Korean J Hepatobiliary Pancreat Surg.  2014 May;18(2):60-63. 10.14701/kjhbps.2014.18.2.60.

Metastatic cholangiocarcinoma as a cause of appendicitis: a case report and literature review

• Kang SI
• Kang J
• Park HS
• Jang SI
• Lee DK
• Lee KY
• Sohn SK

• KMID: 2305245
• DOI: http://doi.org/10.14701/kjhbps.2014.18.2.60

Abstract

Metastatic carcinoma that causes appendicitis is extremely rare. To our knowledge, metastatic cholangiocarcinoma in the appendix has been reported in only 1 case in the English literature. We report herein the case of an 87-year-old woman who presented with abdominal pain and jaundice. Advanced cholangiocellular carcinoma and a proximal appendiceal mass with appendicitis were detected on contrast-enhanced computed tomography and positron emission tomography/computed tomography. After elective laparoscopic appendectomy and wedge resection of the cecum, pathologic results revealed metastatic adenocarcinoma from extrahepatic cholangiocellular carcinoma in the appendix.

Keyword

Cholagiocarcinoma; Appendicitis; Metastasis

MeSH Terms

Abdominal Pain
Adenocarcinoma
Aged, 80 and over
Appendectomy
Appendicitis*
Appendix
Cecum
Cholangiocarcinoma*
Electrons
Female
Humans
Jaundice
Neoplasm Metastasis

Figure

• 

  Fig. 1 Computed tomography finding: (A) A soft tissue mass of approximately 14 mm in diameter was located in the proximal appendix. (B) The appendiceal lumen was dilated to 13 mm with a thickened wall suggesting appendicitis.

• 

  Fig. 2 Positron emission tomograhy finding: hypermetabolic mass was detected in the proximal appendix.

• 

  Fig. 3 Operative findings: A soft tissue mass was observed in the proximal appendix. A, appendix with inflammation; M, mass at the proximal appendix; C, cecum; T, terminal ileum.

• 

  Fig. 4 Gross and microscopic findings of the surgical specimen: (A) The section shows multiple tumors infiltrating the appendiceal serosa through the submucosa (H&E, ×12.5). (B) The cancer cells are moderately differentiated adenocarcinoma (H&E, ×100).

• 

  Fig. 5 Immunohistochemical staining of the surgical specimen: Immunohistochemical staining revealed positive expression of cytokeratin 7. (A) but negative expression of Cdx 2. (B) in the tumor cells (×100).

Reference

1. Akbulut S, Tas M, Sogutcu N, Arikanoglu Z, Basbug M, Ulku A, et al. Unusual histopathological findings in appendectomy specimens: a retrospective analysis and literature review. World J Gastroenterol. 2011; 17:1961–1970. PMID: 21528073.

2. McCusker ME, Coté 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. PMID: 12115365.

3. Kim HC, Yang DM, Jin W, Kim GY, Choi SI. Metastasis to the appendix from a hepatocellular carcinoma manifesting as acute appendicitis: CT findings. Br J Radiol. 2008; 81:e194–e196. PMID: 18559899.

4. Wolf C, Friedl P, Obrist P, Ensinger C, Gritsch W. Metastasis to the appendix: sonographic appearance and review of the literature. J Ultrasound Med. 1999; 18:23–25. PMID: 9952076.

5. Haid M, Larson R, Christ M. Metastasis from adenocarcinoma of the lung producing acute appendicitis. South Med J. 1992; 85:319–321. PMID: 1546358.

6. González-Vela MC, García-Valtuille AI, Fernández FA, Val-Bernal JF. Metastasis from small cell carcinoma of the lung producing acute appendicitis. Pathol Int. 1996; 46:216–220. PMID: 10846573.

7. Ramia JM, Alcalde J, Dhimes P, Cubedo R. Metastasis from choriocarcinoma of the mediastinum producing acute appendicitis. Dig Dis Sci. 1998; 43:332–334. PMID: 9512126.

8. Dirksen JL, Souder MG, Burick AJ. Metastatic Breast Carcinoma Presenting as Perforated Appendicitis. Breast Care (Basel). 2010; 5:409–410. PMID: 21494407.

9. Bair MJ, Lee PH, Chan YJ. Urologic manifestations of acute appendicitis secondary to metastatic cervical cancer. J Formos Med Assoc. 2007; 106:784–787. PMID: 17908669.

10. Ratanarapee S, Nualyong C. Acute appendicitis as primary symptom of prostatic adenocarcinoma: report of a case. J Med Assoc Thai. 2010; 93:1327–1331. PMID: 21114214.

11. Lin CY, Huang JS, Jwo SC, Chen HY. Recurrent gastric adenocarcinoma presenting as acute appendicitis: a case report. Int J Clin Pract Suppl. 2005; (147):89–91. PMID: 15875636.

12. Hsu KL, Wang KS, Chen L, Chou FF. Acute appendicitis secondary to metastatic nasopharyngeal carcinoma. J Surg Oncol. 1995; 60:131–132. PMID: 7564380.

13. Filik L, Ozdal-Kuran S, Cicek B, Zengin N, Ozyilkan O, Sahin B. Appendicular metastasis from pancreatic adenocarcinoma. Int J Gastrointest Cancer. 2003; 34:55–58. PMID: 15235136.

14. Man KM, Keeffe EB, García-Kennedy R, Hansen JE, Verhille MS. Acute appendicitis secondary to metastatic cholangiocarcinoma. Am J Gastroenterol. 1993; 88:1966–1968. PMID: 8237955.

15. Chindaprasirt J, Sookprasert A, Sawanyawisuth K, Limpawattana P, Tiamkao S. Brain metastases from cholangiocarcinoma: a first case series in Thailand. Asian Pac J Cancer Prev. 2012; 13:1995–1997. PMID: 22901160.