Journal of Gastrointestinal Cancer

, Volume 43, Issue 2, pp 349–353 | Cite as

Appendiceal Mucinous Cystadenocarcinoma with Implantation Metastasis to the Incision Scar and Cutaneous Fistula

  • Igor Mishin
  • Gheorghe Ghidirim
  • Marin Vozian
Brief Communication



Mucinous cystadenocarcinoma of the appendix with invasion of the anterior abdominal wall and cutaneous fistula development is a rare condition. To the best of the authors’ knowledge, five such cases have been reported in the medical literature.

Methods and Results

The patient was a 68-year-old man who presented with a mass growing through the incisional scar and a skin fistula with mucinous discharge 1 year after appendectomy via McBurney’s incision. Carcinoembroyonic antigen and carbohydrate antigen 19-9 concentration was elevated. Abdominal computed tomography scan revealed a mass in the cecum with involvement of the abdominal wall. Right hemicolectomy with en bloc abdominal wall implant and skin fistula resection with clear margins was performed.


The patient received intraperitoneal intra- and postoperative chemotherapy. Gross examination of the specimen showed a mass emerging from the remnant stump of the appendix. The patient showed no relapse 1 year after surgery. Clinical, paraclinical features, and treatment options are discussed with review of the literature.


appendiceal cystadenocarcinoma implantation metastasis fistula pseudomyxoma peritonei 


Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Lim HK, Lee WJ, Kim SH, Kim B, Cho JM, Byun JY. Primary mucinous cystadenocarcinoma of the appendix: CT findings. AJR Am J Roentgenol. 1999;173:1071–4.PubMedGoogle Scholar
  2. 2.
    Solkar MH, Khan MZ, Parker MC. Pseudomyxoma peritonei confined to the retroperitoneum occurring 35 years after appendicectomy. Int J Colorectal Dis. 2004;19:399–400.PubMedCrossRefGoogle Scholar
  3. 3.
    Taii A, Sakagami J, Shinoda M, Taniguchi H, Tosa M, Baba T, et al. Pseudomyxoma peritonei occurring after an uneventful 23 years interval from appendectomy. Intern Med. 2007;46:1109–12.PubMedCrossRefGoogle Scholar
  4. 4.
    Johnson MA, Jyotibasu D, Ravichandran P, Jeswanth S, Kannan DG, Surendran R. Retention mucocele of distal viable remnant tip of appendix: an unusually rare late surgical complication following incomplete appendectomy. World J Gastroenterol. 2006;12:489–92.PubMedGoogle Scholar
  5. 5.
    Arly KS, Stephenson DV Jr, Davis WC. Giant retroperitoneal mucocele simulating pseudomyxoma peritonei and mucinous adenocarcinoma. Am J Surg. 1968;116:439–43.PubMedCrossRefGoogle Scholar
  6. 6.
    Nishitani K, Nishitani H, Shimoda Y. Cutaneous invasion of mucinous adenocarcinoma of the appendix. J Dermatol. 1987;14:167–9.PubMedGoogle Scholar
  7. 7.
    Koizumi J, Noguchi H. Pseudomyxoma retroperitonei with spontaneous skin fistula. Abdom Imaging. 1999;24:193–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Nakao A, Sato S, Nakashima A, Nabeyama A, Tanaka N. Appendiceal mucocele of mucinous cystadenocarcinoma with a cutaneous fistula. J Int Med Res. 2002;30:452–6.PubMedGoogle Scholar
  9. 9.
    Cakmak A, Karakayali F, Bayar S, Unal E, Akyol C, Kocaoğlu H. Pseudomyxoma retroperitonei presenting with a skin fistula. Turk J Gastroenterol. 2009;20:79–80.PubMedGoogle Scholar
  10. 10.
    Higa E, Rosai J, Pizzimbono CA, Wise L. Mucosal hyperplasia, mucinous cystadenoma, and mucinous cystadenocarcinoma of the appendix. A re-evaluation of appendiceal “mucocele”. Cancer. 1973;32:1525–41.PubMedCrossRefGoogle Scholar
  11. 11.
    Keynes WM. Implantation from the bowel lumen in cancer of the large intestine. Ann Surg. 1961;153:357–64.PubMedCrossRefGoogle Scholar
  12. 12.
    Hughes ES, McDermott FT, Polglase AL, Johnson WR. Tumor recurrence in the abdominal wall scar tissue after large-bowel cancer surgery. Dis Colon Rectum. 1983;26:571–2.PubMedCrossRefGoogle Scholar
  13. 13.
    Reilly WT, Nelson H, Schroeder G, Wieand HS, Bolton J, O'Connell MJ. Wound recurrence following conventional treatment of colorectal cancer: a rare but perhaps underestimated problem. Dis Colon Rectum. 1996;39:200–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Koea JB, Lanouette N, Paty PB, Guillem JG, Cohen AM. Abdominal wall recurrence after colorectal resection for cancer. Dis Colon Rectum. 2000;43:628–32.PubMedCrossRefGoogle Scholar
  15. 15.
    Miyakura Y, Iwai H, Togashi K, Horie H, Nagai H, Kishaba Y, et al. Mucinous cystadenocarcinoma of the appendix invading the ascending colon with fistula formation: report of a case. Surg Today. 2007;37:806–10.PubMedCrossRefGoogle Scholar
  16. 16.
    Ito H, Utsunomiya K, Murayama M, Fuzino K, Hase K, Watanabe C, et al. A case of the vermiform appendix with ileac and rectal fistula. J Jpn Surg Assoc. 1997;58:855–9 (in Japanese with English abstract).Google Scholar
  17. 17.
    Fann JI, Vierra M, Fisher D, Oberhelman HA Jr, Cobb L. Pseudomyxoma peritonei. Surg Gynecol Obstet. 1993;177:441–7.PubMedGoogle Scholar
  18. 18.
    Landen S, Bertrand C, Maddern GJ, Herman D, Pourbaix A, de Neve A, et al. Appendiceal mucoceles and pseudomyxoma peritonei. Surg Gynecol Obstet. 1992;175:401–4.PubMedGoogle Scholar
  19. 19.
    Hinson FL, Ambrose NS. Pseudomyxoma peritonei. Br J Surg. 1998;85:1332–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Gough DB, Donohue JH, Schutt AJ, Gonchoroff N, Goellner JR, Wilson TO, et al. Pseudomyxoma peritonei. Long-term patients survival with an aggressive regional approach. Ann Surg. 1994;219:112–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Zissin R, Gayer G, Kots E, Apter S, Peri M, Shapiro-Feinberg M. Imaging of mucocele of the appendix with emphasis on the CT findings: a report of 10 cases. Clin Radiol. 1999;54:826–32.PubMedCrossRefGoogle Scholar
  22. 22.
    Ponsky JL. An endoscopic view of mucocele of the appendix. Gastrointest Endosc. 1976;23:42–3.PubMedCrossRefGoogle Scholar
  23. 23.
    Costa M, Oertel YC. Cytology of pseudomyxoma peritonei: report of two cases arising from appendiceal cystadenomas. Diagn Cytopathol. 1990;6:201–3.PubMedCrossRefGoogle Scholar
  24. 24.
    Lo NS, Sarr MG. Mucinous cystadenocarcinoma of the appendix. The controversy persists: a review. Hepatogastroenterology. 2003;50:432–7.PubMedGoogle Scholar
  25. 25.
    Ledesma EJ, Tseng M, Mittelman A. Surgical treatment of isolated abdominal wall metastasis in colorectal cancer. Cancer. 1982;50:1884–7.PubMedCrossRefGoogle Scholar
  26. 26.
    El Sayed S. Pseudomyxoma peritonei treated by radiotherapy. Clin Oncol (R Coll Radiol). 1990;2:120–2.CrossRefGoogle Scholar
  27. 27.
    Miner TJ, Shia J, Jaques DP, Klimstra DS, Brennan MF, Coit DG. Long-term survival following treatment of pseudomyxoma peritonei: an analysis of surgical therapy. Ann Surg. 2005;241:300–8.PubMedCrossRefGoogle Scholar
  28. 28.
    van Ruth S, Acherman YI, van de Vijver MJ, Hart AA, Verwaal VJ, Zoetmulder FA. Pseudomyxoma peritonei: a review of 62 cases. Eur J Surg Oncol. 2003;29:682–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.First Department of Surgery “N. Anestiadi” & Laboratory of Hepato-Pancreato-Biliary SurgeryMedical University “N. Testemitsanu”, National Center of Emergency MedicineKishinevMoldova
  2. 2.KishinevMoldova

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