Goblet Cell Adenocarcinoma of the Appendix Associated with Appendiceal Diverticulitis—Report of Two Cases—

Abstract

Case 1 involved a 73-year-old man who presented to our hospital for right lower quadrant pain. He was diagnosed as having acute appendicitis with an abscess and underwent an appendectomy two days after conservative treatment. Histopathological examination revealed appendiceal diverticulitis, goblet cell adenocarcinoma (GCA) and positive resection margin. He refused to undergo any additional ileocecal resection. Thirty-four months later, he died of lung metastases and carcinomatous peritonitis. Case 2 involved a 39-year-old man who presented to our hospital for right lower quadrant pain. He was diagnosed as having acute appendicitis and received conservative treatment using oral antibiotics. One day later, because of aggravated symptoms, appendectomy was performed. Multiple diverticula and localized wall thickening were found in the resected specimens. Histopathological examination revealed GCA invading the subserosal layer. Additional laparoscopic ileocecal resection was performed two months later. There was no residual GCA in the resected specimen (pT3N0M0, Stage II). Adjuvant chemotherapy (4 courses with XELOX) was performed, and he has had no signs of recurrence 11 months after the operation. Because appendiceal diverticula can be associated with appendiceal tumors, including mucinous neoplasms and GCA, careful image diagnosis and pathological examination should be performed for patients with acute appendicitis.