A Case of Primary Cancer of the Appendix which Directly Invaded the Urinary Bladder

Byonggu An, Takashi Hirai, Yukihide Kanemitsu, Koji Komori, Tomoyuki Kato and Yasushi Yatabe*

Department of Gastroenterological Surgery and Department of Pathology and Molecular Diagnostics*, Aichi Cancer Center Central Hospital

We report a case of primary cancer of the appendix that directly invaded the urinary bladder and was diagnosed preoperatively. A 52-year-old woman seen for polyuria and macroscopic hematuria was found in cystoscopy to have a tumor on the right posterior bladder wall. The lesion was biopsied and immunohistochemical staining-cytokeratin 20 positive/cytokeratin 7 negative- of the specimen showed adenocarcinoma arising from the lower gastrointestinal tract. Enhanced pelvic computed tomography (CT) showed a heterogeneously enhanced mass, arising from the tip of the appendix. Based on a diagnosis of primary cancer of the appendix directly invading the urinary bladder, we conducted laparotomy, finding the tumor to be about 60 mm in diameter, with the part of cystic lesion, arising from the tip of the appendix and directly invading the urinary bladder and the greater omentum with an unclear margin at the right bladder wall. Since the lesion was on the right side of the pelvic cavity, we excised of the ileocecal region and partial resected the urinary bladder (simple closure) and the greater omentum. The excised specimen showed moderately differentiated adenocarcinoma arising from the appendix. The histological stage was IIIa. Although the urinary bladder volume in primary closure was 100 ml, urinary urgency gradually improved. The patient has shown no sign of recurrence in the 48 months since surgery.

Key words
adenocarcinoma of the appendix, urinary bladder invasion, cytokeratin

Reprint requests
Byonggu An Department of Gastroenterological Surgery, Aichi Cancer Center Central Hospital
1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681 JAPAN

Accepted
October 19, 2005

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