Mucinous adenocarcinoma of the appendix with inguinal node metastases

Authors

DOI:

https://doi.org/10.4322/acr.2021.335

Keywords:

Appendix, Adenocarcinoma Mucinous, Lymphatic Metastasis, Groin

Abstract

Mucinous adenocarcinoma of the appendix is a rare neoplasm with a low propensity for lymph node metastasis. The present case refers to an appendicular mucinous adenocarcinoma with inguinal lymph node metastasis. A 71-year-old woman underwent an appendectomy due to a clinical presentation of acute appendicitis. However, the histological examination of the surgical specimen revealed a mucinous adenocarcinoma of the appendix. After staging, the patient underwent a right hemicolectomy and was proposed for adjuvant chemotherapy. At the 3rd year of follow-up, inguinal lymphadenopathy was diagnosed, which biopsy confirmed inguinal node metastases from primary colorectal cancer, with areas of extracellular mucin. Restaging revealed liver and peritoneal metastasis, and the patient was proposed for palliative chemotherapy. Appendicular neoplasms, due to their rarity, represent a diagnostic and therapeutic challenge. This clinical case depicts an unusual metastasis pathway for an unusual neoplasm.

Downloads

Download data is not yet available.

References

Carr NJ, Cecil TD, Mohamed F, et al. A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: the Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process. Am J Surg Pathol. 2016;40(1):14-26. http://dx.doi.org/10.1097/PAS.0000000000000535. PMid:26492181.

MIsdraji J, Pai RK. Appendiceal adenocarcinoma. In: WHO Classification of Tumours Editorial Board, editor. WHO classification of tumours: digestive system tumours. 5th ed. Lyon: International Agency for Research on Cancer; 2019. p. 147.

McCusker ME, Coté TR, Clegg LX, Sobin LH. Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973-1998. Cancer. 2002;94(12):3307-12. http://dx.doi.org/10.1002/cncr.10589. PMid:12115365.

Turaga KK, Pappas SG, Gamblin T. Importance of histologic subtype in the staging of appendiceal tumors. Ann Surg Oncol. 2012;19(5):1379-85. http://dx.doi.org/10.1245/s10434-012-2238-1. PMid:22302267.

Turaga KK, Pappas S, Gamblin TC. Right hemicolectomy for mucinous adenocarcinoma of the appendix: just right or too much? Ann Surg Oncol. 2013;20(4):1063-7. http://dx.doi.org/10.1245/s10434-012-2783-7. PMid:23456377.

Carr NJ, Bibeau F, Bradley RF, et al. The histopathological classification, diagnosis and differential diagnosis of mucinous appendiceal neoplasms, appendiceal adenocarcinomas and pseudomyxoma peritonei. Histopathology. 2017;71(6):847-58. http://dx.doi.org/10.1111/his.13324. PMid:28746986.

Ito H, Osteen RT, Bleday R, Zinner MJ, Ashley SW, Whang EE. Appendiceal adenocarcinoma: long-term outcomes after surgical therapy. Dis Colon Rectum. 2004;47(4):474-80. http://dx.doi.org/10.1007/s10350-003-0077-7. PMid:14978617.

Carmignani CP, Hampton R, Sugarbaker CE, Chang D, Sugarbaker PH. Utility of CEA and CA 19-9 tumor markers in diagnosis and prognostic assessment of mucinous epithelial cancers of the appendix. J Surg Oncol. 2004;87(4):162-6. http://dx.doi.org/10.1002/jso.20107. PMid:15334630.

Low RN, Barone RM, Lucero J. Comparison of MRI and CT for predicting the Peritoneal Cancer Index (PCI) preoperatively in patients being considered for cytoreductive surgical procedures. Ann Surg Oncol. 2015;22(5):1708-15. http://dx.doi.org/10.1245/s10434-014-4041-7. PMid:25201499.

Rohani P, Scotti SD, Shen P, et al. Use of FDG-PET imaging for patients with disseminated cancer of the appendix. Am Surg. 2010;76(12):1338-44. http://dx.doi.org/10.1177/000313481007601217. PMid:21265346.

Trivedi AN, Levine EA, Mishra G. Adenocarcinoma of the appendix is rarely detected by colonoscopy. J Gastrointest Surg. 2009;13(4):668-75. http://dx.doi.org/10.1007/s11605-008-0774-6. PMid:19089515.

Melnitchouk N, Meyerhardt JA. Epithelial tumors of the appendix. UpToDate; 2021 [cited 2020 Oct 23]. Available from: https://www.uptodate.com/contents/epithelial-tumors-of-the-appendix?search=Epithelial%20tumors%20of%20the%20appendix&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

Downloads

Published

2021-11-23

Issue

Section

Clinical Case Report

How to Cite

Vaz-Pereira, R. ., Marques, R. ., Fernandes, U. ., Monteiro, A. ., & Pinto-de-Sousa, J. . (2021). Mucinous adenocarcinoma of the appendix with inguinal node metastases. Autopsy and Case Reports, 11, e2021335. https://doi.org/10.4322/acr.2021.335