Acute appendicitis as the first presentation of appendiceal metastasis of gastric cancer—report of a rare case

Abstract

Metastatic tumors of the appendix is a rare entity, whereas only limited data involving metastasis arising from gastric cancer has been reported. Herein, the case of gastric adenocarcinoma metastasis presenting as acute appendicitis is reported. A 53-year-old male, with a history of subtotal gastrectomy due to gastric adenocarcinoma 3 years before, was referred to the Emergency Department with symptoms of acute appendicitis. While this condition was confirmed intraoperatively, histology examination and comparison with the previously excised gastric specimen indicated that metastasis of gastric adenocarcinoma to the appendix was present. Metastatic appendiceal carcinoma arising from the stomach is an extremely rare condition, associated with poor prognosis. Aggressive treatment of the solitary lesion may present favorable results.

Missed Gastric Cancer Metastasis to the Appendix: Case Report and Literature Review

“…Common sites for distant metastases include liver, peritoneum, lungs, adrenal glands, and ovaries [4,7]. Metastasis of gastric cancer to the appendix is an extremely rare condition with only a few cases reported in the literature [3][4][5][6][7][8]. Table 1 summarizes the data from these cases.…”

“…Appendiceal metastasis can remain asymptomatic until diagnosed incidentally by imaging or colonoscopy [6,7]. However, acute appendicitis is the most common presentation in the cases reported in the literature [3][4][5]8]. The hypothesized mechanism attributes this to the attachment of metastatic cancer cells to the serosa and their infiltration through the A B Figure 2.…”

“…Despite the general decline in the incidence of gastric cancer and the advances in management, it remains one of the most common malignancies and a leading cause of morbidity and mortality worldwide [1,2]. Metastasis of gastric cancer to the appendix is an extremely rare condition, with only a few cases reported in the literature [3][4][5][6][7][8]. In most reported cases, the appendiceal metastasis presents with symptoms of acute appendicitis.…”

Metastatic Gastric Carcinoma Presenting as Acute Appendicitis

“…Metastatic disease to the appendix is sparsely reported in the literature with common primary sites usually being the gastrointestinal and urogenital tracts, breast, lung, and the gallbladder [1,[3][4][5][6]. Metastatic involvement of the appendix by primary gastric tumor was first described in 1951 by Goldfarb and till date, only a limited number of cases have been reported [1][2][3][4]. The most common reported presentation is the development of acute appendicitis and associated peritonism, the same as in our case.…”

“…Metastatic disease to the appendix is a rare entity, the first presentation of which is usually acute appendicitis. Contrast-enhanced computed tomography (CT) is the modality of choice and usually reveals signs of appendiceal inflammation with a dilated caliber of the appendix, luminal obliteration by fluid, peri-appendiceal inflammatory changes as well as free and loculated fluid collections [1][2][3].…”