A chance diagnosis of appendiceal goblet-cell adenocarcinoma in acute appendicitis being teated by ileocecectomy plus partial right-hemicolectomy: A case report.

INTRODUCTION AND IMPORTANCE

Appendiceal Goblet Cell Adenocarcinoma (GCA) is a renamed subtype of appendiceal adenocarcinoma. A proper management is required to improve the outcomes of the patients. We hereby reported a chance diagnosis of GCA presenting as acute appendicitis being teated by ileocecectomy plus partial right-hemicolectomy.

CASE PRESENTATION

A 59-year old male complained of a right lower abdominal pain for 17 h on admission with a history of acute appendicitis. Physical examination revealed hyperactive bowel sound and right lower quadrant tenderness. CBC showed WBC and neutrophil elevation. Abdominal CT demonstrated an enlarged appendix with surrounding fat-stranding. A laparoscopic appendectomy was performed with the unexpected finding of GCA in the surgical specimen. Enhanced CT and colonoscopy were further performed to rule out metastasis. An ileocecectomy plus partial right-hemicolectomy was operated to resect the distal ileum and the proximal ascending colon both about 10 cm with the cecum. The pathology revealed that the ileocecal subserosa was invaded. The patient was then referred to the oncology department for 5-FU-based chemotherapy.

CLINICAL DISCUSSION

GCA requires proper treatment. The diagnosis can be challenging due to the unspecific clinical manifestations, and is depending on pathology in the cases of appendicitis after appendectomy. Though right-hemicolectomy should remain as the standard treatment, the enhanced CT and colonoscopy are necessary for further evaluation. Our case has chosen the ileocecectomy plus partial right-hemicolectomy based on the enhanced CT and colonoscopy ruling out metastasis.

CONCLUSION

The case highlights the ileocecectomy plus partial right-hemicolectomy to treat GCA on the specific preoperative evaluation ruling out metastasis and followed by the recommendation of 5-FU-based chemotherapy.