Abstract
Primary carcinomas of the appendix, especially mucinous adenocarcinomas, manifest various clinical symptoms and present difficulty in preoperative diagnosis. The reasons are: 1) the appendix itself is anatomically an intraperitoneal floating organ; and 2) a variety of clinical symptoms depend on the direction that mucus produced by mucinous adenocarcinoma infiltrates into the surrounding tissues. Recently we experienced three cases of mucinous adenocarcinoma of the appendix with each different direction of infiltration.
Case 1: A 59-year-old man complaining of abdominal pain and high fever underwent a laparotomy with a suspicion of appendicitis. Operative findings revealed swelling and perforated appendix into the mesoappendix. Histological examination revealed mucinous cystadenocarcinoma. An additional ileocecal resection was performed.
Case 2: A 53-year-old woman complaining of vomiting and diarrhear underwent a laparotomy with a suspicion of peritoneal pseudomyxoma. Operative findings revealed a mucinous cystadenocarcinoma perforated at the tip of the appendix. Appendectomy and intra-peritoneal administration of CDDP were conducted.
Case 3: An 80-year-old woman was admitted to the hospital because of high fever and general fatigue. Abdominal CT indicated a retroperitoneal abscess. Total colonoscopy revealed the tumor of the cecum. Ileocecal resection was performed. Histological examination revealed mucinous cystadenocarcinoma of the appendix infiltrated into the retroperitoneum and developed a colonic fistula.
These three cases had the same disease, but different perforated site due to progression of mucus might cause entirely different clinical symptoms each other.
