Prymary Colonic Type Adenocarcinoma of the Cecal Appendix: A Rare Cause of Conversion in Laparoscopic Appendectomy.

Alexander Ramirez Valderrama, MD, Armando Castro, MD FACS. New York Hospital Queens

Appendix tumors are unusual, accounting for 0.4% of all of the gastrointestinal tract malignancies. Approximately 66% of all appendix tumors are carcinoid tumors; mucinous cystadenocarcinoma is the most common non-carcinoid appendix tumor and accounts for about 20% of appendix cancer cases, colonic-type adenocarcinoma accounts for about 10% of appendix tumors and usually occurs at the base of the appendix. This type of tumor looks and behaves like the most common type of colorectal cancer. It often goes unnoticed, and diagnosis is frequently made during or after surgery for appendicitis.
We present a case of a 60-year-old female with abdominal pain for about 2 weeks, with right lower quadrant tenderness, without nauseas, vomiting, fever or chills. Initial work up shows elevated wbc (13.4), normal urinalysis, and abdominal CT scan with dilated appendix with wall thickening of the ileum with adjacent inflammation. Patient underwent to laparoscopic appendectomy, with findings of right lower quadrant phlegmon with difficult safe dissection, and the procedure was converted to open. During the procedure a pelvic collection of 20 cc of pus was drained, a distal ileocecectomy was performed and a JP drain was left on place. Patient had an uneventful recovery and was discharged home on postoperative day seven. Pathology report shows a well-differentiated adenocarcinoma at the appendix base with muscular infiltration to subserosa (T3) with 4 centimeters negative distal margin and eight lymph nodes all negative for malignancy. The case was presented on multidisciplinary tumor board conference and the decision was not perform any additional treatment and continues with a close follow up and colonoscopy.