Appendicitis: A rare case caused by metastatic prostate cancer

Abstract

Acute appendicitis is the most common surgical emergency in the United States. However, unusual causes of appendicitis need to be considered in patients with significant co-morbidities like our patient with history of prostate cancer. Cases of acute appendicitis due to metastatic prostate cancer are rare, with only a few cases reported in the literature. We report a case of a 72 year old male with a history of metastatic prostate cancer that caused acute appendicitis prompting surgical intervention.

Prostate cancer metastasis mimicking appendicitis—A rare but important differential diagnosis in PET/CT imaging

“…Only a small percentage of disseminated prostate cancer shows metastasis in the digestive system or the peritoneum, [1] and even more uncommonly carcinomatosis in relation to the appendix. In all previously reported cases of prostatic metastasis in the appendix, the patients presented with acute appendicitis and had an appendectomy performed from which metastasis was confirmed through histopathological assessment of the surgical specimen [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. Acute appendicitis is found to be the most frequent initial manifestation of appendiceal tumors, seen in 30%-50% of patients [15] .…”

“…Carcinomatosis in relation to the appendix is even more uncommon and not well described in the literature. To the best of our knowledge, only 11 cases of prostate cancer with a metastatic affinity for the appendiceal tissue have been reported worldwide, all located in the appendiceal lumen [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ].…”

An Unusual Case of Acute Appendicitis due to Metastatic Prostatic Adenocarcinoma

“…Secondary involvement of the appendix by a malignant tumor may occur by either lymphohematogenous spread, peritoneal dissemination [ 16 ], or direct extension [ 17 ]. Metastases to the appendix arise most commonly from primary colorectal [ 14 ] and ovarian tumors [ 17 ] but can also originate from primary tumors in virtually any organ, including the breast [ 18 ], lung [ 19 ], stomach [ 16 , 20 ], small bowel [ 21 ], pancreas [ 22 ], liver [ 23 ], endometrium [ 24 ], and the prostate gland [ 4 ]. Up to 97% of patients with appendiceal neoplasms have a preoperative diagnosis of acute appendicitis [ 13 ].…”

“…Metastatic neoplasms are an important cause of acute appendicitis in older adults. The occurrence of acute appendicitis in a patient with an abdominopelvic malignancy, especially when treatment-resistant, should prompt consideration of secondary spread of the neoplasm to the appendix [ 4 ].…”

Metastatic prostate adenocarcinoma and high-grade appendiceal mucinous neoplasm mimicking acute appendicitis in a post-radiation therapy patient

“…10 There have been case reports of metastatic prostate cancer Metastatic prostate adenocarcinoma and high-grade appendiceal mucinous neoplasm mimicking acute appendicitis in a post-radiation therapy patient presenting as acute appendicitis; however, it is an extremely uncommon occurrence with only 1%-2% of metastatic prostate cancer presenting as acute appendicitis. [11][12][13][14] Acute appendicitis is the most common surgical emergency of the abdomen in the United States, with a lifetime incidence of 8.6% in men and 6.7% in women. Although currently uncertain, the pathophysiology of acute appendicitis has been hypothesized to involve obstruction of the appendiceal lumen, resulting in ischemia and secondary bacterial infection of the appendiceal wall.…”