obstetrics and Gynecology (2010;116[6];1348-1353), note that their findings are consistent with previous reports.

“Appendiceal and ovarian abnormalities can sometimes coexist,” explains lead author Amir A. Jazaeri, MD. “Ovarian cancers frequently spread to the appendix, and, conversely, small or even microscopic appendiceal tumors can metastasize to the ovaries and present as an ovarian mass.”

“Appendectomy is usually indicated if the appendix looks abnormal,” Jazaeri writes. “However, our study showed that there are situations where appendectomy is prudent even when the appendix looks completely normal because of risk of microscopic abnormalities.” Linear regression analysis indicated that frozen section diagnosis of ovarian pathology is much more significant than the gross appearance of the appendix for predicting concomitant appendiceal disease.

The researchers recommend appendectomy when frozen section indicates mucinous or serous ovarian carcinoma, low malignant potential tumor, or metastatic carcinoma of suspected gastrointestinal origin.