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Long Y, Xiang YN, Huang F, Xu L, Li XY, Zhen YH. Appendiceal intussusception complicated by adenocarcinoma of the cecum: A case report. World J Clin Cases 2024; 12:1461-1466. [PMID: 38576819 PMCID: PMC10989461 DOI: 10.12998/wjcc.v12.i8.1461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/06/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Appendiceal intussusception is a pathological condition in which the appendix is inverted into the cecum, which may cause symptoms that resemble those of other gastrointestinal disorders and may induce intestinal obstruction. The rarity of this case presentation is the co-occurrence of appendiceal intussusception and cecal adenocarcinoma, a combination that to our knowledge has not previously been reported in the medical literature. This case provides new insights into the complexities of diagnosing and managing overlapping pathologies. CASE SUMMARY A 25-year-old woman presented with persistent periumbilical pain and bloody stools. An initial biopsy showed cecal cancer; however, subsequent colonoscopy and computed tomography findings raised the suspicion of appendiceal intussusception, which was later confirmed postoperatively. This unique case was characterized by a combination of intussusception and adenocarcinoma of the cecum. The intervention included a laparoscopic right hemicolectomy, which led to the histopathological diagnosis of mucinous adenocarcinoma with appendiceal intussusception. The patient recovered well postoperatively and was advised to initiate adjuvant chemotherapy. This case highlights not only the importance of considering appendiceal intussusception in the differential diagnosis, but also the possibility of appendicitis and the atypical presentation of neoplastic lesions. CONCLUSIONS Physicians should consider the possibility of appendiceal intussusception in cases of atypical appendicitis, particularly when associated with neoplastic presentation.
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Affiliation(s)
- Yu Long
- Department of Colorectal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guzihou Province, China
- Department of Colorectal Surgery, Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Yi-Ning Xiang
- Department of Pathology, The Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Fei Huang
- Department of Colorectal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guzihou Province, China
| | - Lei Xu
- Department of Colorectal Surgery, Guizhou Medical University, Guiyang 550001, Guizhou Province, China
| | - Xiao-Yun Li
- Department of Colorectal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guzihou Province, China
| | - Yun-Huan Zhen
- Department of Colorectal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang 550001, Guzihou Province, China
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Nureta TH, Shale WT, Abadura MA, Guluju FA. Primary appendiceal MALT lymphoma clinically masquerading as chronic appendicitis: A case report. Int J Surg Case Rep 2023; 109:108633. [PMID: 37557035 PMCID: PMC10424209 DOI: 10.1016/j.ijscr.2023.108633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Mucosal associated lymphoid tissue (MALT) lymphomas are a type of extranodal indolent lymphoma. They appear in areas ordinarily devoid of lymphoid tissues and are frequently preceded by chronic antigenic stimulation. Primary MALT lymphoma is an extremely rare variant in the appendix. CASE PRESENTATION A 22-year-old man presented with recurrent abdominal pain of three months. CT scan of the abdomen showed appendiceal wall thickening with ileo-colic lymphadenopathy. The patient was managed with right hemicolectomy and the histopathological examination showed MALT lymphoma. CLINICAL DISCUSSION MALT lymphomas of the appendix are extremely rare. Chronic appendicitis is an uncommon but possible clinical presentation. Although imaging techniques are essential for making a diagnosis, histological analysis is what leads to a final diagnosis. While there are no specific recommendations for treating appendiceal MALTomas, prior case reports indicate that appendectomy and surveillance may be sufficient. CONCLUSION Primary MALT lymphoma is extremely uncommon in the appendix. It is indolent in nature and can manifest clinically as chronic appendicitis. The management for localized disease is surgery or radiotherapy. The prognosis is excellent regardless of the initial treatment modality.
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Affiliation(s)
- Tilahun H Nureta
- Jimma University College of Public Health and Medical Sciences, Department of Surgery, Ethiopia; Jimma University College of Public Health and Medical Sciences, Department of Surgery, GI Oncology Surgery Unit, Ethiopia
| | - Wongel T Shale
- Jimma University College of Public Health and Medical Sciences, Department of Surgery, Ethiopia.
| | - Mohammed A Abadura
- Jimma University College of Public Health and Medical Sciences, Department of Surgery, Ethiopia
| | - Fayera A Guluju
- Jimma University College of Public Health and Medical Sciences, Department of Surgery, Ethiopia
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Burchard PR, Thomay AA. Appendiceal intussusception in the setting of ulcerative colitis. J Surg Case Rep 2018; 2018:rjy044. [PMID: 29644035 PMCID: PMC5887521 DOI: 10.1093/jscr/rjy044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 03/23/2018] [Indexed: 12/14/2022] Open
Abstract
Appendiceal intussusception is a very rare condition with an estimated incidence of 0.01%. Most cases present in adults with chronic waxing and waning of symptoms over a period of weeks to months. We report a case of a 39-year-old Caucasian female with a 5-week history of worsening right-sided abdominal pain. Computed tomography revealed cecal thickening without visualization of the appendix. A colonoscopy revealed mild diffuse erythema and edema in the ascending colon as well as a mass within the lumen of the cecum. Biopsies of the colon were suggestive of mild ulcerative colitis (UC). The patient's symptoms continued and laparoscopic assisted ileocecectomy was performed revealing an inverted appendix protruding into the cecal lumen. The patient was discharged without any complications and began mesalamine therapy for her UC.
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Affiliation(s)
- Paul R Burchard
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Alan A Thomay
- West Virginia University School of Medicine, Morgantown, WV, USA
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Sandlund JT, Perkins SL. Uncommon non-Hodgkin lymphomas of childhood: pathological diagnosis, clinical features and treatment approaches. Br J Haematol 2015; 169:631-46. [PMID: 25851546 DOI: 10.1111/bjh.13359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
We provide a review of the pathological and clinical features for uncommon B-cell and T-cell lymphomas of childhood with a specific focus on advances in treatment approaches and outcomes. There is clearly a need for prospective investigation of both the clinical and biological features of the uncommon non-Hodgkin lymphoma subtypes in childhood. These results should lead to more uniform and more effective treatment approaches.
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Affiliation(s)
- John T Sandlund
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN, USA
| | - Sherrie L Perkins
- Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT, USA
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Ghosal A, Acharyya S. A rare presentation of Hodgkin's lymphoma in a very young child, with involvement of the appendix. BMJ Case Rep 2014; 2014:bcr-2014-204027. [PMID: 25015165 DOI: 10.1136/bcr-2014-204027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Hodgkin's lymphoma involving the appendix in young children is an exceptionally rare disease. We report a case of a child less than 3 years who presented to us with gradual weight loss, progressive pallor and diffuse abdominal pain. The symptoms were preceded by a history of varicella infection about 6 months ago. The clinical progression was marked by intermittent episodes of acute abdominal pain and fever, mimicking acute intra-abdominal inflammatory process such as appendicitis. Investigations revealed that the child had direct Coomb's test positive haemolytic anaemia, raised platelet counts, lymphopenia and hypergammaglobulinaemia. The CT of the abdomen showed the presence of significant lymph nodes. Abdominal laparoscopy and biopsy of the lymph nodes showed mixed cellularity Hodgkin's lymphoma that also involved the appendix. Subsequent staging detected an advanced stage IV disease. The child was referred immediately to a specialised oncology centre for further management. Unfortunately he was lost in follow-up.
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Affiliation(s)
- Anirban Ghosal
- Department of Paediatrics, Calcutta Medical Research Institute, Kolkata, West Bengal, India
| | - Saugata Acharyya
- Department of Paediatrics, Calcutta Medical Research Institute, Kolkata, West Bengal, India
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Bergman K, Mones R, Matuozzi W. Idiopathic cecocolic intussusception in a 16-year-old boy. Pediatr Surg Int 2009; 25:819-21. [PMID: 19629499 DOI: 10.1007/s00383-009-2418-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2009] [Indexed: 11/29/2022]
Abstract
Intussusception is a relatively common problem requiring evaluation and treatment by pediatric surgeons and radiologists. While ileocolic and small bowel intussusceptions are frequently observed, cecocolic intussusception is a rare event, most commonly occurring as a result of a pathologic lead point. To our knowledge, this is the first reported case of cecocolic intussusception occurring without an identifiable pathologic lead point or intestinal infection.
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Affiliation(s)
- Kerry Bergman
- Division of Pediatric Surgery, The Goryeb Children's Center at Overlook Hospital, 99 Beauvoir Avenue, Summit, NJ 07901, USA.
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Intussusception of the appendix: comprehensive review of the literature. Am J Surg 2009; 198:122-8. [PMID: 19249733 DOI: 10.1016/j.amjsurg.2008.08.023] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2008] [Revised: 08/26/2008] [Accepted: 08/26/2008] [Indexed: 01/07/2023]
Abstract
BACKGROUND Intussusception of the appendix is a rare disease that constitutes a diagnostic challenge to the surgeon. The literature on this condition is limited to case reports. The demographics, presentation, and treatment remain debatable in the absence of a comprehensive review of the literature. DATA SOURCES This article reports a case of a 40-year-old woman who presented with intussusception of the appendix caused by endometriosis. A comprehensive review of the English literature in PubMed was performed. The trends in incidence, sex predilection, presentation, and treatment of appendiceal intussusception were derived based on the reports of 191 patients. COMMENTS The incidence was more common in adults (76%) than in children (24%). Female patients (72%) were 2 times more affected in adults than in children, whereas male patients (58%) seem to be more affected in the pediatric population. Intussusception of the appendix has most commonly a chronic presentation (63%). Endometriosis (33%) and inflammation (76%) were the most common pathologic findings in adults and children, respectively. Only 49% of patients were treated by simple appendectomy; 49% patients underwent partial colectomy; and 2% of patients had their appendixes endoscopically removed.
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Marte A, Sabatino MD, Cautiero P, Accardo M, Romano M, Parmeggiani P. Unexpected finding of laparoscopic appendectomy: appendix MALT lymphoma in children. Pediatr Surg Int 2008; 24:471-3. [PMID: 17628810 DOI: 10.1007/s00383-007-1957-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/18/2007] [Indexed: 10/23/2022]
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphomas comprise a group of indolent B-cell non-Hodgkin lymphomas (NHL), which are rare in pediatric age. The clinical presentation of MALT lymphomas varies according to the location of the lymphoma. We report on a case of MALT lymphoma involving the appendix in a 6-year-old girl. A 6-year-old girl was referred to our institution in May 2005 with a diagnosis of appendicitis. The abdominal ultrasound showed slight effusion in the pelvic fossa. The patient underwent laparoscopic appendectomy using the three-trocar technique. The appendix appeared moderately hyperaemic with slight enlargement of the two-thirds of the distal portion. The postoperative course was uneventful and the girl was discharged on day 1 without any complication. The morphological and immunohistochemical examination showed typical findings of low-grade MALT lymphoma (positivity for CD20, no immunostaing for CD5 and CD10, positivity for anti-lambda light chain and low positivity for Ki-67). Further extensive examinations (abdominal MRI, gastroscopy, colonscopy and capsule endoscopy of the ileum) revealed that the lymphoma was limited to the distal two-third of the appendix (stage IA) and was not associated with any specific infection. At a recent follow-up the patients appeared to be doing well. Appendiceal MALToma is a rather uncommon pathology and, to our knowledge, there is only one report of appendiceal intussusception associated with appendiceal maltoma. According to our experience, low-grade MALToma can be managed by simple appendectomy. The histological examination should be the rule whenever an appendectomy is performed in children.
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Affiliation(s)
- A Marte
- Department of Paediatrics, Paediatric Surgery, Second University of Naples, S. Pansini, 5. 80131 Naples, Italy.
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Tavakkoli H, Sadrkabir SM, Mahzouni P. Colonoscopic diagnosis of appendiceal intussusception in a patient with intermittent abdominal pain: A case report. World J Gastroenterol 2007; 13:4274-7. [PMID: 17696262 PMCID: PMC4250632 DOI: 10.3748/wjg.v13.i31.4274] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Intussusception of the appendix is a rare condition. Most cases are diagnosed during operation of the patients suspected to have appendicitis. In this report we present a seventy one year-old man with a history of periumbilical intermittent abdominal pain for several months. None of the paraclinical tests were useful for determining the diagnosis. Colonoscopy performed during the last episode of abdominal pain revealed the prolapsed appendix in the cecum and the patient was sent to the operating room. Macroscopic appearance of the appendix was normal and microscopic examination revealed follicular hyperplasia and acute focal appendicitis. Appendiceal intussusception should be considered in differential diagnosis of intermittent abdominal pain and colonoscopic diagnosis could be very important to avoid dangerous or unnecessary decision making.
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Affiliation(s)
- Hamid Tavakkoli
- Department of Gastroenterology, Alzahra Hospital, Isfahan University of Medical Sciences (IUMS), Poursina Hakim Research Institute, Isfahan, Iran.
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Seo HE, Lee JH, Park TI, Lee KS. Small Intestinal Mucosa Associated Lymphoid Tissue (MALT) Lymphoma in a Child Presenting with Recurrent Intussusception: A Case Report. THE KOREAN JOURNAL OF HEMATOLOGY 2007. [DOI: 10.5045/kjh.2007.42.4.419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hye-Eun Seo
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ji Hye Lee
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
| | - Tae In Park
- Department of Pathology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Kun Soo Lee
- Department of Pediatrics, Kyungpook National University School of Medicine, Daegu, Korea
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