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(a&b) – CT Scan: Bilateral hydronephrosis with associated caecal mass (arrow showing hydronephrosis).
Source publication
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 subs...
Similar publications
Appendix vermiformis agenesis is quite rare. It is seen in 1/100,000 of patients who underwent laparotomy with an initial diagnosis of appendicitis. A 72-year-old woman who had not undergone any previous surgery was operated on for mechanical intestinal obstruction. Right hemicolectomy was performed due to obstructive tumoral mass in the hepatic fl...
Citations
... A comparatively longer survival rate of 5 years has been reported with a right hemicolectomy (73%) over appendectomy alone (44%) [2,3,13]. Treatment for metastatic disease includes chemotherapy, hyperthermic intraoperative intraperitoneal chemotherapy, radical surgery with peritonectomy, and a combination of these treatments [14]. ...
Introduction
Primary appendiceal carcinoma is rare and comprises up to 1% of all colorectal malignancies. Its invasion into adjacent organs, such as the bladder and rectum, especially as a presenting characteristic, is even less common.
Case Presentation
A 75-year-old asymptomatic male tested positive on a screening fecal immunochemical test (FIT). Colonoscopy showed a rectosigmoid tumor and normal appendiceal orifice. Staging MRI surprisingly showed that the cancer was, in fact, of appendiceal origin, coursed posteriorly to invade the rectosigmoid and form adhesions with the urinary bladder. Staging CT did not show metastatic disease. Low anterior resection, en bloc appendectomy, and right hemicolectomy were performed along with cystectomy and ileal conduit. Hematoxylin and eosin stains showed appendiceal adenocarcinoma invading through the appendiceal wall into the rectal muscularis and submucosa. Features of neuroendocrine carcinoma were not identified on immunohistochemistry. This was a colonic type of adenocarcinoma of the appendix.
Conclusion
This is a rare case of appendiceal carcinoma invading the rectum and presenting as a positive screening fecal immunochemical test in an asymptomatic individual. We effectively demonstrate the use of preoperative MRI to identify the appendiceal origin of the tumor, as well as to demonstrate the extent of tumor spread, which assisted with operative management and treatment planning.
... It has the worst prognosis with 5-year survival described as low as 7% [3]. Previous reports have suggested the presence of local invasion and distant metastasis in up to 76 and 93% of patients, respectively, at the time of diagnosis [4,5]. ...
... Previous reports suggested most appendiceal malignancies (37-79.1%) present as appendicitis, whereas others may present as vague abdominal pain or non-specific gastrointestinal symptoms [5][6][7][8][9]. Rarer presentations described included vesico-appendiceal fistula, caeco-colic intussusception, neck mass, per vaginal bleeding, spontaneous entero-cutaneous fistula or bilateral ureteric obstruction. ...
Signet cell carcinoma of the appendix is the rarest and the most aggressive subtype of appendiceal malignancy, typically presenting with non-specific symptoms. We describe a case of a 62-year-old male with large bowel obstruction, with computed tomography demonstrating dilated large bowels from caecum to proximal sigmoid colon and pneumoperitoneum. Intraoperatively, closed loop obstruction caused by dense adherence of sigmoid colon to caecum was noted, which had resulted in caecal perforation. Histopathology study indicated primary appendiceal malignancy of signet cell morphology with intraperitoneal spread to sigmoid colon. Large bowel obstruction from appendiceal malignancy has rarely been reported and similar presentations have not been described in the existing literature. When left-sided large bowel obstruction is suspected to be caused by a malignant stricture, it is essential to consider transperitoneal spread of appendiceal malignancy as potential aetiology, particularly in the elderly.
... SRCC has been defined by the World Health Organization classification as adenocarcinoma in which the predominant component (more than 50%) is composed of isolated malignant cells containing intracytoplasmic mucin [2]. Case reports and case series suggest that SRCCA is highly aggressive and has a dismal prognosis [3][4][5]; however, limited data are available on the discrete characteristics and survival probabilities of this tumor. We aimed to utilize the Surveillance, Epidemiology, and End Results (SEER) database to explore patient and tumor characteristics and to characterize the three-and five-year cancer-specific survival (CSS) probabilities of SRCCA. ...
Background and objective
Signet ring cell carcinoma of the appendix (SRCCA) is an exceedingly rare tumor, and very limited data are available regarding its characteristics and survival probabilities. Our objective in this study was to utilize the Surveillance, Epidemiology, and End Results (SEER) database to explore the patient and tumor characteristics and to characterize the three- and five-year cancer-specific survival (CSS) probabilities of SRCCA.
Methods
Patients with SRCCA diagnosed between 2000 and 2015 were analyzed using the SEER database. The three- and five-year CSS probabilities were estimated by the Kaplan-Meier method, and the groups were compared using log-rank comparisons and multivariable Cox hazard regression analysis.
Results
A total of 527 patients were identified. The median age of the participants at diagnosis was 56 years, with a majority of them being female and white. Histologically, 60% of the tumors were high grade, and 61.3 % of the tumors were found to be metastatic on presentation. Three- and five-year CSS probabilities were 39% and 18.4%, respectively, and median survival was 26 months. Best survival outcomes were noted in males (five-year CSS: 25.4%, p=0.027), unmarried patients (five-year CSS: 19.1%, p=0.042), tumors <2 cm in size (five-year CSS: 50.5%, p<0.001), and low-grade tumors (five-year CSS: 44.8%, p<0.001). Subtotal colectomy yielded better three- and five-year CSS probabilities compared to no surgery and partial colectomy (48.5% and 26.5%, respectively, p<0.001). On the multivariate analysis, it was found that age and stages T4, N1, and M1 were associated with an increased risk of mortality, while surgery, regardless of the extent, was a protective factor.
Conclusion
SRCCA is a rare tumor with a high prevalence among old-aged white females. This tumor is usually diagnosed in an advanced stage and has a dismal prognosis. Surgical intervention, regardless of the extent, showed better survival probabilities compared to no surgery.
... A right lower quadrant mass with resultant hydroureteronephrosis should prompt the reporting radiologist to consider an underlying appendiceal neoplasm (Fig. 16). (15) ...
Appendiceal neoplasms are rare and often only discovered incidentally during surgery performed for acute appendicitis. Computed tomography (CT) has been demonstrated to be a reliable technique for accurately establishing the preoperative diagnosis of appendiceal neoplasms that manifest as acute appendicitis through the presence of certain imaging findings. Other manifestations of appendiceal neoplasms include appendiceal mass, mucocoele, localised abscess formation, ileus, increasing abdominal girth from pseudomyxoma peritonei, and intussusception. This pictorial essay illustrates varied CT findings of neoplasms of the appendix, with emphasis on the more commonly encountered manifestations of these tumours.
... It might be associated with fever, nausea, vomiting, constipation, diarrhoea, weight loss etc. Obesity and tenderness make clinical examination difficult leading to diagnostic difficulties. Also those who present with atypical manifestations [6] and associated comorbidities like diabetes mellitus, hypertension, cardiac illness,etc make the management tougher. Hence this prospective clinical study was conducted at our institute to evaluate the clinical presentation and management of patients with RIF mass. ...
Patients presenting with mass in the right iliac fossa is common for a surgeon. The causes differ based on the organ of origin. The common conditions include appendicular mass, appendicular abscess, ileocecal tuberculosisand ascending colon carcinoma. Rare conditions include Non-Hodgkin’s lymphoma, cecal carcinoma, amoeboma, lymph node mass, iliopsoas mass, retroperitoneal mass and Crohn’s disease. This makes it difficult to diagnose and manage these patients. Hence a prospective study on right iliac fossa masses was conducted. Out of a total of 50 patients, the most common cause was of appendicular origin, mainly appendicular mass followed by ileocecal tuberculosis. Pain, fever and leucocytosiswere predominantly noted in inflammatory conditions whereas weight loss, anaemia and painless mass were noted in neoplastic causes. Appendicular mass patients were treated conservatively followed by interval appendectomy. Appendicular abscess was drained extra-peritoneally. Right hemi-colectomy was done for carcinoma in the cecum and ascending colon. Tubercular patients with intestinal obstruction also underwent right hemi-colectomy. Intra-venous antibiotics were administered to all infective cases. Tubercular masses were started on anti-tubercular drugs. Carcinoma patients received adjuvant therapy. Crohn’s disease and non-specific lymphadenitis were treated medically. Hence our study shows that managing right iliac fossa mass patients can be challenging and requires vigilance.
... Men and women seem to be at equal risk for all appendiceal neoplasms except for malignant carcinoid which may have woman to man ratio in excess of 3: 1. Adenocarcinoma of the appendix is usually seen in the 6 th to 7 th decade with a male preponderance [2,4]. Appendicular adenocarcinoma usually presents as appendicitis with or without appendicular abscess, palpable abdominal mass, intestinal obstruction and pseudomyxoma peritonei [5]. Adenocarcinoma of appendix is most frequently perforating tumour of gastrointestinal tract due to anatomical peculiarity of appendix which has an extremely thin subserosal and peritoneal coat and the thinnest muscle layer of the whole gastrointestinal tract. ...
... Extraperitoneal spread is associated with relatively good prognosis by preventing the development of peritoneal carcinomatosis [6,7]. Unusual presentation includes haematuria due to bladder infiltration, direct invasion of ascending colon detected on colonoscopy, intussusception, hydronephrosis due to ureteric infiltration, retroperitoneal abscess, vaginal bleeding, lower gastrointestinal bleed, epididimitis in case of metastases to the spermatic cord or testicles, ovarian mass due to Krukenberg tumor and cutaneous infiltration [5,[8][9][10][11][12][13][14]. Management of appendiceal neoplasms should follow oncosurgical principles same as colorectal adenocarcinomas. ...
Neoplasms of the appendix are rare, accounting for less than 0.5% of all gastrointestinal malignancies and found incidentally in approximately 1% of appendectomy specimen. Carcinoids are the most common appendicular tumors, accounting for approximately 66%, with cystadenocarcinoma accounting for 20% and adenocarcinoma accounting for 10%. Appendiceal adenocarcinomas fall into one of three separate histologic types. The most common mucinous type produces abundant mucin, the less common intestinal or colonic type closely mimics adenocarcinomas found in the colon, and the least common, signet ring cell adenocarcinoma, is quite virulent and associated with a poor prognosis. Adenocarcinoma of appendix is most frequently perforating tumour of gastrointestinal tract due to anatomical peculiarity of appendix which has an extremely thin subserosal and peritoneal coat and the thinnest muscle layer of the whole gastrointestinal tract. In addition to the risk of perforation, mucinous adenocarcinoma of appendix have peculiar tendency for fistula formation. Many of unusual presentations reported for primary appendicular carcinoma are the results of fistula formation into the adjacent viscera such as the urinary bladder, bowel or vagina as well as extraperitoneally into retroperitoneal tissues or directly to the skin surface.
... 5 Males are typically more frequently affected than females with a peak incidence between 50 and 70 years of age. 2 In about 37% of reported cases patients usually present with acute appendicitis. 6 Less commonly, they may present with an appendicular mass or abscess. Rare presentations reported in published literature to date include intussusception, ureteric obstruction, renal mass, lower gastrointestinal bleeding and ovarian mass. ...
... Rare presentations reported in published literature to date include intussusception, ureteric obstruction, renal mass, lower gastrointestinal bleeding and ovarian mass. [6][7][8] Surgical treatment of appendicular adenocarcinoma with right hemicolectomy has been reported as the treatment of choice because it facilitates lymph node resection to enable accurate tumour staging. Several studies have showed significantly better 5 year survival rates in patients treated with right hemicolectomy compared to appendicectomy alone. ...
Adenocarcinoma of the vermiform appendix is a rare malignant neoplasm of the gastrointestinal tract encountered rarely within general surgical practice. We present the case of a 49-year-old man who, while undergoing investigations for haematuria, was diagnosed with an appendicular adenocarcinoma following bladder biopsy. Consequently he underwent right hemicolectomy and partial cystectomy followed by adjuvant chemotherapy. By discussing this case we hope to raise awareness within the medical profession of this rare presentation so that it may be considered within clinicians' differential diagnoses.
... Additionally, proposed application of postoperative chemotherapy could be appropriate for cases of peritoneal implantation of tumor cells in combine with peritoneum therapeutic approaches such as surgical treatment of the peritoneum [12] [13]. Carcinomas of the appendix may have a variety of clinical symptoms that may be associated with the tumor size and cellular atypia such as bladder symptoms [14] or in some cases unilateral ureteral obstruction [15] and bilateral obstruction of both ureters due to the size of the tumor [16]. ...
The adenocarcinomas of the appendix are rare tumors of the gastrointestinal truct that often reveal no clear clinical symptoms and are not diagnosed in time. In this study, we analyze a rare case of an incidentally discovered adenocarcinoma of the appendix after appendicectomy. Case presentation: A Greek male patient of 37 years old patient presented to our hospital with signs of acute appendicitis and peritonitis. He underwent appendicectomy as therapeutic treatment. Post operational histological examination revealed in situ carcinoma of the appendix without high hematological tumor markers or visible metastasis in CT scan analysis. We decided to proceed to right hemicolectomy. The patient was discharged without complications and without displaying other symptoms in a monitoring interval of two months after surgery. Conclusion: Adenocarcinomas of the appendix are generally difficult to detect in the early stage leading to significant morbidity and mortality rates. Therefore, it is necessary to execute a very careful histopathological examination and perform a detailed intraperitoneal cleaning during operation, so that any indications of appendix adenocarcinomas in cases of appendectomy won’t be missed or misjudged.
... 2 Rare tumours, such as appendiceal tumours can present atypically and so a high index of suspicion is needed to diagnose such conditions. [13][14] This patient had extensive investigations to determine the presence of malignancy but somehow a definitive diagnosis was never made prior to her final admission 11 moths later. CT scanning has shown its place in the investigation of acute abdominal pain and has a sensitivity approaching 93-98% and specificity of 92%. ...
Appropriate management of appendix mass is based on an accurate diagnosis of the underlying pathology. This is a report of a complex patient presenting with an appendix mass, whose surgery was deferred due to severe co-morbidities and who later died from severe metastatic disease. A 65-year-old lady presented with right iliac fossa pain and a mass. She was treated for an appendix mass initially and when the mass failed to resolve after four weeks, she was thoroughly investigated for the possibility of a tumour. Severe co-morbities had a significant impact on her management as definitive surgery was delayed. She represented 10 months after the initial admission with small bowel obstruction and died of metastatic caecal cancer. Management of appendix mass must entail a careful approach to investigating and treatment with emphasis on early intervention if the mass does not resolve promptly. This will avoid delayed diagnosis, treatment and a detrimental impact on prognosis.
Introduction:
Appendicitis is a prevailing cause of acute abdomen, but is often difficult to diagnose due to its wide range of symptoms, anatomical variations, and developmental abnormalities. Urological disorders of the genitourinary tract may be closely related to appendicitis due to the close proximity of the appendix to the genitourinary tract. This review provides a summary of the urological complications and simulations of appendicitis. Both typical and urological symptoms of appendicitis are discussed, as well as recommended diagnostic and treatment methods.
Methods:
Medline searches were conducted via PubMed in order to incorporate data from the recent and early literature.
Results:
Urological manifestations of appendicitis affect the adrenal glands, kidney, retroperitoneum, ureter, bladder, prostate, scrotum, and penis. Appendicitis in pregnancy is difficult to diagnose due to variations in appendiceal position and trimester-specific symptoms. Ultrasound, CT, and MRI are used in diagnosis of appendicitis and its complications. Treatment of appendicitis may be done via open appendectomy or laparoscopic appendectomy. In some cases, other surgeries are required to treat urological complications, though surgery may be avoided completely in other cases.
Conclusion:
Clinical presentation and complications of appendicitis vary among patients, especially when the genitourinary tract is involved. Appendicitis may mimic urological disorders and vice versa. Awareness of differential diagnosis and proper diagnostic techniques is important in preventing delayed diagnosis and possible complications. MRI is recommended for diagnosis of pregnant patients. Ultrasound is preferred in patients exhibiting typical symptoms.
