Abstract
A 69-year-old man complaining of right hypochondralgia was referred to the hospital with a diagnosis of cholecystlithiasis based on an abdominal ultrasonography (US) at another hospital. Abdominal US performed in our department revealed a 6cm-sized tumor in the right flank abdomen as well as gallstones. Abdominal CT scan demonstrated a cystic tumor extending to the appendix area in the right abdomen, which invaded the peritoneum. Contents of the tumor were considered to be mucoid substance on an abdominal magnetic resonance imaging (MRI). Barium enema X-ray examination did not visualize the appendix but revealed an extramural shift of the ascending colon. On the basis of these findings, he was diagnosed as having cholecystolithiasis and mucinous cystadenocarcinoma arisen from the appendix, and a cholecystectomy and a right hemicolectomy were performed. Histopathological diagnosis was mucinous cystadenocarcinoma of the appendix associated with direct invasion to serosa of the ascending colon. Primary carcinoma of the appendix occurs rarely and the most common clinical finding is right lower abdominal pain which leads us to make the diagnosis of acute appendicitis preoperatively. This case is rare, in that a right hypochondralgia developed because the tumor extended from the appendix area to head side and it could be diagnosed preoperatively.
