When do you recommend adjuvant chemotherapy for an incidentally detected, low grade appendiceal mucinous neoplasm s/p appendectomy?

Low-grade appendiceal mucinous neoplasm (LAMN) is one common type of neoplastic mucinous appendiceal lesions and it is a true neoplasm that produces abundant mucin but does not have infiltrative epithelial invasion of the appendiceal wall (pushing but not infiltrating). LAMN can be discovered incidentally during radiologic evaluation or colonoscopy for unrelated complaints, and it may also be identified incidentally in the appendectomy pathology specimen.
The key management for LAMN is that complete surgical resection without spillage of the lesion during the surgery, the surrounding area and peritoneal cavity should be evaluated carefully to make sure no mucinous lesion is detected. If the patient had a successful appendectomy without rupt...

Accurate histologic diagnosis of appendiceal neoplasms can be quite challenging. A complete examination of the entire specimen and rigorous evaluation of the appendiceal wall for any evidence of epithelial invasion is crucial to distinguish between adenocarcinomas and all other types of mucinous lesions.

Low-grade appendiceal mucinous neoplasms (LAMNs) are true neoplasms, with dysplastic epithelium and expansile growth, however, they lack overt infiltrative epithelial invasion of the appendiceal wall. They remain mostly confined to the muscularis propria. Due to their expansile growth pattern, however, they may push and cause the thinning and rupture of the appendiceal wall; this can result in spillage of cellular or acellular mucin, leading...