Persistent pain in the right lower abdomen, raised sedimentation rate and a palpable mass.
The symptoms diminished, but a repeated CT scan still showed the mass. The patient was released from the hospital but returned after a few months because she had persistent pain.
Because of the cystic nature of the mass and the inflammatory symptoms the first impression was that the mass could be an appendiceal abscess. Although the patient was ill, there was doubt about the nature of the mass. Instead of doing a percutaneous drainage as requested by the surgeon, it was decided to biopsy the solid part of the mass under ultrasound guidance first to exclude a malignancy. Unfortunately for the patient the cystic mass proved to be a mucinous carcinoma. The patient was referred to a special cancer centre were she was successfully operated.
Appendiceal carcinoma is rare. Mucinous carcinoma is the most common form of appendiceal carcinoma. Usually the diagnosis is made by laparoscopy.
Differentiation from inflammatory disease, a mucocele of the appendix or ovarian tumors can be very difficult.
References
McGory ML, Maggard MA, Kang H, O'Connell JB, Ko CY.
Malignancies of the appendix: beyond case series reports.
Dis Colon Rectum. 2005 Dec;48(12):2264-71.
Dr. Taco Geertsma is the founder of UltrasoundCases.info and a retired radiologist and has worked in the Gelderse Vallei hospital from January 1, 1983. till July 1, 2014. He was the head of the ultrasound department for many years.
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