Metastatic gastric signet-ring cell carcinoma: A rare cause of acute appendicitis

Acute Appendicitis Caused by Metastasis from Other Organs: A Systematic Review

BACKGROUND

Acute appendicitis resulting from inflammation of the mucosa is the most common cause of emergency surgical causes. However, acute appendicitis caused by metastasis from other organs is very rare. Patients having this entity were only described in the literature as case reports. This study aims to analyze data from published articles about this condition.

METHODS

We performed a systematic review using the PRISMA protocol. PubMed/MEDLINE, Embase and the Google Scholar Library were searched up to the end of December 2022.

RESULTS

A total of 34 patients were included, of which 22 were male. The mean age was 58.94. Primary site of tumors were mainly lungs (32.35%), breast (20.59%), and stomach (17.65%). All patients underwent surgical treatment except one patient who was given medical treatment. In 10 patients (29.41%), acute appendicitis was the initial manifestation to diagnose the primary malignancy and in 21 patients (61.77%), there were other sites of secondary lesions. Post operative mortality was reported in 1 patient (2.93%).

CONCLUSION

Acute appendicitis secondary to metastatic disease is uncommon but rarely will be the presenting sign of new cancer diagnosis. Most of the patients have other sites of secondary lesions. Surgical treatment is commonly performed to treat appendicitis.

Acute Appendicitis as a First Presentation of Unimetastatic Gastric Adenocarcinoma

Appendicitis is one of the most common causes of abdominal surgery emergencies worldwide. Here, we report a case of acute appendicitis as a primary presentation of gastric adenocarcinoma with appendiceal metastasis and no evidence of other lesions. This case can be added to only a few other reported cases, showing a similar situation that can help clarify the spread of gastric adenocarcinoma.

Metastatic gastric adenocarcinoma with appendiceal phlegmon: a case report

BACKGROUND

Gastric carcinoma is one of the most frequent malignancies worldwide. Gastric cancer metastasis to the appendix is uncommon in incidence, and has been rarely described in acute-appendicitis-related literature reviews. In this presented case, we have reported a rare case of appendiceal phlegmon, due to a diagnosis of metastatic gastric adenocarcinoma with uncommon symptoms.

CASE PRESENTATION

A 79-year-old Caucasian male presented to the emergency department with history of weakness, anorexia, lethargy, and mood changes for 2 months. Abdominopelvic computed tomography showed an abscess in right iliac muscle. After percutaneous drainage of the abscess and 6 weeks antibiotic therapy, an appendectomy was done for the patient. Histopathologic findings revealed the involvement of the appendiceal wall by adenocarcinoma, most probably with gastrointestinal origin. Gastric cancer was confirmed later by upper endoscopy and pathologic report.

CONCLUSIONS

Although the presence of tumor in appendectomy specimens is rare, and metastasis to appendix is even rarer, it should be considered as a cause of appendicitis, especially in elderly patients.

Metastatic Gastric Carcinoma Presenting as Acute Appendicitis

Metastatic disease is one of the few rare causes which can present with clinical and radiological features of acute appendicitis. In this article, we present a case of a 33-years-old man with known primary gastric malignancy undergoing adjuvant treatment, who presented with clinical peritonitis. Imaging findings revealed acute appendicitis and a sealed-off appendiceal perforation. Diagnosis of metastatic adenocarcinoma to the appendix was confirmed on histopathology. Sound knowledge among clinicians and radiologists regarding clinical presentation and radiological findings of acute abdomen in patients with known primary malignancy can aid in rapid diagnosis and management.

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

Acute appendicitis as the first presentation of appendiceal metastasis of gastric cancer-report of a rare case

Metastatic tumors of the appendix is a rare entity, whereas only limited data involving metastasis arising from gastric cancer has been reported. Herein, the case of gastric adenocarcinoma metastasis presenting as acute appendicitis is reported. A 53-year-old male, with a history of subtotal gastrectomy due to gastric adenocarcinoma 3 years before, was referred to the Emergency Department with symptoms of acute appendicitis. While this condition was confirmed intraoperatively, histology examination and comparison with the previously excised gastric specimen indicated that metastasis of gastric adenocarcinoma to the appendix was present. Metastatic appendiceal carcinoma arising from the stomach is an extremely rare condition, associated with poor prognosis. Aggressive treatment of the solitary lesion may present favorable results.

Metastatic gastric adenocarcinoma and synchronous carcinoid tumour mimicking appendicitis: A case report

INTRODUCTION

Silent metastatic gastric adenocarcinoma presenting as appendicitis is very rare. Rare pathologies may be encountered during common operations such as appendicectomy and an awareness of possible alternative pathological entities would be helpful in a surgeon's wealth of knowledge.

PRESENTATION OF CASE

A 63-year-old man presented with a three-day history of acute abdominal pain suggestive of appendicitis. Intra-operatively, a macroscopically inflamed and perforated appendix was found. There were however some atypical features, which included multiple inflamed ulcerated lesions throughout the small bowel mesentery and along the terminal ileum. Appendicectomy was performed and biopsies of these lesions were taken. Subsequent histopathology revealed that there were metastatic deposits of poorly differentiated adenocarcinoma in the appendix and mesenteric biopsies, as well as a neuroendocrine (carcinoid) tumour of the appendix. Upper endoscopy confirmed a gastric primary leading to peritoneal dissemination. The patient was scheduled to undergo a course of palliative chemotherapy.

DISCUSSION

Metastatic gastric adenocarcinomas with peritoneal dissemination have a very poor prognosis and often the first choice of treatment is chemotherapy as a complete cure through surgery is often not feasible. As for classical carcinoid tumours smaller than 2 cm towards the tip of the appendix with low proliferative index and without angiolymphatic or mesoappendiceal extension, then appendicectomy alone is indicated. Synchronous neoplastic pathologies presenting as appendicitis is largely unknown.

CONCLUSION

To our knowledge, this is the first report in the literature of synchronous carcinoid tumour and metastatic gastric cancer co-existing within an inflamed appendix.

Metastasis to the appendix from adenocarcinoma of the ascending colon: A case report

RATIONALE

Metastasis of cancer cells involves shedding from the primary tumor through various means to distant tissues and organs with continued growth and formation of new metastatic tumors of the same cancer type as the original tumor. The common sites for colon cancer metastases include the pelvis, retroperitoneal lymph nodes, liver, and lungs; Colon cancer metastases to the appendix are rare, as reported in this case.

PATIENT CONCERNS AND DIAGNOSES

A 45-year-old man was admitted to our department with a 24-hour history of abdominal distension and incomplete obstruction. Colonoscopy showed an elevated lesion in the ascending colon and the pathologic diagnosis was adenocarcinoma.

INTERVENTIONS AND OUTCOMES

This patient underwent a radical right hemi-colectomy. The post-operative pathologic examination revealed metastatic adenocarcinoma in all layers of the appendix, especially the muscularis mucosae. The diagnosis was adenocarcinoma of the ascending colon (pT4bN2bM0 stage IIIC) with metastatic adenocarcinoma of the appendix.

LESSONS

An absent right colic artery with lymph node fusion might increase the risk of appendiceal cancer metastasis.