Appendiceal diverticulosis: a harbinger of underlying primary appendiceal adenocarcinoma?

J Gastrointest Oncol 2018 Apr;9(2):E1-E5

Department of Colorectal Surgery, Division of Pathology, Singapore General Hospital, Singapore.

Diagnosis of primary appendiceal adenocarcinoma (PAA) is hindered by its rarity and largely asymptomatic nature. Appendiceal diverticulosis (AD) is equally rare. We report an unusual case of PAA presenting with perforated appendiceal diverticulitis, and discuss a review of the literature about its association, and its surgical and pathological implications. A middle-aged man was admitted with right iliac fossa (RIF) pain and a corresponding tender abdominal mass for 5 days. Computerised tomography (CT) scan demonstrated a thickened appendix with 3 cm abscess at its base. During laparoscopic appendicectomy, the appendiceal phlegmon was adhered to the surrounding bowel. Histology showed a perforated diverticulum near the appendiceal tip, and a primary appendiceal well-differentiated adenocarcinoma located proximal to it with clear margins. Up to 48% of ADs are associated with appendiceal neoplasms, but its coexistence with PAA is reported in fewer than ten instances worldwide. Obstructing appendiceal tumours, by raising intraluminal pressure, can predispose to AD formation. Intestinal-type PAA is often managed like its colorectal counterpart, although controversies about management of PAA in a perforated AD remain. Recognition of the association of AD and PAA is critical to ensure meticulous oncological resection and histological examination.

Download full-text PDF

Source
http://dx.doi.org/10.21037/jgo.2017.08.18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934151PMC
April 2018
2 Reads

Publication Analysis

Top Keywords

primary appendiceal
12
appendiceal
10
appendiceal diverticulosis
8
paa
6
appendiceal primary
4
diverticulum appendiceal
4
perforated diverticulum
4
surrounding bowel
4
bowel histology
4
histology perforated
4
appendiceal well-differentiated
4
adenocarcinoma located
4
48% ads
4
ads associated
4
associated appendiceal
4
margins 48%
4
clear margins
4
adhered surrounding
4
located proximal
4
proximal clear
4

Similar Publications