Primary Appendiceal Adenocarcinoma Masquerading as Primary Bladder Tumor: a Case Report and Review of Literatures

Abstract

Adenocarcinoma of the appendix invading the urinary bladder is very rare. We describe such a case in a 42-year-old man and review the relevant literatures. In the present case, although ultrasonography and computed tomography scan revealed a mass in the bladder or in the pelvic and biopsies by cystoscopy showed an adenocarcinoma suspicious for primary of the bladder, its real origin was hard to distinguish. An open exploratory surgery was performed with subsequent resection of appendix and partial bladder. Postoperative histopathological examinations revealed the appendiceal adenocarcinoma infiltrating the bladder wall. The patient refused the right hemicolectomy and received 3 cycles of adjuvant radiotherapy. However, tumor recurrence was found in the bladder 6 months after surgery, and radical cystectomy was eventually performed.

Appendiceal adenocarcinoma presenting as a bladder tumor

“…Presenting symptoms included dysuria, urgency, hematuria, and recurrent infections. 3 , 4 , 5 Patients generally presented without gastrointestinal complaints; the anatomic position of the appendix is such that the tumor may invade the urinary bladder prior to affecting the gastrointestinal system. 3 Histopathologic examination of bladder biopsy specimens show adenocarcinoma.…”

“… 3 Histopathologic examination of bladder biopsy specimens show adenocarcinoma. 3 , 4 However, it is not possible to distinguish primary bladder or urachal origin from a gastrointestinal primary with secondary involvement of the urinary tract. Clinical and radiographic correlation can assist in making the diagnosis.…”

“… 2 However, the prognosis of appendiceal tumors invading the bladder is thought to be relatively favorable if the tumor remains localized and resectable. 4 The appendix base and mesoappendix should be examined thoroughly intraoperatively to ensure complete excision of the tumor. Additionally, it is important that the appendix not be ruptured, as spillage may lead to peritoneal spread.…”

“… 2 Recurrence of appendiceal adenocarcinoma in the bladder after partial cystectomy has been described, despite negative lymph nodes and negative surgical margins. 4 …”

Appendiceal adenocarcinoma masquerading as a primary rectal tumour

“…It most commonly presents as an incidental finding at appendicectomy performed for acute appendicitis, although a minority of cases present as a pelvic mass . Such masses can rarely be locally invasive into adjacent pelvic structures, typically the bladder . In the setting of bladder invasion, formation of vesicoappendiceal fistulae has been reported .…”