2 in 1: Which one to remove?
Synchronous primary appendiceal tumor in colorectal cancer is very rare. Unexpected appendicular neoplasm diagnose intraoperatively pose a management dilemma. Case Summary: This is a 68 years old gentleman with underlying diabetes, hypertension and history of stroke 3 years ago with right hemip...
| Main Authors: | , , , |
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| Format: | Conference or Workshop Item |
| Language: | English English |
| Published: |
2015
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/58386/ http://irep.iium.edu.my/58386/ http://irep.iium.edu.my/58386/13/58386-abstract.pdf http://irep.iium.edu.my/58386/1/poster%202%20in%201.pdf |
| Summary: | Synchronous primary appendiceal tumor in colorectal cancer is very rare. Unexpected
appendicular neoplasm diagnose intraoperatively pose a management
dilemma.
Case Summary:
This is a 68 years old gentleman with underlying diabetes, hypertension and history of
stroke 3 years ago with right hemiplegia presented with per rectal bleeding for 2 weeks.
Colonoscopy found clinically obstructing tumor at rectosigmoid junction and biopsy of
the tumor came back as moderately differentiated adenocarcinoma. CT scan for staging
showed no distant metastasis. After discussing option with family, we decided to proceed
with surgery.
Intraoperatively, we found a huge rectosigmoid tumor with multiple mucinous cysts
around it. We also found a bulky appendix (1.5cm) with healthy base. We did appendicectomy,
resected the rectosigmoid tumor with good oncologic margin and brought out
the descending colon as stoma. He recovered and discharged well.
Surprisingly, the rectosigmoid tumor was moderately differentiated adenocarcinoma (not
otherwise specific) with good surgical margin and staging as pT2N0Mx. The appendix’s
histology reported as mucinous adenocarcinoma with involved surgical margin and presence
of metastatic tumor deposit on the pericolic fat and serosal layer of the rectosigmoid
specimen. The appendiceal tumor staging was pT4Nx M1. The family was not
keen for another surgery so we had a close follow-up for recurrence and oncology referral
for chemoradiation therapy |
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