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Adenocarcinoma of the appendix presenting as bilateral ureteric obstruction.

Ahmed K, Hoque R, El-Tawil S, Khan MS, George ML - World J Surg Oncol (2008)

Bottom Line: CT scan showed a caecal mass.The patient was referred for chemotherapy where he received infusional 5 fluorouracil but died 7 months after surgery.Every attempt should be made to make a precise diagnosis through all the available means to direct the treatment along correct lines.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, St Thomas' Hospital, London, UK. kahmed198@yahoo.co.uk

ABSTRACT

Background: Adenocarcinoma of the vermiform appendix is a rare neoplasm of the gastrointestinal tract. Presentation mimics acute appendicitis, but right iliac fossa mass and intestinal obstruction have also been reported. These presentations reflect various stages of a locally expanding tumour causing luminal obstruction of appendix. The investigation and subsequent management with a review of the literature is presented.

Case presentation: We report a case of appendicular adenocarcinoma found unexpectedly in a 43 year old male who presented with urinary symptoms. Cystoscopy and uretero-renoscopy showed normal bladder but external compression of the ureters and therefore bilateral stents were inserted. CT scan showed a caecal mass. After colonoscopy, that showed external compression, and diagnostic laparoscopy the patient underwent right hemicolectomy. Histopathology revealed well differentiated adenocarcinoma with signet ring morphology with multiple lymph node involvement. The patient was referred for chemotherapy where he received infusional 5 fluorouracil but died 7 months after surgery.

Conclusion: Patients with atypical manifestations related to right lower abdominal quadrant should be thoroughly investigated with an open mind. Every attempt should be made to make a precise diagnosis through all the available means to direct the treatment along correct lines.

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(a&b) Laparoscopy: appendicular tumour.
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Figure 3: (a&b) Laparoscopy: appendicular tumour.

Mentions: A diagnostic laparoscopy (Figure 3) was performed which confirmed a tumour of appendix with biopsies showing poorly differentiated adenocarcinoma. Due to on going pain the patient underwent a laparotomy. The pelvis was frozen secondary to peritoneal disease and a right hemicolectomy was performed. Pathology showed a poorly differentiated adenocarcinoma (Figure 4) with signet ring morphology with multiple lymph node involvement (16/28). The patient was discharged on the third post operative day and referred for chemotherapy. He received infusional 5 fluorouracil but died 7 months after surgery.


Adenocarcinoma of the appendix presenting as bilateral ureteric obstruction.

Ahmed K, Hoque R, El-Tawil S, Khan MS, George ML - World J Surg Oncol (2008)

(a&b) Laparoscopy: appendicular tumour.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2277416&req=5

Figure 3: (a&b) Laparoscopy: appendicular tumour.
Mentions: A diagnostic laparoscopy (Figure 3) was performed which confirmed a tumour of appendix with biopsies showing poorly differentiated adenocarcinoma. Due to on going pain the patient underwent a laparotomy. The pelvis was frozen secondary to peritoneal disease and a right hemicolectomy was performed. Pathology showed a poorly differentiated adenocarcinoma (Figure 4) with signet ring morphology with multiple lymph node involvement (16/28). The patient was discharged on the third post operative day and referred for chemotherapy. He received infusional 5 fluorouracil but died 7 months after surgery.

Bottom Line: CT scan showed a caecal mass.The patient was referred for chemotherapy where he received infusional 5 fluorouracil but died 7 months after surgery.Every attempt should be made to make a precise diagnosis through all the available means to direct the treatment along correct lines.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, St Thomas' Hospital, London, UK. kahmed198@yahoo.co.uk

ABSTRACT

Background: Adenocarcinoma of the vermiform appendix is a rare neoplasm of the gastrointestinal tract. Presentation mimics acute appendicitis, but right iliac fossa mass and intestinal obstruction have also been reported. These presentations reflect various stages of a locally expanding tumour causing luminal obstruction of appendix. The investigation and subsequent management with a review of the literature is presented.

Case presentation: We report a case of appendicular adenocarcinoma found unexpectedly in a 43 year old male who presented with urinary symptoms. Cystoscopy and uretero-renoscopy showed normal bladder but external compression of the ureters and therefore bilateral stents were inserted. CT scan showed a caecal mass. After colonoscopy, that showed external compression, and diagnostic laparoscopy the patient underwent right hemicolectomy. Histopathology revealed well differentiated adenocarcinoma with signet ring morphology with multiple lymph node involvement. The patient was referred for chemotherapy where he received infusional 5 fluorouracil but died 7 months after surgery.

Conclusion: Patients with atypical manifestations related to right lower abdominal quadrant should be thoroughly investigated with an open mind. Every attempt should be made to make a precise diagnosis through all the available means to direct the treatment along correct lines.

Show MeSH
Related in: MedlinePlus