A Rare Case of Ruptured Appendicitis Secondary to Metastatic Ovarian Cancer

Abstract

Unusual clinical course Background:Patients with advanced stage ovarian cancer typically have vague non-specific abdominal symptoms related to pelvic tumor, metastasis, and ascites. When these patients present with more acute abdominal pain, appendicitis is rarely considered. Acute appendicitis due to metastatic ovarian cancer has been sparsely documented in the medical literature; only twice, to our knowledge. Case Report:A 61-year-old woman with a 3-week history of abdominal pain, shortness of breath, and bloating was diagnosed with ovarian cancer after computed tomography (CT) demonstrated a large pelvic cystic and solid mass. Five weeks later she underwent an omental biopsy to determine cell type and potential upstaging of the ovarian cancer to stage IV, as other aggressive cancers such as breast cancer can also involve the pelvis/omentum. Seven hours after her biopsy, she presented with increasing abdominal pain. Post-biopsy complications such as hemorrhage or bowel perforation were initially suspected to be the cause of her abdominal pain. However, CT demonstrated ruptured appendicitis. The patient underwent an appendectomy and histopathologic examination of the specimen revealed infiltration by low-grade ovarian serous carcinoma. Conclusions:Given the low incidence of spontaneous acute appendicitis in this patient's age group, and the lack of any other clinical, surgical, or histopathological evidence to suggest another cause, metastatic disease was ruled to be the likely source of her acute appendicitis. Providers should be aware of appendicitis in a broad differential diagnosis and have a low threshold for ordering abdominal pelvis CT when advanced stage ovarian cancer patients present with acute abdominal pain.

Acute Appendicitis Secondary to Metastatic Malignancy - A Review of 78 Cases in Literature

“…Nineteen other eclectic cases of metastatic malignancy, non-primary appendiceal tumours causing acute appendicitis were identified [66]. There was one low-grade serous ovarian carcinoma metastasis [67] causing perforated appendicitis. The other cases included hepatocellular carcinoma [68], choriocarcinoma of the mediastinum [69] granular cell tumor [70] acute promyelocytic leukemia [71], nasopharyngeal carcinoma [72], non-seminomatous testicular cancer [73], testicular seminoma [74], inflammatory myofibroblastic tumour [75], two cases of Kaposi's sarcoma [76,77] a natural killer cell/ T cell lymphoma [78], two cases of appendiceal schwannoma [79,80], two cases of cholangiocarcinoma [81,82], a case of metastatic gallbladder carcinoma [83,84], and two cases of pancreatic adenocarcinoma [85,86].…”