Case Report

Primary Appendiceal Adenocarcinoma Presenting with Hematochezia due to the Invading Tumor in the Sigmoid Colon

Table 1

Summary of reported cases and our case of appendiceal tumors invading the sigmoid colon or rectum.

YearAuthorAge/sexChief complaintInvaded organColonoscopic findings at SC or rectumBiopsy at SC or rectumCT findingsPreoperative diagnosisSurgical procedure/postoperative therapyHistological type WHO 2010pTNM UICC 8thFollow-up

1975Andersson et al. [4]82/FConstipation, abdominal painSCn.m.n.m.n.m.n.m.Ap, SgANOSn.m.Dead (180 days)
1985Yamada et al. [5]#67/FAbdominal massSC, ileumn.m.n.m.n.m.CystomyxomaICR, closure of fistula/n.m.AMN or MAn.m.n.m.
1990Corder et al. [6]67
/M
Hematochezia, syncopeSCDevoid of mucosaGranulation tissuen.m.n.m.Ap, Sg, PC (en bloc)/no therapyLow-grade AMNn.m.n.m.
1993Kato et al. [7]#48/MIleus symptomsSC, bladderFistulan.m.A distended appendix filled with high-density substanceAppendiceal cancerICR, Sg, PC (en bloc)/ACMAT4bN1-2M1b (PMP)Alive (n.m.)
1997Ito et al. [8]#49/MIleus symptomsSC, ileumSubmucosal-tumor like lesionMAA mass connected with the vermiform appendix medial to the ileocecal partAppendiceal cancerICR, HAR (en bloc)/ACAMNT4b N0 M0Alive (1080 days)
1999Tanakaya et al. [9]#68/FHematochezia, abdominal painSCType 1 tumor (polypoid type)n.m.n.m.SC cancerTumorectomy, colostomy/no therapyAMN or MAT4b NX M1b (PMP)Dead (33 days)
2004Sano et al. [10]#89/FHematocheziaRSType 2 tumor (ulcerated type with clear margin)ANOSNo findings of metastasisRectal cancerICR, LAR, etc. (en bloc)/no therapyAMN or MA, partly ANOST4b N0 M0Alive (n.m.)
2007Kumon et al. [11]#80/FHematocheziaRSRough and red mucosa, stenosisANOSA rectal mass with heterogeneous enhancement continuous with appendixRectal cancerICR, AR (en bloc)/no therapyAMN or MAT4b N0 M1c (no. 251)Alive (150 days)
2009Murphy and Matar [12]38/MHematochezia, abdominal painSC, ileum, bladdern.m.n.m.A complex mass, arising in the lower abdomen, incorporating the caecum, small intestine, and sigmoid colonCrohn’s disease, SC, or ileal cancerRHC, Sg, PC (en bloc)/AC“Moderately differentiated, partly MA”T4b N0 M0Alive (300 days)
2009Stojanovic et al. [13]55/FHematocheziaSCExternal compression, tumor infiltrationn.m.Sigmoid colon infiltrated by hypodense irregular tumor mass connected to the end of the appendixAppendicular cancerLaparoscopic RHC, Sg (en bloc)/no therapyMAT4b N0 M0Alive (60 days)
2009Mori et al. [14]#58/FAbdominal discomfortSCElevated lesionGranulation tissueA 1 cm width dilated appendixAppendiceal cancerRHC, Sg/ACAMN or MAT4b N0 M0Alive (600 days)
2013Shibata et al. [15]#44/MHematochezia, diarrheaSCStenosisANOS or MAA pelvic tumor extended from the ileocecal part to the sigmoid colonSC cancer or appendiceal cancerBypass, sigmoidostomy/chemotherapy“Atypical, mucin-producing adenocarcinoma”T4b NX M1bDead (210 days)
2016Fitzgerald et al. [16]75/FHematocheziaRectumFingerlike/frond-like polypAdenomaA dilated appendix with its tip near the rectumn.m.Ap, AR (en bloc)/n.m.“Adenocarcinoma”T4b N0 M0n.m.
2016Hakim et al. [17]68/MAbdominal pain, constipationSC, cecumn.m.n.m.A dilated appendix with an 8 cm long, ovoid, periappendiceal mass containing a fistula to sigmoid colonn.m.Cecectomy, Ap, Sg, PC etc. (en bloc)/no therapyMAT4b N0 M0Alive (360 days)
2018Takahashi et al. [18]13/FHematochezia, abdominal painSC, uterus, ovaryn.m.n.m.A mass with fecalith in the pelvic and right lower abdominal cavityAcute appendicitisICR, Sg/AC“Primary appendiceal adenocarcinoma”T4b N0 M0Alive (1800 days)
2018Tokai et al. [19]#66/MPositive fecal
occult blood test
SCElevated lesionMAA sized cystic tumor adjacent to the sigmoid colon and cecumAppendiceal cancerICR, Sg, ileectomy (en bloc)/ACMAT4b N1 M0Alive (900 days)
Our case69/FHematochezia, anorexiaSCType 1 tumor (polypoid type)ANOSAn appendiceal mass at the distal part of appendix, involving sigmoid colonAppendiceal cancerICR, Sg (en bloc)/no therapyANOST4b N0 M0Alive (600 days)

AC: adjuvant chemotherapy; ANOS: adenocarcinoma not otherwise specified; AR: anterior resection; Ap: appendectomy; F: female; ICR: ileocecal resection; AMN: appendiceal mucinous neoplasm; M: male; MA: mucinous adenocarcinoma; n.m.: not mentioned; PC: partial cystectomy; PMP: pseudomyxoma peritonei; RHC: right hemicolectomy; RS: rectosigmoid junction; SC: sigmoid colon; Sg: sigmoidectomy; #: written in Japanese.