A case of signet ring carcinoma of the appendix: dilemmas in differential diagnosis and management.
OBJECTIVE
Signet ring carcinoma (SRC) of the appendix consists one of the most biologically virulent cancers. We present the case of a patient with primary SRC complicated by the development of acute inflammation of the appendix.


METHODS
A 78-year-old man was admitted due to a 5-day history of increasing colicky abdominal pain and vomiting. Clinical examination revealed a firm, tender mass in the right ileac fossa. Laparotomy confirmed a tumor mass which appeared to originate from the appendix. The affected part of the bowel was resected and a right hemicolectomy with an end-to-side ileotransverse anastomosis was performed. The appendix was notably thickened with an ulcerated wall containing sinus tracts, chronic inflammation, and scarring. Moreover, a focus of SRC was detected.


CONCLUSIONS
Appendiceal SRC is a rare entity, which may sometimes be confused with other pathologies providing difficulties in differential diagnosis, having an impact on therapeutic decisions and affecting prognosis.
Mastoraki
Aikaterini
A
4th Department of Surgery, Medical School, ATTIKON University Hospital, Athens University, 1 Rimini str., 12462, Chaidari, Athens, Greece. dr_kamast@yahoo.gr
Papanikolaou
Ioannis S
IS
Kanakis
Dimitrios
D
Safioleas
Panagiotis
P
Sakorafas
George
G
Safioleas
Michael
M
D015746:Abdominal Pain; D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001063:Appendiceal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D018279:Carcinoma, Signet Ring Cell / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D007813:Laparotomy; D002955:Leucovorin / Q000627:therapeutic use; D008297:Male; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D000077150:Oxaliplatin; D014803:Vitamin B Complex / Q000627:therapeutic use; D014839:Vomiting
D000964:Antimetabolites, Antineoplastic; D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077150:Oxaliplatin; D014803:Vitamin B Complex; D002955:Leucovorin; D005472:Fluorouracil