Intramucosal Carcinoma of the Appendix Arising from Traditional Serrated Adenoma

Abstract

Introduction. Serrated adenomas of the appendix are rare and usually found during appendectomy or autopsies. The preoperative diagnosis of these tumors is uncommon. This report describes a case of a sessile serrated adenoma located in the appendix diagnosed by a screening colonoscopy and successfully treated by laparoscopic removal. Presentation of Case. An 86-year-old woman underwent colonoscopy to investigate the cause of her diarrhea, weight loss, and anemia. During the colonoscopy, an expansive and vegetating mass of 1.5 cm in diameter was identified, protruding through the appendicular ostium with slightly lateral growth to the cecum. The patient was referred for laparoscopic surgical resection due to the location of the lesion, which did not allow its removal by colonoscopy. She underwent wedge removal of the cecum without complications and was discharged on the 4th postoperative day. Histopathological examination showed the presence of a sessile serrated adenoma with an intramucosal adenocarcinoma. The patient is currently well one year after surgery, without endoscopic signs of relapse. Conclusion. Despite serrated adenomas being a possibility rarely described in appendix it should be recognized and properly treated because it is presenting a higher risk of cancer.

Occult appendix pathology in patients undergoing colorectal cancer resection and prophylactic appendectomy

“…14 Although appendix serrated polyps are rare lesions, published series report an association of appendiceal serrated polyps with appendicitis and malignant progression. [15][16][17] Serrated polyps are precancerous lesions and differentiating them from hyperplastic polyps is clinically important. Rubio et al 16 previously warned about aggressiveness of serrated polyps, and Chezar et al 15 more recently published data suggesting that at least a subset of LAMNs may arise from a precursor serrated polyp.…”

Herida crónica en región inguinal derecha por adenoma serrado apendicular

“…Los pólipos serrados del apéndice son asintomáticos o presentan síntomas inespecíficos (25), esto explica por qué sus hallazgos son incidentales, siendo la forma más frecuente durante el estudio de especímenes de apéndices producto de apendicectomías por apendicitis aguda, debido a la oclusión de la luz apendicular por el tumor que predispone a la inflamación y perforación (26). Otras formas incluyen, masa abdominal palpable, ascitis, carcinomatosis y peritonitis por perforación como hallazgos incidentales durante la cirugía intraabdominal (25), como causante de intususcepción en el colon (27), como lesiones elevadas en el ciego visualizadas por colonoscopia (24) o durante la tomografía computarizada abdominal como en este caso, pero no se encontró en la literatura revisada que se reporten como causante de una HC o herida de difícil cicatrización sin un cuadro de apendicitis aguda previo.…”

Appendiks Sesil Serrated Adenomu

“…Kaya & Demirli Atıcı Sessile Serrated Adenoma 108 Also, cecal mass, peritonitis, carcinomatosis and ascites can be seen in CT performed due to nonspecific symptoms (3,(8)(9)(10).…”

“…SSA develops from the serrated pathway of colorectal carcinogenesis with KRAS mutation, methylation of the CpG island promoter regions of the tumor suppressor gene BRAF and inactivation of hMLH1 repair gene increases cytological dysplasia and potentially malign transformation (3,6,11,12). Within the serrated pathway, there is also a possibility that there may be methylation of hMLH1, which is associated with SSA with severe dysplasia.…”

“…During colonoscopy mostly polyps and neoplastic lesions of the appendix due to the characteristics and location of the lesion by piecemeal resection can be completely resected with sufficient (3,6). The important point of resection was an invasion of the layers of submucosa and muscularis propria, protrusion of cecal wall, and removing the lesion with free margins (3).…”