Synchronous Colonic and Appendicial Adenocarcinoma

MD Anas Hani Al-Rifai, MD Lubna Zuhier AlKhatib, MD Raad Youssef Al Tahat,
MD Tasneem AL-Malahmeh, MD Mahmoud AL-Haj.

Corresponding Author: MD Anas Hani Al-Rifai,

Copy Right: © 2022 MD Anas Hani Al-Rifai, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received Date: July 19, 2022

Published Date: August 01, 2022

Abstract

Colon cancer has had an increasing incidence in the last years due to many factors including higher lifetime expectancy in the population and the improvement of the various diagnostic modalities as well as the availability of different imaging modalities that became more widely available in the hospitals. However this is not the case for appendicial tumors as their small caliber and their site makes the diagnosis overlooked, and most of the time found during histopathological exam.The combination of both pathologies in the same patient is even more rare, but still a possible event.

Introduction

Appendicial adenocarcinoma is rare, comprising no more than 6 % of all primary appendicial carcinomas , and mostly are only diagnosed histopathologially as the clinical and radiological pictures is similar to acute appendicitis. The synchronous occurrence of colonic and appendicial carcinoma , defined as diagnosing both in a period of 6 months , occurs at a rate of less than  1 % of all synchronous tumors, rendering  the case we present as an extreme rarity.

Case Report

This is a 71 year old male patient, not known to have any previous medical illness, nor has he undergone any previous operations, has arrived to the emergency casualty complaining of lower abdominal pain, vague in nature during the past month,worsening over time, associated with vomiting the day before presentation, which was nonbloody nonbilious.The last bowel motion was 2 days ago. There has been no significant weight loss, and no family history for malignancy.

Physical exam showed blood pressure of 122/75 pulse rate of 90 and temperature of 37 C, the abdomen was soft and lax with right lower quadrant tenderness on deep palpation.

Basic labs showed white count of 13000, hemoglobin of 10.1, platelet count of 215000 , sodium level was 138 potassium level was 5.0 and his creatinine measured 0.75.

CT of the abdomen withintravenous contrast was done:

The patient was admitted to the hospital and underwent right hemicolectomy, his histopathology (see below) result showed synchronous appendicial and colonic adenocarcinoma.

The hospitalization course was uneventful and the patient was discharged without complications.
 

Discussion

Appendicial tumors are rare and the diagnosis is usually made histopathologically; as an incidental finding. 80% of appendicial tumors are of neuroendocrine origin occurring synchronously at a rate pf 55% with other colonic tumors. Other appendicial tumors include mucoceles and adenocarcinoma. Both of which have an incidence rate of 5% among appendicial tumors. The incidence of synchronous tumors was found to be more intimately related to conditions of chronic colorectal inflammation namely ulcerative colitis. Recent studies advocate going for incidental appendectomy in colorectal oncological surgeries as the rate of occurrence of synchronous tumors; although rare, is still possible, additionally those patients have a lifetime risk of acute appendicitis of 7% and will be of course more challenging technically in such patients.

Synchronous tumors are defined as those occurring in a period of  no more than 6 months and in case of colorectal and appendicial adenocarcinoma this Is an extreme rarity; according to literature less than 40 cases were identified, and that was mostly a post-operativediagnoses. The use of imaging is vital in staging and looking for other gross lesions, however post-operative upper and lower GI endoscopy is strongly recommended.

Conclusion
Appendicial adenocarcinomas are rare and even more unlikely to be synchronous with colorectal neoplasia however such finding should not tone down or even change oncological management

References

1. Synchronous Appendiceal Neoplasia of Ascending Colon Cancers: Three Case Reports And Review of the Literature; ?brahim Y?lmaz, Mustafa Taner Bostanc?, Mehmet Saydam, Ahmet Seki, O?uzhan Eyi.

2. Incidence of synchronous appendiceal neoplasm in patients with colorectal cancer and its clinical significance; Varut Lohsiriwat, Akkrarash Vongjirad and Darin Lohsiriwat.

3. Synchronous occurrence of colon and appendicial adenocarcinoma; Tomasz Goryn, Monica Meszka, Jacek Pawlak.

4. Synchronous primary adenocarcinoma of the appendix and colon: Case report and literature review; K.M.Al-Wiswasy, HamzehAl-Balas, Raith A.S.Al-Saffar,MahmoudAl-Balas.