Mimicry in the abdomen: A rare case of appendiceal carcinoma presenting as appendicitis

Apart from usual occurrence of abscess or appendicitis, carcinoma of appendix is quite rare to occur. Yet, here, we describe a reported case of appendiceal adenocarcinoma that clinically presented as appendicitis in a 60-year-old man. The patient presented with pain in right iliac fossa, which was sudden in onset, nonradiating, and progressively increased in severity with complaints of nausea. He had no history of fever, vomiting, cough, or constipation. Computed tomography revealed a well-defined collection with surrounding fat stranding and peritoneal thickening in right iliac fossa measuring 2.6 * 4.2 * 3.5 cm, volume 20 cc. Appendix was retrocecal and thickened with tip leading to the collection. A few prominent mesenteric lymph nodes were seen in right iliac fossa. These features suggested perforated appendix with abscess formation. An open appendicectomy was done under general anesthesia, and the specimen was sent for histopathological analysis. On a surprise note, the microscopic section of the specimen revealed tumor cells with a conventional glandular appearance favoring a diagnosis of moderately differentiated adenocarcinoma, following which an elective right hemicolectomy was advised. Nonspecific symptoms and difficulties in reaching a diagnosis preoperatively may contribute to underreporting of appendiceal carcinomas. Complete surgical excision and/or chemotherapy may be necessary and help in the better prognosis of the patient.