A Case of Appendiceal Goblet Cell Adenocarcinoma Diagnosed after Small Bowel Obstruction

Abstract

The patient, a 74-year-old man, presented with complaints of lower abdominal pain and distention. He was diagnosed as having small bowel obstruction caused by an intra-abdominal abscess, with an indistinct appendiceal structure noted. Initial relief was achieved through conservative measures ; however, the intestinal obstruction recurred 9 months later. Subsequent investigation showed adhesive bowel obstruction following abscess resolution, with an unsuccessful response to conservative treatment. Laparoscopically, adhesion of the appendix, sigmoid mesentery, and ileum was observed, and resection of the appendix and ileum was performed. On pathological examination, the diagnosis was mixed adeno-neuroendocrine carcinoma of the appendix (MANEC) according to the WHO classification, 4th edition. Consequently, laparoscopic right hemicolectomy (D3) was performed. The final diagnosis was appendiceal goblet cell adenocarcinoma (GCA), categorized as T4bN1aM0 Stage IIIb according to the WHO classification 5th edition. The patient died without recurrence 46 months later. Conversely, appendiceal GCA represents a rare tumor, newly acknowledged in the WHO classification of 2019. This report provides the details of a case of appendiceal GCA identified in the context of small bowel obstruction, along with a literature review.