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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

Gross and microscopic findings of the surgical specimen: (A) The section shows multiple tumors infiltrating the appendiceal serosa through the submucosa (H&E, ×12.5). (B) The cancer cells are moderately differentiated adenocarcinoma (H&E, ×100).
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Figure 4: Gross and microscopic findings of the surgical specimen: (A) The section shows multiple tumors infiltrating the appendiceal serosa through the submucosa (H&E, ×12.5). (B) The cancer cells are moderately differentiated adenocarcinoma (H&E, ×100).

Mentions: The patient complained of diffuse abdominal pain in the right lower quadrant. Although the rebound tenderness was not severe, we were concerned that the degree of appendicitis might intensify as the metastatic mass in the appendix grew. Therefore, we decided to perform an elective laparoscopic appendectomy before the start of palliative chemotherapy. Surgery revealed a dilated appendix with minimal inflammation. A mass-like lesion was detected between the proximal appendix and the cecum base (Fig. 3). For safe and complete resection, appendectomy with wedge resection of the cecum was performed. The pathologic report indicated metastatic adenocarcinoma involving the subserosa and proper appendiceal muscle involving the serosa through the mucosa of the cecum (Fig. 4). Immunohistochemical staining revealed positive expression of cytokeratin 7 (CK7) but negative expression of cytokeratin 20 (CK20) and Cdx 2 in tumor cells, which was suggestive of adenocarcinoma of upper gastrointestinal or pancreaticobiliary origin (Fig. 5).


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)

Gross and microscopic findings of the surgical specimen: (A) The section shows multiple tumors infiltrating the appendiceal serosa through the submucosa (H&E, ×12.5). (B) The cancer cells are moderately differentiated adenocarcinoma (H&E, ×100).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Gross and microscopic findings of the surgical specimen: (A) The section shows multiple tumors infiltrating the appendiceal serosa through the submucosa (H&E, ×12.5). (B) The cancer cells are moderately differentiated adenocarcinoma (H&E, ×100).
Mentions: The patient complained of diffuse abdominal pain in the right lower quadrant. Although the rebound tenderness was not severe, we were concerned that the degree of appendicitis might intensify as the metastatic mass in the appendix grew. Therefore, we decided to perform an elective laparoscopic appendectomy before the start of palliative chemotherapy. Surgery revealed a dilated appendix with minimal inflammation. A mass-like lesion was detected between the proximal appendix and the cecum base (Fig. 3). For safe and complete resection, appendectomy with wedge resection of the cecum was performed. The pathologic report indicated metastatic adenocarcinoma involving the subserosa and proper appendiceal muscle involving the serosa through the mucosa of the cecum (Fig. 4). Immunohistochemical staining revealed positive expression of cytokeratin 7 (CK7) but negative expression of cytokeratin 20 (CK20) and Cdx 2 in tumor cells, which was suggestive of adenocarcinoma of upper gastrointestinal or pancreaticobiliary origin (Fig. 5).

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