Intussusception of the appendix simulating carcinoma of the cecum

Appendiceal intussusception induced by tubulovillous adenoma with carcinoma in situ: report of a case

Appendiceal intussusception is an uncommon pathologic condition; however, villous adenoma of the appendix is a distinctly rare entity. We report herein a case of appendiceal intussusception induced by tubulovillous adenoma with carcinoma in situ. A 67-year-old man was admitted to our hospital with a 1-year history of lower abdominal pain for investigation. Barium enema showed a filling defect with an irregular surface in the cecum, and colonoscopy revealed a cecal tumor with a granular surface. Pathological examination of biopsy samples revealed tubulovillous adenoma with well-differentiated adenocarcinoma, and a diagnosis of cecal cancer in tubulovillous adenoma was made. Surgery was performed and the resected specimen was found to contain a tumor arising from the appendix. The tumor was 5.5 x 4.5 cm in size in the cecal cavity, and the appendix had invaginated into the cecum at its base. The cut surface of the appendix showed the villous tumor filling the appendiceal lumen and projecting into the cecal cavity. Microscopic examination revealed well-differentiated adenocarcinoma in tubulovillous adenoma. To the best of our knowledge, this is the first report of appendiceal intussusception caused by tubulovillous adenoma with carcinoma of the appendix.

A case of cecocolic intussusception with complete invagination and intussusception of the appendix with villous adenoma

Villous adenoma of the appendix is a rare neoplasm and intussusception of the appendix is a rare pathologic condition. A very rare case seen in a 35-year-old male with pain in the right lateral abdomen is reported. In this patient, the appendix along with the villous adenoma intussuscepted and invaginated into the cecal lumen, and presented as cecocolic intussusception. A polypoid lesion was diagnosed in the cecum by fiberoptic colonoscopy. Unlike polypoid lesions at other sites in the large intestine, polypoid lesions of the cecum may accompany intussusception and invagination of the appendix. Consequently, caution is required in performing endoscopic polypectomy in cases of polypoid lesions of the cecum.

Sonography of appendiceal intussusception

A case in which appendiceal intussusception was diagnosed preoperatively by sonography is described. The sonographic finding of multiple concentric hypoechoic and hyperechoic rings was confirmed at laparotomy to be due to appendiceal intussusception. Demonstration of the sonographic coiled spring sign in the right lower quadrant should raise the possibility of appendiceal intussusception. The differential diagnosis is discussed.

Intussusception of the appendix with a calcified fecalith

We treated a patient with a complete invagination of the appendix which contained one large laminated calcified fecalithy. Colonofiberscopy showed a dimpling submucosal tumor, which was palpated as a bony hard tumor at laparotomy. This finding suggested that the fecalith caused an intussusception of the appendix and that such an intussusception should be suspected when there is a bony hard dimpling submucosal tumor in the cecum.

Endometriosis of the appendix. Report of twelve cases and review of the literature

Twelve cases of endometriosis of the vermiform appendix are discribed and reviewed. The incidence of 0.80 per cent is higher than has been previously reported. None of the patients displayed symptoms of acute appendicitis, however, five (42 per cent) patients had symptoms suggestive of chronic or cyclic appendicitis. Laboratory tests were nondiagnostic of this lesion. There did not appear to be a correlation between the histologic location of the endometriosis and the symptoms of chronic or cyclic appendicitis. All cases of endometriosis of the appendix were discovered as a result of incidental appendectomy.

Intussusception of the appendix

Two cases of intussusception of the appendix are reported. In both cases there was a palpable tumour within the caecum and a short thickened appendix. Both intussuceptions were predominantly mucosal and of a type not previously described.