Skip to main content

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

Abstract

Introduction

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.

Discussion

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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  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.

    PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  Google Scholar 

  5. Arly KS, Stephenson DV Jr, Davis WC. Giant retroperitoneal mucocele simulating pseudomyxoma peritonei and mucinous adenocarcinoma. Am J Surg. 1968;116:439–43.

    Article  PubMed  CAS  Google Scholar 

  6. Nishitani K, Nishitani H, Shimoda Y. Cutaneous invasion of mucinous adenocarcinoma of the appendix. J Dermatol. 1987;14:167–9.

    PubMed  CAS  Google Scholar 

  7. Koizumi J, Noguchi H. Pseudomyxoma retroperitonei with spontaneous skin fistula. Abdom Imaging. 1999;24:193–5.

    Article  PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  11. Keynes WM. Implantation from the bowel lumen in cancer of the large intestine. Ann Surg. 1961;153:357–64.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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. Fann JI, Vierra M, Fisher D, Oberhelman HA Jr, Cobb L. Pseudomyxoma peritonei. Surg Gynecol Obstet. 1993;177:441–7.

    PubMed  CAS  Google Scholar 

  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.

    PubMed  CAS  Google Scholar 

  19. Hinson FL, Ambrose NS. Pseudomyxoma peritonei. Br J Surg. 1998;85:1332–9.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  22. Ponsky JL. An endoscopic view of mucocele of the appendix. Gastrointest Endosc. 1976;23:42–3.

    Article  PubMed  CAS  Google Scholar 

  23. Costa M, Oertel YC. Cytology of pseudomyxoma peritonei: report of two cases arising from appendiceal cystadenomas. Diagn Cytopathol. 1990;6:201–3.

    Article  PubMed  CAS  Google Scholar 

  24. Lo NS, Sarr MG. Mucinous cystadenocarcinoma of the appendix. The controversy persists: a review. Hepatogastroenterology. 2003;50:432–7.

    PubMed  Google Scholar 

  25. Ledesma EJ, Tseng M, Mittelman A. Surgical treatment of isolated abdominal wall metastasis in colorectal cancer. Cancer. 1982;50:1884–7.

    Article  PubMed  CAS  Google Scholar 

  26. El Sayed S. Pseudomyxoma peritonei treated by radiotherapy. Clin Oncol (R Coll Radiol). 1990;2:120–2.

    Article  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Igor Mishin.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Mishin, I., Ghidirim, G. & Vozian, M. Appendiceal Mucinous Cystadenocarcinoma with Implantation Metastasis to the Incision Scar and Cutaneous Fistula. J Gastrointest Canc 43, 349–353 (2012). https://doi.org/10.1007/s12029-010-9181-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12029-010-9181-9

Keywords

  • appendiceal cystadenocarcinoma
  • implantation metastasis
  • fistula
  • pseudomyxoma peritonei