Abstract
A 71-year-old woman was admitted due to nausea and abdominal pain. Abdominal CT showed stricture of the duodenum and expansion of the bile duct and pancreatic duct. However, there was no apparent tumor in the pancreas. Gastric fiberoscopy showed stenosis of the duodenum but the mucosa appeared normal. There was no tumor stain on abdominal angiography. Laboratory data showed elevation of CA19-9, DUPAN2 and IL-2R, but CEA was normal. PET-CT showed accumulation of FDG in the duodenum and hilum of the lung. Therefore, we diagnosed the patient as having pancreatic cancer and performed surgery. The tumor had invaded the pancreatic head and duodenum and showed extensive disseminations. On tumor biopsy, mucinous carcinoma was diagnosed. The apex of the vermiform appendix was swollen, and we considered dissemination of cystadenocarcinoma of the appendix which constricted the duodenum. We performed an appendectomy and gastrojejunostomy. Postoperatively, outpatient chemotherapy was administered with TS1 (80mg/day). Primary appendiceal carcinoma is a rare disease. There are no specific symptoms of appendiceal carcinoma, and preoperative diagnosis is difficult. In most cases, resection was performed for appendicitis and the identification as carcinoma was made based on postoperative pathology. We diagnosed this case as having appendiceal carcinoma with duodenal stenosis due to dissemination.
