'Signet-ring' cell gastric adenocarcinoma metastatic to a neurogenous hyperplasia of the appendix

Missed Gastric Cancer Metastasis to the Appendix: Case Report and Literature Review

Patient: Female, 54-year-old

Final Diagnosis: Metastatic gastric cancer

Symptoms: Incidental finding

Medication: —

Clinical Procedure: Right extended hemicolectomy

Specialty: Surgery

A case of signet ring carcinoma of the appendix: dilemmas in differential diagnosis and management

PURPOSE

Signet ring carcinoma (SRC) of the appendix consists one of the most biologically virulent cancers. We present the case of a patient with primary SRC complicated by the development of acute inflammation of the appendix.

CASE REPORT

A 78-year-old man was admitted due to a 5-day history of increasing colicky abdominal pain and vomiting. Clinical examination revealed a firm, tender mass in the right ileac fossa. Laparotomy confirmed a tumor mass which appeared to originate from the appendix. The affected part of the bowel was resected and a right hemicolectomy with an end-to-side ileotransverse anastomosis was performed. The appendix was notably thickened with an ulcerated wall containing sinus tracts, chronic inflammation, and scarring. Moreover, a focus of SRC was detected.

CONCLUSIONS

Appendiceal SRC is a rare entity, which may sometimes be confused with other pathologies providing difficulties in differential diagnosis, having an impact on therapeutic decisions and affecting prognosis.