Metastasis of esophageal small cell carcinoma to the appendix: A case report and literature review

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.

Endometriosis of the Appendix: When Appendicitis Is Less Than Straightforward

We present a case report of a 49-year-old female with a history of ulcerative colitis who originally presented to the general surgery clinic after an incidental finding on computed tomography was concerning for a dilated, fluid-filled appendix. She ultimately underwent a laparoscopic appendectomy. The pathology returned consistent with early acute appendicitis, with endometrial tissue along the outer wall of the appendix. We then performed a literature review regarding appendiceal masses and the occurrence of endometriomas and/or endometriosis of the appendix. A PubMed search was performed using the key words of appendix and appendicitis and endometrioma. Specific articles were examined mentioning the occurrence of endometriomas of the appendix and isolated endometriosis of the appendix. Between 2% and 6% of cases of appendicitis present due to an appendiceal mass, usually an inflammatory phlegmon. A variety of other causes, including primary malignancy, secondary malignancy, and combinations of pathologies, may lead to the eventual removal of the appendix. Specifically, endometriosis of the appendix is reported in less than 1% of females on post-appendectomy pathologic analysis. Although specific symptoms may guide a provider, there are few distinguishing symptoms that would point a provider toward a different etiology, to include malignancy, for appendicitis. Further information is needed to determine when a patient has an increased risk for an underlying pathology when presenting with appendicitis. This information will help drive continued treatment and lead to improved screening for appendiceal masses.

Rapidly Extensive Recurrence of Esophageal Neuroendocrine Carcinoma After Complete Pathologic Response to Definitive Chemoradiation

Primary esophageal neuroendocrine carcinoma is a rare, aggressive malignancy lacking evidence-based treatment guidelines. The timing and nature of relapse after successful treatment of locoregional disease are not well characterized. We report a patient lacking risk factors for esophageal cancer who rapidly developed extensive disease recurrence 4 months after achieving complete pathologic response to nonsurgical treatment. Although optimal survival for early stage nonmetastatic disease is achieved by esophagectomy with adjuvant therapy, definitive chemotherapy is also appropriate for late stage nonmetastatic patients. There are presently no protocols for maintenance therapy. We highlight complex treatment considerations for this rare malignancy.