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Metastatic cholangiocarcinoma as a cause of appendicitis: a case report and literature review.

Kang SI, Kang J, Park HS, Jang SI, Lee DK, Lee KY, Sohn SK - Korean J Hepatobiliary Pancreat Surg (2014)

Bottom Line: Metastatic carcinoma that causes appendicitis is extremely rare.To our knowledge, metastatic cholangiocarcinoma in the appendix has been reported in only 1 case in the English literature.After elective laparoscopic appendectomy and wedge resection of the cecum, pathologic results revealed metastatic adenocarcinoma from extrahepatic cholangiocellular carcinoma in the appendix.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Metastatic carcinoma that causes appendicitis is extremely rare. To our knowledge, metastatic cholangiocarcinoma in the appendix has been reported in only 1 case in the English literature. We report herein the case of an 87-year-old woman who presented with abdominal pain and jaundice. Advanced cholangiocellular carcinoma and a proximal appendiceal mass with appendicitis were detected on contrast-enhanced computed tomography and positron emission tomography/computed tomography. After elective laparoscopic appendectomy and wedge resection of the cecum, pathologic results revealed metastatic adenocarcinoma from extrahepatic cholangiocellular carcinoma in the appendix.

No MeSH data available.


Related in: MedlinePlus

Positron emission tomograhy finding: hypermetabolic mass was detected in the proximal appendix.
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Figure 2: Positron emission tomograhy finding: hypermetabolic mass was detected in the proximal appendix.

Mentions: An 87-year-old female was admitted to the department of medicine with a chief complaint of abdominal pain with jaundice. She had a history of hypertension and type II diabetes mellitus for which she was treated at the local clinic with regular medications. Her vital signs were stable. Laboratory findings revealed a white blood cell count within normal range (5,680 cells/mm3 with 74.7% segmented neutrophils), but C-reactive protein and the erythrocyte segmentation rate were elevated to 16.1 mg/L and 105 mm/hour, respectively. Liver function tests for aspirate aminotransferase, alanine aminotransferase, total bilirubin, direct bilirubin, alkaline phosphatase, and gamma-guanosinetriphospate were 284 IU/L, 403 IU/L, 9.1 mg/dl, 6.4 mg/dl, 540 IU/L, and 965 IU/L, respectively. Contrast-enhanced computed tomography (CT) revealed extrahepatic cholangiocellular carcinoma with direct hepatic invasion and lymph node metastasis in the para-aortic and peri-portal area. In addition, a dilated appendiceal lumen caused by a soft tissue mass at the base of the appendix was detected (Fig. 1). Positron emission tomography-computed tomography (PET-CT) scan revealed an approximately 4.3 cm hypermetabolic mass in segment 4 of the liver with biliary dilatation and hypermetabolic nodes in the portocaval and para-aortic areas. Focal strong uptake in the proximal appendix suggested a malignant mass (Fig. 2). The patient underwent an endoscopic retrograde cholangiopancreatography (ERCP)-guided biopsy of the common bile duct (CBD) and ultrasonography-guided biopsy of the metastatic hepatic mass. The result of the hepatic mass revealed adenocarcinoma; however, the results of the CBD revealed chronic non-specific inflammation.


Metastatic cholangiocarcinoma as a cause of appendicitis: a case report and literature review.

Kang SI, Kang J, Park HS, Jang SI, Lee DK, Lee KY, Sohn SK - Korean J Hepatobiliary Pancreat Surg (2014)

Positron emission tomograhy finding: hypermetabolic mass was detected in the proximal appendix.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4492315&req=5

Figure 2: Positron emission tomograhy finding: hypermetabolic mass was detected in the proximal appendix.
Mentions: An 87-year-old female was admitted to the department of medicine with a chief complaint of abdominal pain with jaundice. She had a history of hypertension and type II diabetes mellitus for which she was treated at the local clinic with regular medications. Her vital signs were stable. Laboratory findings revealed a white blood cell count within normal range (5,680 cells/mm3 with 74.7% segmented neutrophils), but C-reactive protein and the erythrocyte segmentation rate were elevated to 16.1 mg/L and 105 mm/hour, respectively. Liver function tests for aspirate aminotransferase, alanine aminotransferase, total bilirubin, direct bilirubin, alkaline phosphatase, and gamma-guanosinetriphospate were 284 IU/L, 403 IU/L, 9.1 mg/dl, 6.4 mg/dl, 540 IU/L, and 965 IU/L, respectively. Contrast-enhanced computed tomography (CT) revealed extrahepatic cholangiocellular carcinoma with direct hepatic invasion and lymph node metastasis in the para-aortic and peri-portal area. In addition, a dilated appendiceal lumen caused by a soft tissue mass at the base of the appendix was detected (Fig. 1). Positron emission tomography-computed tomography (PET-CT) scan revealed an approximately 4.3 cm hypermetabolic mass in segment 4 of the liver with biliary dilatation and hypermetabolic nodes in the portocaval and para-aortic areas. Focal strong uptake in the proximal appendix suggested a malignant mass (Fig. 2). The patient underwent an endoscopic retrograde cholangiopancreatography (ERCP)-guided biopsy of the common bile duct (CBD) and ultrasonography-guided biopsy of the metastatic hepatic mass. The result of the hepatic mass revealed adenocarcinoma; however, the results of the CBD revealed chronic non-specific inflammation.

Bottom Line: Metastatic carcinoma that causes appendicitis is extremely rare.To our knowledge, metastatic cholangiocarcinoma in the appendix has been reported in only 1 case in the English literature.After elective laparoscopic appendectomy and wedge resection of the cecum, pathologic results revealed metastatic adenocarcinoma from extrahepatic cholangiocellular carcinoma in the appendix.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Metastatic carcinoma that causes appendicitis is extremely rare. To our knowledge, metastatic cholangiocarcinoma in the appendix has been reported in only 1 case in the English literature. We report herein the case of an 87-year-old woman who presented with abdominal pain and jaundice. Advanced cholangiocellular carcinoma and a proximal appendiceal mass with appendicitis were detected on contrast-enhanced computed tomography and positron emission tomography/computed tomography. After elective laparoscopic appendectomy and wedge resection of the cecum, pathologic results revealed metastatic adenocarcinoma from extrahepatic cholangiocellular carcinoma in the appendix.

No MeSH data available.


Related in: MedlinePlus