Adenocarcinoma of the Appendix, a Differential Diagnosis in Patients with Abdominal Pain. Case Report
Abstract
Introduction. Acute abdominal pain is a frequent cause of consultation to emergency services. Its incidence is about 5%, of which 10%-25% of patients require surgical treatment. Primary appendiceal neoplasms are infrequent. They currently represent 1% of malignant neoplasms of gastrointestinal origin. They are predominant in women and must be suspected in patients with risk factors. The objective is to understand the importance of timely diagnosis in approaching patients with acute abdominal pain. Case Presentation. A woman with clinical condition of 5 days of abdominal pain. Marked cystic dilation of the cecal appendix with linear and nodular calcifications on its wall and interior found in a tomography of the abdomen. Intraoperatively, a right hemicolectomy was performed with a histological result of mucinous neoplasm of the appendix (serrated adenoma) with loss of the muscularis mucosae, classifying it as a low grade adenocarcinoma. Discussion. Appendiceal tumors represent 1% of malignant neoplasms of gastrointestinal origin, with an incidental finding (0.7-1.4%) in appendectomy procedures. The diagnosis is histopathological, and prognosis is related to its classification. It is important to know, identify and suspect this pathology due to its infrequency, which can improve the patient's prognosis. Conclusion. Appendiceal tumors are infrequent and should be included in the group of pathologies that cause acute abdominal pain.
References
Gans SL, Pols MA, Stoker J, Boermeester MA. Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain. Dig Surg [Internet]. 2015;32:23-31. doi: https://doi.org/10.1159/000371583
McNamara R, Dean AJ. Approach to Acute Abdominal Pain. Emerg Med Clin North Am [Internet]. 2011;29(2):159-173. doi: https://doi.org/10.1016/j.emc.2011.01.013
Bejarano M, Gallego CX, Gómez JR. Frecuencia de abdomen agudo quirúrgico en pacientes que consultan al servicio de urgencias. Rev Colomb Cir [Internet]. 2011;26:33-41. Recuperado a partir de: https://www.revistacirugia.org/index.php/cirugia/article/view/149
Bolmers MDM, de Jonge J, van Rossem CC, van Geloven AAW, Bemelman WA. Appendicular neoplasms and consequences in patients undergoing surgery for suspected acute appendicitis. Int J Colorectal Dis [Internet]. 2020;35(11):2065-2071. doi: https://doi.org/10.1007/s00384-020-03673-0
Fulle A, Castillo R, Moreno P, Orellana M, Cabreras M, Briones P, et al. Análisis de casos de adenocarcinoma apendicular y su manejo en una serie de 10 años en el Hospital Doctor Sótero del Río. Rev Chil Cir [Internet]. 2017;69(4):297-301. doi: https://doi.org/10.1016/j.rchic.2016.12.002
Ruoff C, Hanna L, Zhi W, Shahzad G, Gotlieb V, Saif MW. Cancers of the Appendix: Review of the Literatures. ISRN Oncology [Internet]. 2011;ArticleID728579,6pp. doi: https://doi.org/10.5402/2011/728579
Tirumani SH, Fraser-Hill M, Auer R, Shabana W, Walsh C, Lee F, et al. Mucinous neoplasms of the appendix: a current comprehensive clinicopathologic and imaging review. Cancer Imaging [Internet]. 2013;13(1):14-25. doi: https://doi.org/10.1102/1470-7330.2013.0003
Livingston EH, Woodward WA, Sarosi GA, Haley RW. Disconnect Between Incidence of Nonperforated and Perforated Appendicitis. Implications for Pathophysiology and Management. Annals of Surgery [Internet]. 2007;245(6):886-892. doi: https://doi.org/10.1097/01.sla.0000256391.05233.aa
Shaib WL, Assi R, Shamseddine A, Alese OB, Staley CIII, Memis B et al. Appendiceal Mucinous Neoplasms: Diagnosis and Management. The Oncologist [Internet]. 2017;22(9):1107-1116. doi: https://doi.org/10.1634/theoncologist.2017-0081
Pickhardt PJ, Levy AD, Rhormann CA J, Kende AI. Primary Neoplasms of the Appendix: Radiologic Spectrum of Disease with Pathologic Correlation. RadioGraphics [Internet]. 2003;23(3):645-662. doi: https://doi.org/10.1148/rg.233025134
Jann H, Roll S, Couvelard A, Hentic O, Pavel M, Müller-Nordhorn J, et al. Neuroendocrine tumors of midgut and hindgut origin: Tumor-node-metastasis classification determines clinical outcome. Cancer [Internet]. 2011;117(15):3332-3341. doi: https://doi.org/10.1002/cncr.25855
Butte JM, García-Huidobro MA, Torres J, Salinas M, Duarte I, Pinedo G, et al. Tumores del apéndice cecal. Análisis anatomoclínico y evaluación de la sobrevida alejada. Rev. Chil Cir [Internet]. 2007;59(3):217-222. doi: http://dx.doi.org/10.4067/S0718-40262007000300009
McCusker ME, Coté TR, Clegg LX, Sobin LH. Primary malignant neoplasms of the appendix: A population-based study from the surveillance, epidemiology and end-results program, 1973-1998. Cancer [Internet]. 2002;94(12):3307-3312. doi: https://doi.org/10.1002/cncr.10589
McGory ML, Maggard MA, Kang H, O'Connell JB, Ko CY. Malingnancies of the Appendix: Beyond Case Seirs Reports. Dis Colon Rectum [Internet]. 2005;48(12):2264-2271. doi: https://doi.org/10.1007/s10350-005-0196-4
Díaz-Rivera MC, Buitrago-Toro K, Gonzales P. Tumor carcinoide del apéndice cecal: cuando un hallazgo incidental modifica drásticamente el pronóstico y tratamiento del paciente. Rev Colomb Gastroenterol [Internet]. 2017;32(1):72-74. doi: https://doi.org/10.22516/25007440.133
Nagtegaal ID, Odze RD, Klimstra D, Paradis V, Rugge M, Schirmacher P, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology [Internet]. 2020;76(2):182-188. doi: https://doi.org/10.1111/his.13975
van Eeden S, Quaedvlieg P, Taal BG, Offerhaus GJA, Lamers C, van Velthuysen ML. Classification of low-grade neuroendocrine tumors of midgut and unknown origin. Hum Pathol [Internet]. 2002;33(11):1126-1132. doi: https://doi.org/10.1053/hupa.2002.129204
García-Norzagaray JC, Villalobos-López JA, Flores-Nájera H, Valle-Leal J, García-Torres CD. Primary lymphoma of the appendix: A case report and review of the literature. Rev Gastroenterol Méx [Internet]. 2019;84(2):254-257. doi: https://doi.org/10.1016/j.rgmxen.2018.07.003
Esquivel J, Elias D, Baratti D, Kusamura S, Deraco M. Consensus statement on the loco regional treatment of colorectal cancer with peritoneal dissemination. J Surg Oncol [Internet]. 2008;98(4):263-267. doi: https://doi.org/10.1002/jso.21053
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