A Case Study of a Poorly Differentiated Appendiceal Cancer Discovered at the Onset of Acute Appendicitis

Koji Yamaguchi, Motoki Abe, Kiyotaka Ito, Takayuki Suzuki and Kenzo Okamoto*

Department of Surgery and Department of Pathology*, Labor Welfare Corporation Iwamizawa Rosai Hospital

A 54-year-old woman was admitted to our hospital complaining of right lower quadrant abdominal pain. Based on abdominal CT findings showing a swollen appendix and right fallopian tube, the patient was diagnosed with acute appendicitis and received an appendectomy and a right tubectomy. A postoperative histopathological examination revealed the presence of a poorly differentiated adenocarcinoma with proliferation in a scirrhous fashion from the mucosa through the muscularis, as well as part of a serous membrane. One month following the initial operation, a right colectomy was performed in order to conduct D3 lymph node dissection. Tumor marker elevation and ascites retention were observed 2 years and 4 months after the radical operation. We diagnosed with recurrence of the appendiceal cancer, and treated the patient with chemotherapy, but a complete response was not attained. The patient died 2 years and 10 months after the initial diagnoses. Colonic carcinoma is rarely seen among appendiceal cancer and is very difficult to diagnose preoperatively. Therefore, many cases are initially diagnosed as appendicitis, and only later recognized as cancer based on intraoperative findings or a postoperative histological examination. Therefore, it is necessary for positive histopathological examinations after appendectomy. Furthermore, based on the depth of cancer invasion, appropriate additional operations must be considered.

Key words
appendiceal cancer, poorly differentiated adenocarcinoma

Reprint requests
Koji Yamaguchi Department of Surgery, Labor Welfare Corporation Iwamizawa Rosai Hospital
4-16-5 Iwamizawa, 068-0004 JAPAN

Accepted
April 26, 2006

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