Abstract
A 59-year-old man admitted for lower right abdominal pain was found in blood test to have leukocytosis (WBC count 18,870/mm3) and elevated C-reactive protein (CRP 12.3 mg/dl). Abdominal computed tomography showed a swollen appendix, necessitating appendectomy based on a preoperative diagnosis of acute appendicitis. Postoperative histopathological examination of the resected appendix showed signet ring cell carcinoma from the mucosa to the serosal membrane and mesoappendix. Twenty one days after initial surgery, we conducted ileocecal resection with D3 lymph node dissection, but neither residual tumor nor lymph node metastasis was seen. The man underwent postoperative chemotherapy for six months and has remained in good health in the interim 18 months without clinical recurrence. Signet ring cell carcinoma is extremely rare in appendiceal cancer, with many cases initially diagnosed as appendicitis and only after postoperative histopathological examination found to be cancer. Postappendectomy histopathological examination is therefore necessary. Additional surgery and chemotherapy may then be considered based on the pathological stage disease.
