A patient with primary adenocarcinoma of the appendix metastasizing to the ovary

Czech version

Authors: Frgálová A. ¹; Marek R. ²; Klos D. ³; J. Hanáček ⁴; Radovan Pilka ²
Authors‘ workplace: Gynekologicko-porodnické oddělení, Nemocnice Agel Prostějov ¹; Porodnicko-gynekologická klinika FN Olomouc ²; I. chirurgická klinika FN Olomouc ³; Ústav pro péči o matku a dítě, Praha ⁴
Published in: Ceska Gynekol 2022; 87(4): 255-260
Category: Case Report
doi: https://doi.org/10.48095/cccg2022255

Overview

Objective: The aim of this work is to draw attention to the difficulty of differential diagnosis of rare adenocarcinoma of the appendix and the histological diversity of ovarian tumors. Case report: We present a case of a 62-year-old patient sent by an attending gynecologist for the finding of an asymptomatic adnextumor diagnosed during a routine preventive examination. Based on preoperative examinations, a malignant ovarian tumor was suspected. Standard surgery was performed including hysterectomy with bilateral adnexectomy, total omentectomy, appendectomy, pelvic and paraaortic lymphadenectomy. Definitive histopathological analysis revealed a secondary ovarian tumor, with the adenocarcinoma of the appendix appearing to be the primary site. Conclusion: Up to 25% of all ovarian tumors are secondary metastatic tumors. Appendix neoplasia should be considered in the differential diagnosis of right-sided adnextumors. Due to their localization, they can only mimic an ovarian tumor during imaging examinations, or they can be the primary origin of an already metastatic ovary, as in our case.

Keywords:

appendiceal adenocarcinoma – secondary ovarian tumor

Sources

1. Ústav zdravotnických informací a statistiky ČR. Národní zdravotnický informační systém (NZIS), Národní onkologický registr (NOR). 2022 [online]. Dostupné z: http: //www.uzis.cz/ registry-nzis/nor.

2. Frühauf F, Sláma J, Zikán M. Význam screeningu v onkogynekologii. Ceska Gynekol 2014; 79 (6): 491–498.

3. Kubeček O, Laco J, Špaček J et al. The pathogenesis, diagnosis, and management of metastatic tumors to the ovary: a comprehensive review. Clin Exp Metastasis 2017; 34 (5): 295–307. doi: 10.1007/s10585-017-9856-8.

4. de Waal YR, Thomas CM, Oei AL et al. Secondary ovarian malignancies: frequency, origin, and characteristics. Int J Gynecol Cancer 2009; 19 (7): 1160–1165. doi: 10.1111/IGC.0b013e 3181b33cce.

5. Karaosmanoglu AD, Onur MR, Salman MC et al. Imaging in secondary tumors of the ovary. Abdom Radiol (NY) 2019; 44 (4): 1493–1505. doi: 10.1007/s00261-018-1809-4.

6. Sain B, Gupta A, Bhattacharya S et al. Primary adenocarcinoma of the appendix presenting with fresh bleeding per rectum: a case report. Int J Surg Case Rep 2021; 86: 106285. doi: 10.1016/j.ijscr.2021.106285.

7. Ruoff C, Hanna L, Zhi W et al. Cancers of the appendix: review of the literatures. ISRN Oncol 2011; 2011: 728579. doi: 10.5402/2011/728579.

8. Hoehn RS, Rieser CJ, Choudry MH et al. Curret management of appendiceal neoplasm. Am Soc Clin Oncol Educ Book 2021; 41: 1–15. doi: 10.1200/EDBK_321009.

9. Leonards LM, Pahwa A, Patel MK et al. Neoplasms of the appendix: pictorial review with clinical and pathologic correlation. Radiographics 2017; 37 (4): 1059–1083. doi: 10.1148/ rg.2017160150.

10. Petrovová D, Minář L, Doubek R. Tumor malé pánve u gynekologické pacientky – raritní případ benigního nádoru apendixu: kazuistika. Prakt Gyn 2006; 10 (2): 69–70.

11. Al-Wiswasy MK, Al-Balas H, Al-Saffar RA et al. Synchronous primary adenocarcinoma of the appendix and colon: case report and literature review. Int J Surg Case Rep 2020; 77: 628–633. doi: 10.1016/j.ijscr.2020.11.075.

12. Takahashi T, Nouso H, Yamoto M et al. Primary adenocarcinoma of the appendix in a child: a case report. Surg Case Rep 2018; 4 (1): 109. doi: 10.1186/s40792-018-0514-4.

13. Perivoliotis K, Christodoulidis G, Samara AA et al. Low-grade appendiceal mucinous neoplasm (LAMN) primarily diagnosed as an ovarian mucinous tumor. Case Rep Surg 2021; 2021: 5523736. doi: 10.1155/2021/5523736.

14. Zhang W, Tan C, Xu M et al. Appendiceal mucinous neoplasm mimics ovarian tumors: challenges for preoperative and intraoperative diagnosis and clinical implication. Eur J Surg Oncol 2019; 45 (11): 2120–2125. doi: 10.1016/ j.ejso.2019.08.004.

15. Fischerová D. Doporučený diagnostický postup u ženy s ovariální cystou nebo nádorem. Ceska Gynekol 2014; 79 (6): 477–486.

16. Borges AL, Reis-de-Carvalho C, Chorão M et al. Low-grade mucinous appendiceal neoplasm mimicking an ovarian lesion: a case report and review of literature. World J Clin Cases 2021; 9 (10): 2334–2343. doi: 10.12998/wjcc.v9.i10.2334.

17. Škapa P, Pluta M. Intraoperative consultation in gynecologic pathology. Cesk Patol 2018; 54 (3): 105–118.

18. Kudela M, Marek R, Pilka R et al. Přínos a validita peroperační frozen section u suspektních ovariálních tumorů. Ceska Gynekol 2015; 80 (4): 250–255.