Surgical Resection of Liver Metastasis from Adenocarcinoma of the Appendix

Hwang, Hyung Chul; Lee, Dong Shik; Yun, Sung Su; Kim, Hong Jin

Abstract

Primary appendiceal adenocarcinoma is a rare neoplasm, which constitutes less than 0.5% of all gastrointestinal neoplasms. Very few cases of primary tumors of the appendix have been reported in the literature; and no prior case reports of surgical resection of appendiceal adenocarcinoma with liver metastasis have been published. In this study, we report for the first time a case of the surgical resection of liver metastasis from a case of adenocarcinoma of the appendix. (Case) A 53-year-old man was admitted complaining of intermittent abdominal pain. The patient's CEA level was mildly elevated, at a level of 30.8 ng/ml; the AFP was 1.93 ng/ml, and all additional blood tests were normal. Abdominal CT revealed a 9 cm sized malignant-appearing peripheral enhancing mass in the right lobe of the liver. In an effort to rule out metastatic cancer originating from the GI tract, we conducted gastroendoscopy and colonoscopy. However, we were unable to detect any malignant lesions. Therefore, we conducted a whole body fusion PET scan, which revealed a hot uptake of FDG at the right lobe of the liver, as well as a terminal ileum. We concluded with a diagnosis of primary small bowel malignancy with liver metastasis; the patient underwent surgery. During surgery, we detected a very large malignant-appearing tumor in the right lobe of the liver, and an appendix which appeared suspicious for malignancy, and measured 8.0 cm in length and 1.5 cm in diameter. The frozen biopsy of the appendix at surgery confirmed a malignant adenocarcinoma of the appendix, coupled with vascular invasion. Thus, we conducted a right hemihepatectomy and a right hemicolectomy. The post-operative course was uneventful; the patient was discharged at POD #21 after the application of systemic chemotherapy. We detected no evidence of recurrence five months after surgery.