A CASE OF AN APPENDICEAL VILLOUS TUMOR CAUSING APPENDICEAL INTUSSUSCEPTION AND COLONIC INTUSSUSCEPTION

Abstract

A 48-year-old woman, who was under treatment for malignant rheumatoid arthritis at the department of internal medicine in our hospital, had recurrent abdominal pain and a palpable mass in the right upper quadrant of abdomen. Abdominal CT scan and barium enema showed that the cecum was invaginated in the transverse colon. Colonoscopy demonstrated an incomplete intussusception of the appendix into the cecum and villous change of the appendiceal mucosa; the colonic intussusception was already reduced. Histologic examination of a biopsy taken from the appendiceal mucosa revealed villous adenoma with severe atypia. Appendiceal intussusception caused by an appendiceal villous tumor was diagnosed and an ileocecal resection was performed. Microscopic findings revealed tubulovillous adenoma with severe atypia.
Villous tumors of the appendix are complicated with intussusception in more than 50% of cases and have a high potential risk of malignancy (62%). Therefore, the extended radical surgery with lymph node dissection should be considerd to obtain a higher curability for appendiceal villous tumors than that by simple appendectomy.