Two concurrent appendiceal neoplasms in an elderly patient: A case report

• Published in: International journal of surgery case reports 2017-01, Vol.40, p.124-126
• Main Authors: Das, Riva, Cantor, Joshua P., Vu, Thai Q.
• Format: Article
• Language: English
• Subjects: Appendicitis; Carcinoid; Casereport; Lamn; Mucinous; Synchronous
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2017.09.007

•Acute appendicitis is a rare diagnosis in the elderly; atypical causes like cancer should be considered in these scenarios.•Risk factors for appendiceal cancer include older age, abnormally long duration of symptoms, and low hematocrit.•High incidence of synchronous colon cancers with appendiceal tumors entails ruling out such lesions before definitive surgery.•The role/timing of right hemicolectomy in appendiceal cancers remain controversial - evaluate on a case by case basis. Acute appendicitis, one of the commonest surgical diagnoses, is rare and more complex presentation in the elderly. Physicians must consider atypical causes appendicitis in this population, which could affect the management of the patient. An elderly female presented with a two-day history of lower abdominal pain, associated with low-grade fevers and chills. Studies showed leukocytosis and computed tomography (CT) findings consistent with appendicitis. She underwent laparoscopic appendectomy. Intra-operatively, the Appendix had an unusual appearance, so a frozen-section was obtained, suggestive of a mucinous neoplasm with grossly clear margins. Despite the possibility that she may require a more extensive cancer operation pending the final Pathology results, the decision was made to complete the operation at this stage, and return at a later date if needed, after completing the patient's work-up with a colonoscopy to rule out any synchronous colonic lesions that could alter her surgical management. Final Pathology revealed both a low-grade appendiceal mucinous neoplasm, as well as a tip carcinoid tumor, both of which were adequately treated with appendectomy alone. Physicians treating elderly patients with appendicitis should suspect an atypical etiology, such as appendiceal cancer. Early identification and appropriate pre-operative counseling may alter the surgical management. The role and timing of right hemicolectomy in treating appendiceal cancers remain controversial, and should be evaluated on a case by case basis.