Primary signet ring cell carcinoma of the appendix mimicking acute appendicitis
An 80-year-old man presented to the Emergency Department in May 2009 with persistent right lower quadrant abdominal pain. Baseline blood tests showed neutrophilic leukocytosis. Preoperative contrast-enhanced CT scan (Figs. and ) showed a wide and severe thickening of the appendiceal walls with extensive soft-tissue stranding and inflammation of the peri-appendicular fat. Loculated fluid and lymphadenopathy adjacent to the appendix were also detected on the CT examination.\nThe patient underwent an appendectomy. At laparotomy the appendix appeared severely inflamed with an associated abscess at its apex. The inflammatory process also involved the first part of the cecum, making it difficult for the identification of the ceco-appendiceal junction. The final histological diagnosis was consistent with well-differentiated infiltrating adenocarcinoma of the appendix with mucinous and “signet ring cells” appearance, with signs of infiltration of peri-appendicular fat and a peritoneal abscess (Fig. ).\nThe patient underwent colonoscopy for the evaluation of synchronous disease, which was negative. Neoplastic markers were negative as well.\nThe patient subsequently underwent right hemicolectomy and no residual carcinoma with negative lymph nodes was found. The patient was discharged from the hospital 10 days later and had an uneventful postoperative course.