Tuberc Respir Dis.  2008 Sep;65(3):230-234.

A Case of Extensive Stage Small Cell Lung Cancer Presenting as an Acute Appendicitis with Perforation

• Shin DW
• Choi MH
• Park SS
• Park SW
• Kim KU
• Jang AS
• Park CS
• Lim CW
• Ko ES
• Paik SH
• Kim DJ

Abstract

The incidence of appendiceal metastatic cancer is quite low. In particular, in small cell lung cancer, there is a very low incidence of a metastasis to the appendix. A 75-years old man with right lower quadrant pain, cough and sputum was transferred to our hospital. Abdominal CT revealed acute appendicitis with a perforation. The patient underwent surgery. The frozen sections of the tissue obtained during surgery, indicated a malignancy, but a right hemicolectomy was not performed due to the patient's poor general condition. The histology findings of the appendix were identified as a small cell carcinoma. The abdominal CT scan and chest x-ray at admission day showed a mass in the right lower lobe, and a further evaluation of the lesion was performed including positron emission tomography and flexible bronchoscopy with a biopsy. The pathology findings of the lung mass were also small cell lung cancer. The specimens from both sites stained positive for cytokeratin, cluster designation 56, synaptophysin, chromogranin-A and thyroid transcription factor 1. It was concluded that the appendiceal small cell cancer originated from the lung.

Keyword

Appendix; Metastasis; Small cell carcinoma

MeSH Terms

Appendicitis
Appendix
Biopsy
Bronchoscopy
Carcinoma, Small Cell
Cough
Frozen Sections
Humans
Incidence
Keratins
Lung
Neoplasm Metastasis
Nuclear Proteins
Positron-Emission Tomography
Small Cell Lung Carcinoma
Sputum
Synaptophysin
Thorax
Thyroid Gland
Transcription Factors
Keratins
Nuclear Proteins
Synaptophysin
Transcription Factors

Figure

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  Figure 1 Abdominal enhanced CT finding shows a distended appendix (1.4 cm) with wall thickening and fat infiltration around appendix.

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  Figure 2 In follow-up chest CT after 8 days showed about 4.5 cm sized mass with ill-defined margin and increased pleural effusion.

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  Figure 3 Post-operative PET-CT scan reveals hypermetabolic activity in right lower paratracheal lymph node, right lower lobe, right adrenal gland and right anterior abdominal wall (clockwise direction from upper left panel). Beside abdominal wall, other sites were considered as malignancy with the calculated SUVs more than 3.6.

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  Figure 4 Microscopic findings. (A) Appendix. Light microscopic findings shows round shaped small cells with dense nuclei, inconspicuous nucleoli, and sparse cytoplasm (H&E stain, ×400). (B) Light microscopic finding of bronchoscopic biopsy tissue shows similar features as appendix (H&E stain, ×200).

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  Figure 5 Immunohistochemistry for cluster designation 56 (A, ×200) and thyroid transcription factor-1 (B, ×200) are positive.

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