Abstract
Appendiceal cancer is rare and associated with a poor prognosis because it is usually found at an advanced stage. We report a case of appendiceal adenocarcinoma manifesting as a colonic obstruction with a lower abdominal mass. Laparotomy revealed bilateral ovarian tumors and a small appendiceal tumor with peritoneal metastases. We performed ileocecal resection, colectomy, and oophorectomy, following which a histological diagnosis of signet ring cell carcinoma was made. Immunohistochemical analysis revealed positive expression of cytokeratin 7 and 20, and mucin core protein 2 (MUC2), compatible with appendiceal cancer and Kruckenberg metastases. When a patient is found to have disseminated pelvic signet ring cell carcinoma of unknown origin, the appendix should be considered as a possible primary site.
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Nitecki SS, Wolff BG, Schlinkert R, Sarr MG. The natural history of surgically treated primary adenocarcinoma of the appendix. Ann Surg 1994;219:51–57.
Connor SJ, Hanna GB, Frizelle FA. Appendiceal tumors: retrospective clinicopathologic analysis of appendiceal tumors from 7,970 appendectomies. Dis Colon Rectum 1998;41:75–80.
Tjalma WA, Shatteman E, Goovaerts G, Verkinderen L, Van-den Borre F, Keersmaekers G. Adenocarcinoid of the appendix presenting as a disseminated ovarian carcinoma: report of a case. Surg Today 2000;30:178–181.
McCusker ME, Cote TR, Clegg LX, Sobin LH. Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973–1998. Cancer 2002;94:3307–3312.
Beger A. Ein Fall von Krebs des Wurmfortsatzes. Berl K Wochenschr 1882;19:616–618.
Dietrich CS, Desimone CP, Modesitt SC, Depriest PD, Ueland FR, Pavlik EJ, et al. Primary appendiceal cancer: gynecologic manifestations and treatment options. Gynecol Oncol 2007;104:602–606.
Vang R, Gown AM, Zhao C, Barry TS, Isacson C, Richardson MS, et al. Ovarian mucinous tumors associated with mature cystic teratomas: morphologic and immunohistochemical analysis identifies a subset of potential teratomatous origin that shares features of lower gastrointestinal tract mucinous tumors more commonly encountered as secondary tumors in the ovary. Am J Surg Pathol 2007;31:854–869.
Lee KR, Young RH. The distinction between primary and metastatic mucinous carcinomas of the ovary. Am J Surg Pathol 2003;27:281–292.
Kiyokawa T, Young RH, Scully RE. Krukenberg tumors of the ovary: a clinicopathologic analysis of 120 cases with emphasis on their variable pathologic manifestations. Am J Surg Pathol 2006;30:277–299.
Hristov AC, Young RH, Vang R, Yemelyanova AV, Seidman JD, Ronnett BM. Ovarian metastases of appendiceal tumors with goblet cell carcinoid-like and signet ring cell patterns: a report of 30 cases. Am J Surg Pathol 2007;31:1502–1511.
Moll R. Schiller DL. Franke WW. Identification of protein IT of the intestinal cytoskeleton as a novel type I cytokeratin with unusual properties and expression patterns. J Cell Biol 1990;111:567–580.
Moll R, Lowe A, Laufer J, Franke WW. Cytokeratin 20 in human carcinomas. A new histodiagnostic marker detected by monoclonal antibodies. Am J Pathol 1992;140:427–447.
Wauters CC, Smedts F, Gerrits LG, Bosman FT, Ramaekers FC. Keratins 7 and 20 as diagnostic markers of carcinomas metastatic to the ovary. Hum Pathol 1995;26:852–885.
Loy TS, Calaluce RD, Keeney GL. Cytokeratin immunostaining in differentiating primary ovarian carcinoma from metastatic colonic adenocarcinoma. Mod Pathol 1996;9:1040–1044.
Ronnett BM, Kurman RJ, Shmookler BM, Sugarbaker PH, Young RH. The morphologic spectrum of ovarian metastases of appendiceal adenocarcinomas: a clinicopathologic and immunohistochemical analysis of tumors often misinterpreted as primary ovarian tumors or metastatic tumors from other gastrointestinal sites. Am J Surg Pathol 1997;21:1144–1155.
Yajima N, Wada R, Yamagishi S, Mizukami H, Itabashi C, Yagihashi S. Immunohistochemical expressions of cytokeratins, mucin core proteins, p53, and neuroendocrine cell markers in epithelial neoplasm of appendix. Hum Pathol 2005;36:1217–1225.
Feng H, Ghazizadeh M, Konishi H, Araki T. Expression of MUC1 and MUC2 mucin gene products in human ovarian carcinomas. Jpn J Clin Oncol 2002;32:525–529.
Ozols RF, Bundy BN, Greer BE, Fowler JM, Clarke-Pearson D, Burger RA, et al. Phase III trial of carboplatin and paclitaxel compared with cisplatin and paclitaxel in patients with optimally resected stage III ovarian cancer: a Gynecologic Oncology Group study. J Clin Oncol 2003;21:3194–3200.
Du BA, Luck HJ, Meier W, Adams HP, Mobus V, Costa SK et al. A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. J Natl Cancer Inst 2003;95:1320–1329.
Glehen O, Mohamed F, Sugarbaker PH. Incomplete cytoreduction in 174 patients with peritoneal carcinomatosis from appendiceal malignancy. Ann Surg 2004;240:278–285.
Niesel T, Bohm J, Paul R, Breul J, Hartung R. Rare metastases of signet ring cell carcinomas to the scrotum: report of two cases. Urology 1996;47:769–771.
Marcia LM, Melinda Am, Hakjung K et al. Malignancies of the appendix: Beyond case series reports. Dis Colon rectum 2005;48:2264–2271.
Won-Suk L, Ho-Kyung C, Woo YL et al. Treatment outcomes in patients with signet ring cell carcinoma of the colorectum. Am J Surg 2007;194:294–298.
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Suzuki, J., Kazama, S., Kitayama, J. et al. Signet ring cell carcinoma of the appendix manifesting as colonic obstruction and ovarian tumors: Report of a case. Surg Today 39, 235–240 (2009). https://doi.org/10.1007/s00595-008-3839-y
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DOI: https://doi.org/10.1007/s00595-008-3839-y