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Burute N, Aseyev O, Hasan F, Allard-Ihala E, Shahrour W, Kotb A, Harris W, Rozenberg R. Bladder-Adherent Primary Appendiceal Carcinoma Masquerading as a Carpeting Rectal Lesion Detected by a Fecal Immunochemical Test: A Case Report. Case Rep Gastroenterol 2024; 18:1-7. [PMID: 38188592 PMCID: PMC10766397 DOI: 10.1159/000535273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 11/08/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Primary appendiceal carcinoma is rare and comprises up to 1% of all colorectal malignancies. Its invasion into adjacent organs, such as the bladder and rectum, especially as a presenting characteristic, is even less common. Case Presentation A 75-year-old asymptomatic male tested positive on a screening fecal immunochemical test (FIT). Colonoscopy showed a rectosigmoid tumor and normal appendiceal orifice. Staging MRI surprisingly showed that the cancer was, in fact, of appendiceal origin, coursed posteriorly to invade the rectosigmoid and form adhesions with the urinary bladder. Staging CT did not show metastatic disease. Low anterior resection, en bloc appendectomy, and right hemicolectomy were performed along with cystectomy and ileal conduit. Hematoxylin and eosin stains showed appendiceal adenocarcinoma invading through the appendiceal wall into the rectal muscularis and submucosa. Features of neuroendocrine carcinoma were not identified on immunohistochemistry. This was a colonic type of adenocarcinoma of the appendix. Conclusion This is a rare case of appendiceal carcinoma invading the rectum and presenting as a positive screening fecal immunochemical test in an asymptomatic individual. We effectively demonstrate the use of preoperative MRI to identify the appendiceal origin of the tumor, as well as to demonstrate the extent of tumor spread, which assisted with operative management and treatment planning.
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Affiliation(s)
- Nishigandha Burute
- Department of Diagnostic Imaging, Thunder Bay Regional Health Sciences Centre, Thunderbay, ON, Canada
- Northern Ontario School of Medicine - University, Thunder Bay, ON, Canada
| | - Olexiy Aseyev
- Northern Ontario School of Medicine - University, Thunder Bay, ON, Canada
- Department of Medical Oncology, Thunder Bay Regional Health Sciences Centre, Thunderbay, ON, Canada
| | - Fauzia Hasan
- Northern Ontario School of Medicine - University, Thunder Bay, ON, Canada
- Department of Pathology, Thunder Bay Regional Health Sciences Centre, Thunderbay, ON, Canada
| | - Erika Allard-Ihala
- Department of General Surgery, Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Walid Shahrour
- Northern Ontario School of Medicine - University, Thunder Bay, ON, Canada
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Thunderbay, ON, Canada
| | - Ahmed Kotb
- Northern Ontario School of Medicine - University, Thunder Bay, ON, Canada
- Department of Urology, Thunder Bay Regional Health Sciences Centre, Thunderbay, ON, Canada
| | - William Harris
- Department of Surgery, Thunder Bay Regional Health Sciences Centre, Thunderbay, ON, Canada
| | - Radu Rozenberg
- Department of Diagnostic Imaging, Thunder Bay Regional Health Sciences Centre, Thunderbay, ON, Canada
- Northern Ontario School of Medicine - University, Thunder Bay, ON, Canada
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