A Case Report of Primary Signet-Ring Cell Carcinoma of the Vermiform Appendix

Masaaki Iwatsuki¹⁾³⁾, Shigeru Katafuchi¹⁾, Yoshio Haga¹⁾, Shinichi Yamashita¹⁾, Housei Matsuzaki¹⁾, Hisahiko Murayama²⁾, Satoshi Ikei¹⁾ and Hideo Baba³⁾

Department of Surgery¹⁾ and Department of Pathology²⁾,
National Hospital Organization Kumamoto Medical Center
Department of Gastroenterological Surgery³⁾,
Graduate School of Medical Sciences, Kumamoto University

We here report a 41-year-old woman with an appendical signet-ring cell carcinoma operated by laparoscopic surgery followed by radical right hemicolectomy. She complained right lower abdominal pain, however she had not shown any specific inflammatory sign or symptom (WBC 5,500/mm³, CRP 0.05 mg/dl). Although the diagnosis that suggested malignant tumor was not reached by computed tomography (CT) and ultrasonography (US), she was operated to treat her abdominal pain, which she was treated by antibiotics for 3 days. Histological examination showed appendical signet-ring cell carcinoma with positive surgical margin. Additionally, she operated radically at 17^th days after the first operation, and final reports showed the peritoneal dissemination in the adipose tissue around resected margin even if the depth of tumor invasion reached until proper muscularis. These findings suggest the adverse effect due to dissemination durind operative period. We propose the careful indication for laparoscopic surgery if the existence of appendical malignant tumor is doubted.

Key words
appendiceal carcinoma, signet-ring cell carcinoma, postoperative chemotherapy

Reprint requests
Masaaki Iwatsuki Department of Gastroenterocogical Surgery Graduate School of Medical Sciences, Kumamoto University 1-1-1 Honjo, Kumamoto, 860-8556 JAPAN

Accepted
January 25, 2006

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