Lung cancer presenting as an acute appendicitis

Acute Appendicitis Caused by Metastasis from Other Organs: A Systematic Review

BACKGROUND

Acute appendicitis resulting from inflammation of the mucosa is the most common cause of emergency surgical causes. However, acute appendicitis caused by metastasis from other organs is very rare. Patients having this entity were only described in the literature as case reports. This study aims to analyze data from published articles about this condition.

METHODS

We performed a systematic review using the PRISMA protocol. PubMed/MEDLINE, Embase and the Google Scholar Library were searched up to the end of December 2022.

RESULTS

A total of 34 patients were included, of which 22 were male. The mean age was 58.94. Primary site of tumors were mainly lungs (32.35%), breast (20.59%), and stomach (17.65%). All patients underwent surgical treatment except one patient who was given medical treatment. In 10 patients (29.41%), acute appendicitis was the initial manifestation to diagnose the primary malignancy and in 21 patients (61.77%), there were other sites of secondary lesions. Post operative mortality was reported in 1 patient (2.93%).

CONCLUSION

Acute appendicitis secondary to metastatic disease is uncommon but rarely will be the presenting sign of new cancer diagnosis. Most of the patients have other sites of secondary lesions. Surgical treatment is commonly performed to treat appendicitis.

Metastatic small cell lung cancer presenting as acute appendicitis: a case report

We present a case of extensive stage small cell lung cancer presenting as perforated appendicitis secondary to an appendiceal metastasis. This is a rare presentation with only six reported cases in the literature. Surgeons must be aware of unusual causes for perforated appendicitis as in our case the prognosis can be dire. A 60-year-old man presented with an acute abdomen and septic shock. Urgent laparotomy and a subtotal colectomy were performed. Further imaging suggested the malignancy was secondary to a primary lung cancer. Histopathology demonstrated a ruptured small cell neuroendocrine carcinoma in the appendix with thyroid transcription factor 1 positive immunohistochemistry. Unfortunately, the patient deteriorated due to respiratory compromise and was palliated day six postoperatively. Surgeons should consider a broad differential diagnosis for the cause of acute perforated appendicitis as this can rarely be due to a secondary metastatic deposit from a widespread malignant process.

A Unique Presentation of Metastatic Gallbladder Carcinoma

Gallbladder carcinoma can be challenging to diagnose and treat and usually leads to poor outcome, due to its aggressive nature and the nonspecific clinical presentation at early stage. We describe an interesting case of a 60-year-old female who presented with stage 3 appendiceal carcinoma after appendectomy was performed outside hospital. Further imaging workup demonstrated enlarged ovarian cysts and porcelain gallbladder. Upon exploration, she was found to have carcinomatosis and we proceeded with cytoreductive surgery (CRS) and hyperthermic intraperitoneal therapy (HIPEC). Final pathology demonstrated carcinoma from gallbladder primary.