A Case of Simultaneous Double Primary Cancers Occurring in the Ileum and Appendix

Abstract

Herein we report our experience treating an extremely rare case of synchronous cancers of the small intestine and appendix. The patient was an 84-year-old man who presented to his local physician with chief complaints of diarrhea, vomiting, constipation, and abdominal bloating. The patient was subsequently referred to our hospital and was admitted with a diagnosis of intestinal obstruction. Symptoms were ameliorated following the insertion of an ileus tube. However, as the intestinal obstruction was not the result of previous operative therapy and CT findings revealed that the ileum was the source of the obstruction, we considered the possibility that the obstruction was due to a neoplastic lesion and recommended the patient for surgical treatment. A tumor was observed approximately 60 cm from the terminal ileum. It had infiltrated the surrounding intestinal mesentery and formed a tumor mass. Furthermore, the caudal end of the appendix had become attached to the nearby mesentery. Based on intraoperative findings, we determined that the ileal tumor had infiltrated the intestinal mesentery and appendix; therefore, we performed partial ileectomy and appendectomy. However, histopathological diagnosis revealed that the ileal tumor was a moderately differentiated adenocarcinoma, whereas the appendiceal tumor was a mucinous, well-differentiated adenocarcinoma. As a result, we comprehensively determined that both tumors were primary cancers.