A Case of Signet Ring Cell Carcinoma of the Vermiform Appendix diagnosed as Acute Appendicitis at the Onset

Masayuki Tanaka, Tatsuya Matsuo, Daisuke Mori¹⁾, Sadami Harada and Khoji Miyazaki²⁾

Department of Surgery, Taku City Hospital
Department of Pathology, Saga Prefectural Hospital¹⁾
Department of Surgery, Saga University Faculty of Medicine²⁾

A 59-year-old man admitted for lower right abdominal pain was found in blood test to have leukocytosis (WBC count 18,870/mm³) and elevated C-reactive protein (CRP 12.3 mg/dl). Abdominal computed tomography showed a swollen appendix, necessitating appendectomy based on a preoperative diagnosis of acute appendicitis. Postoperative histopathological examination of the resected appendix showed signet ring cell carcinoma from the mucosa to the serosal membrane and mesoappendix. Twenty one days after initial surgery, we conducted ileocecal resection with D3 lymph node dissection, but neither residual tumor nor lymph node metastasis was seen. The man underwent postoperative chemotherapy for six months and has remained in good health in the interim 18 months without clinical recurrence. Signet ring cell carcinoma is extremely rare in appendiceal cancer, with many cases initially diagnosed as appendicitis and only after postoperative histopathological examination found to be cancer. Postappendectomy histopathological examination is therefore necessary. Additional surgery and chemotherapy may then be considered based on the pathological stage disease.

Key words
appendiceal cancer, signet ring cell carcinoma, acute appendicitis

Reprint requests
Masayuki Tanaka Department of Surgery, Taku City Hospital
1771-4 Takumachi, Taku, 846-0031 JAPAN

Accepted
June 16, 2010

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