Mucinous Adenocarcinoma of the Appendix. Case Report and Literature Review

Victoria Ivanukoff, DO, Demin Aleksandr, BS, Sharique Nazir, MD

LUTHERAN MEDICAL CENTER

Introduction
Appendicular carcinoma is a rare occurrence in the world of gastrointestinal tumors which comprises approximately 0.0-1.4% of appendectomies. In the 1990’s Connor etc. reported that out of almost eight thousand cases of appendectomies around 0.5% showed neoplastic features of which carcinoid tumor was predominant (57%). Recently a closer look utilizing the SEER database by Turaga, etc. showed that mucinous adenocarcinoma has the highest prevalence at 37% followed closely colonic-type adenocarcinoma at 27%, adenocarcinoid at 19% and malignant carcinoid at 11%, lowest rate attributed to signet ring type at 6%. The 5-year survival rate for mucinous adenocarcinoma is only 58%. These neoplasms are rare entities that need to be explored further to get a better understanding of the progression and treatment of this disease.

Case description
A 74-year-old male with multiple medical problems presented to the hospital for scheduled elective resection of pelvic mass. During the work up a CT scan of the abdomen and pelvis showed a mass in the right lower quadrant. There was not a clear distinction to the origin of the mass. A colonoscopy was performed, visualizing to the base of the appendix, which did not show any evidence of a mass. The patient was taken to the operating room where upon entering the abdomen a huge mass was identified at the ileocecal junction. The mass was non-adherent to the surrounding structures. A Right hemicolectomy was performed. Pathology reported a mucinous adenocarcinoma of the appendix measuring 22x15x11cm in size.

Discussion
Mucinous adenocarcinoma of the appendix falls into the category of epithelial tumors. There is an overwhelming range of pathologic entities that fall into this category. When it comes to the mucinous type there exists an undefined distinction when trying to classify these tumors. Nonetheless mucinous neoplasm shows a pathological spectrum of malignant potential. It is an aggressive tumor of mucinous origin, which historically has been described in association with its unique feature of Pseudomyxoma peritonei. In this individual despite the large size of the tumor the pathology report showing local containment of the tumor, with-out luminal penetration and absence of macroscopic metastasis to the peritoneum.

Session: Poster Presentation

Program Number: P115