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Aoun R, Akel R, Kassar S, Mouawad C, Dahboul H, Chakhtoura G, Noun R, Osseis M. Acute Appendicitis Caused by Metastasis from Other Organs: A Systematic Review. J Gastrointest Cancer 2024; 55:143-152. [PMID: 37976003 DOI: 10.1007/s12029-023-00986-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
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.
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Affiliation(s)
- Rany Aoun
- Department of Digestive Surgery, Hotel Dieu de France Hospital, University Saint Joseph Medical School, Beirut, Lebanon.
| | - Rhea Akel
- Department of Radiology, Hotel Dieu de France Hospital, University Saint Joseph Medical School, Beirut, Lebanon
| | - Serge Kassar
- Department of Digestive Surgery, Hotel Dieu de France Hospital, University Saint Joseph Medical School, Beirut, Lebanon
| | - Christian Mouawad
- Department of Digestive Surgery, Hotel Dieu de France Hospital, University Saint Joseph Medical School, Beirut, Lebanon
| | - Houssam Dahboul
- Department of Digestive Surgery, Hotel Dieu de France Hospital, University Saint Joseph Medical School, Beirut, Lebanon
| | - Ghassan Chakhtoura
- Department of Digestive Surgery, Hotel Dieu de France Hospital, University Saint Joseph Medical School, Beirut, Lebanon
| | - Roger Noun
- Department of Digestive Surgery, Hotel Dieu de France Hospital, University Saint Joseph Medical School, Beirut, Lebanon
| | - Michael Osseis
- Department of Digestive Surgery, Hotel Dieu de France Hospital, University Saint Joseph Medical School, Beirut, Lebanon
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Callum J, Paik J, Hibbert M. Lung cancer presenting as an acute appendicitis. Respirol Case Rep 2021; 9:e00703. [PMID: 33510895 PMCID: PMC7815438 DOI: 10.1002/rcr2.703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 11/11/2022] Open
Abstract
Appendiceal metastasis is a rare complication of primary lung cancer and an extremely rare cause of appendicitis. We present the case of a 62-year-old male who presented with right lower quadrant abdominal pain which revealed not only appendiceal inflammation, but also a lung mass and mediastinal lymph nodes. He then proceeded to appendicectomy and two days post-operatively an endobronchial ultrasound-guided biopsy. His mediastinal lymph node biopsy revealed a lung adenocarcinoma and his subsequent appendiceal immunohistochemistry revealed the same staining pattern for thyroid transcription factor 1 (TTF-1) and cytokeratin 7 (CK-7). We conducted a literature review which revealed 12 previous case reports of lung metastasis to the appendix causing appendicitis including three patients in whom appendicitis was the presenting complaint leading to lung cancer diagnosis. This case highlights the diversity of presentations for patients suffering from metastatic lung cancer.
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Affiliation(s)
- Jack Callum
- Respiratory DepartmentRoyal North Shore HospitalSydneyNSWAustralia
- Faculty of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Julie Paik
- Respiratory DepartmentRoyal North Shore HospitalSydneyNSWAustralia
| | - Michael Hibbert
- Respiratory DepartmentRoyal North Shore HospitalSydneyNSWAustralia
- Faculty of MedicineUniversity of SydneySydneyNSWAustralia
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3
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Kimura Y, Machimoto T, Yasukawa D, Aisu Y, Hori T. Acute appendicitis caused by metastatic adenocarcinoma from the lung: a case report. Surg Case Rep 2018; 4:59. [PMID: 29904902 PMCID: PMC6003897 DOI: 10.1186/s40792-018-0467-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/05/2018] [Indexed: 12/18/2022] Open
Abstract
Background Appendiceal metastasis from lung cancer is rare. However, it often causes acute appendicitis that requires emergency surgery. We herein report a thought-provoking case of appendiceal metastasis from lung cancer. Case presentation A 71-year-old man was diagnosed with advanced lung cancer with multiple metastases and underwent chemotherapy. One month later, he developed acute appendicitis, and laparoscopic appendectomy was promptly performed. A swollen appendix and pus collection were observed during surgery. Histological analysis revealed an invasive adenocarcinoma in the appendix that infiltrated the mucosal, submucosal, and muscular layers. Positive immunostaining of thyroid transcription factor 1 indicated appendiceal metastasis of pulmonary adenocarcinoma, not a primary appendiceal malignancy. The postoperative course was uneventful, and the patient’s pulmonary internist resumed continuous chemotherapy after surgery. Conclusions Although appendiceal metastasis from pulmonary adenocarcinoma is rare, it often results in acute appendicitis. Optimal therapy including emergency surgery should be performed without hesitation so that chemotherapy can be resumed as soon as possible.
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Affiliation(s)
- Yusuke Kimura
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.
| | - Takafumi Machimoto
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Daiki Yasukawa
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Yuki Aisu
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Tomohide Hori
- Department of Digestive Surgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.
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Wang Q, Zhou T, Sun H, Li B. Metastasis of esophageal small cell carcinoma to the appendix: A case report and literature review. Cancer Biol Ther 2017; 18:666-669. [PMID: 28886266 PMCID: PMC5663406 DOI: 10.1080/15384047.2017.1360447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Primary small cell carcinoma (SCC) of the esophagus is characterized by high malignancy with a tendency to metastasize early through lymph and blood circulation. Metastasis of esophageal SCC frequently occurs to distant organs such as liver and lung. However, few cases of appendiceal metastasis have been reported. This paper first presents a pathologically confirmed case with metastasis of esophageal SCC to the appendix. This particular case highlights the importance of pathological diagnosis and provides new evidence of appendiceal metastasis from esophageal SCC.
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Affiliation(s)
- Qianrong Wang
- a School of Medicine and Life Sciences , University of Jinan-Shandong Academy of Medical Sciences , Jinan , Shandong province , China.,b Department of Radiation Oncology , Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences , Jinan , Shandong province , China
| | - Tao Zhou
- b Department of Radiation Oncology , Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences , Jinan , Shandong province , China
| | - Hongfu Sun
- b Department of Radiation Oncology , Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences , Jinan , Shandong province , China
| | - Baosheng Li
- b Department of Radiation Oncology , Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences , Jinan , Shandong province , China
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5
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Acute appendicitis secondary to metastatic small cell lung cancer incidentally found on F-18 FDG PET/CT. Clin Nucl Med 2012; 37:e19-21. [PMID: 22157053 DOI: 10.1097/rlu.0b013e3182336222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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An unexpected abdominal 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) in a patient with limited stage small cell lung cancer. J Thorac Oncol 2008; 3:174-6. [PMID: 18303440 DOI: 10.1097/jto.0b013e318162336b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We report the case of an unexpected 18F-fluorodeoxyglucose-avid lesion in the right lower abdomen in a patient with otherwise "very limited" (T1N0) small cell lung cancer (SCLC). Additional imaging and endoscopic studies showed no abnormality. The patient was treated for presumed very limited disease SCLC, with resection, adjuvant chemotherapy, and prophylactic brain irradiation. Follow-up fusion positron emission tomography-computed tomography revealed an unusual SCLC complication.
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8
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Shin DW, Choi MH, Park SS, Park SW, Kim KU, Jang AS, Park CS, Lim CW, Ko ES, Paik SH, Kim DJ. A Case of Extensive Stage Small Cell Lung Cancer Presenting as an Acute Appendicitis with Perforation. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.65.3.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Dong Won Shin
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Moon Han Choi
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Seung Sik Park
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Sung Woo Park
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Ki Up Kim
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - An Soo Jang
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Choon-Sik Park
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Cheol Wan Lim
- Department of Surgery, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Eun Suk Ko
- Department of Pathology, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Sang Hyun Paik
- Department of Radiology, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
| | - Do Jin Kim
- Department of Internal Medicine, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon, Korea
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9
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Yang CJ, Hwang JJ, Kang WY, Chong IW, Wang TH, Sheu CC, Tsai JR, Huang MS. Gastro-intestinal metastasis of primary lung carcinoma: clinical presentations and outcome. Lung Cancer 2006; 54:319-23. [PMID: 17010474 DOI: 10.1016/j.lungcan.2006.08.007] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Revised: 08/17/2006] [Accepted: 08/22/2006] [Indexed: 02/08/2023]
Abstract
Symptomatic gastro-intestinal (GI) metastasis in lung carcinomas is extremely rare and only a few case reports have been published. Here we review all of the cases of lung cancer from January 2003 to April 2005 in a tertiary teaching hospital in Taiwan. A total of six patients (1.77%, 6/339) with primary lung cancer demonstrated symptomatic gastro-intestinal metastasis. Three patients had squamous cell carcinoma, one had adenocarcinoma, and two had small cell carcinoma. Three patients with gastric metastasis were diagnosed via gastro-endoscopy while one with cecal involvement was diagnosed via colon fiberscopy. Two patients with small bowel perforation and intussusception were diagnosed via laparotomy. We presented these rare cases and made a review of the literature.
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Affiliation(s)
- Chih-Jen Yang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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10
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Lin CY, Huang JS, Jwo SC, Chen HY. Recurrent gastric adenocarcinoma presenting as acute appendicitis: a case report. Int J Clin Pract 2005:89-91. [PMID: 15875636 DOI: 10.1111/j.1368-504x.2005.00360.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We report a case of acute appendicitis due to recurrent metastatic gastric adenocarcinoma involving only appendix, without the evidence of abdominal carcinomatosis 2 years after initial diagnosis of the primary gastric lesion. This case, in contrast to other previously reported cases that carried a dismal prognosis, had survived without tumour recurrent for more than 1 year after appendectomy, while this report was made.
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Affiliation(s)
- C Y Lin
- Department of Pathology, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC
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11
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Abstract
A variety of miscellaneous conditions affect the appendix, both as incidental findings and as causes of clinical signs and symptoms that often mimic appendicitis. Congenital abnormalities of the appendix are rare; the two most commonly reported are congenital absence and appendiceal duplication. Diverticular disease may be an incidental finding, but when inflamed, can be clinically confused with appendicitis. Endometriosis of the appendix, which usually occurs in the setting of generalized gastrointestinal endometriosis, often presents as acute appendicitis, but may present as intussusception, lower intestinal bleeding, and, particularly during pregnancy, perforation. Peritoneal endosalpingiosis often involves the appendiceal serosa and occasionally the wall but has no clinical manifestations in contrast to endometriosis. Vasculitis may be either isolated to the appendix or part of a systemic vasculitis, most often polyarteritis nodosa. Neural proliferations of the appendix include lesions associated with von Recklinghausen's disease, as well as mucosal and axial neuromas that are theorized to progress to fibrous obliteration of the appendix. Mesenchymal tumors of the appendix are most often of smooth muscle type, usually leiomyoma but rarely leiomyosarcoma; nonmyogenic neoplasms such as gastrointestinal stromal tumor, granular cell tumor, Kaposi's sarcoma, and miscellaneous other curiosities occur rarely. Lymphoma affects the appendix exceptionally; in children, Burkitt lymphoma is most common whereas in adults, large cell lymphomas and low grade B-cell lymphomas predominate. Secondary involvement of the appendix by leukemia has been reported. Secondary involvement of the appendix by carcinomas of the female genital tract, particularly ovary, and diverse other sites are in aggregate common but only rarely a clinical or pathological difficulty. Occasionally, however, appendiceal neoplasia that is secondary from another site may dominate the clinical picture and lead to potential pathologic misdiagnosis as primary appendiceal disease.
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Affiliation(s)
- Joseph Misdraji
- James Homer Wright Pathology Laboratories, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
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12
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Filik L, Ozdal-Kuran S, Cicek B, Zengin N, Ozyilkan O, Sahin B. Appendicular metastasis from pancreatic adenocarcinoma. ACTA ACUST UNITED AC 2004; 34:55-8. [PMID: 15235136 DOI: 10.1385/ijgc:34:1:55] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We present a 78-yr-old man with appendicular metastases from pancreatic adenocarcinoma. Barium enema X-ray showed incomplete filling of a distended appendix in a patient with abdominal discomfort. Colonoscopic evaluation revealed firm nodules in appendicular orifice. Histopathological examination of the nodule in the appendix revealed a metastatic adenocarcinoma. Abdominal computed tomography showed a low-density mass in the body of the pancreas. Endoscopic ultrasonography disclosed a hypoechoic mass in the body of the pancreas. Appendicular metastasis is extremely rare. To our knowledge, this is the second case of adenocarcinoma of the pancreas metastatic to the appendix in English language literature. A brief review of relevant literature is presented.
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Affiliation(s)
- Levent Filik
- Turkiye Yuksek Ihtisas Hospital, Gastroenterology Clinic, Ankara, Turkey.
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13
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Goldstein EB, Savel RH, Walter KL, Rankin LF, Satheesan R, Lehman HE, Steiner H. Extensive Stage Small Cell Lung Cancer Presenting as an Acute Perforated Appendix: Case Report and Review of the Literature. Am Surg 2004. [DOI: 10.1177/000313480407000810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Malignancies of the appendix are uncommon; a small subset of these lesions are actually metastatic cancers. In some rare cases, these lesions can cause obstruction, appendicitis, and perforation. M.K. is a 54-year-old man who presented to our institution with a 1-day history of right lower quadrant pain and a past medical history significant only for a 75-pack-year smoking history. CT scan revealed a perforated appendix, and the patient was taken to the operating room where a gangrenous appendix was removed uneventfully. Two days post-procedure, the patient was found to have acute mental status changes, requiring intubation and transfer to the surgical intensive care unit. As part of a workup, a CT scan of the head revealed multiple lesions compatible with metastatic disease. At that point, the pathology from the appendix came back as small cell lung cancer. Chest CT revealed hilar adenopathy and a hilar mass. The patient received emergent whole-brain irradiation therapy with improvement in his mental status, allowing him to be extubated and discharged from the hospital within 10 days of admission. Surgeons should remember that an underlying oncologic process may be the etiology of appendicitis in a small but important subgroup of patients.
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Affiliation(s)
- Evan B. Goldstein
- From the Department of Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Richard H. Savel
- From the Department of Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Kristin L. Walter
- From the Department of Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Linda F. Rankin
- From the Department of Surgery, Maimonides Medical Center, Brooklyn, New York
| | | | - Herbert E. Lehman
- From the Department of Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Henry Steiner
- From the Department of Surgery, Maimonides Medical Center, Brooklyn, New York
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Ramia JM, Alcalde J, Dhimes P, Cubedo R. Metastasis from choriocarcinoma of the mediastinum producing acute appendicitis. Dig Dis Sci 1998; 43:332-4. [PMID: 9512126 DOI: 10.1023/a:1018806422490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- J M Ramia
- Department of Surgery, Hospital 12 de Octubre, Madrid, Spain
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González-Vela MC, García-Valtuille AI, Fernández FA, Val-Bernal JF. Metastasis from small cell carcinoma of the lung producing acute appendicitis. Pathol Int 1996; 46:216-20. [PMID: 10846573 DOI: 10.1111/j.1440-1827.1996.tb03601.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A case of acute gangrenous appendicitis with perforation caused by metastatic small cell carcinoma of the lung in a 65 year old man is reported. The manifestation of appendicitis occurred more than 4 years after the diagnosis of the bronchogenic carcinoma. With longer survival of patients with disseminated tumors it is probable that new manifestations of those malignancies will be discovered. Acute appendicitis due to metastasis from a distant neoplasm should be considered in the differential diagnosis of right lower abdominal pain in the oncology patient.
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Affiliation(s)
- M C González-Vela
- Department of Anatomical Pathology, Marqués de Valdecilla University Hospital, Faculty of Medicine, University of Cantabria, Santander, Spain
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Ende DA, Robinson G, Moulton J. Metastasis-induced perforated appendicitis: an acute abdomen of rare aetiology. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1995; 65:62-3. [PMID: 7818428 DOI: 10.1111/j.1445-2197.1995.tb01753.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- D A Ende
- Repatriation General Hospital, Sydney, New South Wales, Australia
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