Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

VOLUME 10 , ISSUE 4S2 ( October-December, 2018 ) > List of Articles


A Rare Case of Primary Mucinous Adenocarcinoma of the Appendix Presenting as Ovarian Mass: A Diagnostic Challenge

Pooja Sehagal, Anitha Vijay, Kaveri Sharma

Keywords : Appendiceal malignancy, Ovarian metastasis, Ovarian carcinoma, Primary carcinoma of appendix

Citation Information : Sehagal P, Vijay A, Sharma K. A Rare Case of Primary Mucinous Adenocarcinoma of the Appendix Presenting as Ovarian Mass: A Diagnostic Challenge. J South Asian Feder Obs Gynae 2018; 10 (4S2):425-428.

DOI: 10.5005/jp-journals-10006-1637

License: CC BY-NC 4.0

Published Online: 01-06-2019

Copyright Statement:  Copyright © 2018; The Author(s).


Introduction: Cancer of the appendix is an uncommon disease and is typically identified incidentally during appendicectomy. Bilateral ovarian metastases may occasionally occur in mucinous adenocarcinomas of appendix mimicking primary ovarian malignancies and can present a diagnostic challenge. The prognosis is poor as it is usually diagnosed at an advanced stage, either due to a low threshold of suspicion and also due to difficulties in diagnosis before surgery. Here we are reporting such a case of occult appendiceal adenocarcinoma which presented clinically as primary ovarian malignancy. Staging laparotomy revealed large bilateral ovarian tumors of FIGO Stage III, with presumed appendiceal implants. Histological examination revealed transmurally infiltrating Mucinous Adenocarcinoma of the appendix with mesoappendiceal invasion and serosal involvement, with lymphovascular invasion with secondaries to bilateral ovaries and omentum. Immunohistochemical staining revealed positive for CK 20 and CDX2 and negative staining for CK 7. The diagnosis of a primary mucinous adenocarcinoma of Appendix with bilateral ovarian metastasis was confirmed with pT4aG2pNxpM1c; TNM stage IV. The patient is planned for right hemicolectomy, total peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC). Conclusion: Although adenocarcinoma of the appendix is uncommon, they should be considered in the differential diagnosis of intraabdominal masses, as the treatment modalities vary.

PDF Share
  1. McCusker ME, Coté TR, et al. Primary malignant neoplasms of the appendix: a population-based study from the surveillance, epidemiology and end-results program, 1973–1998. Cancer 2002;94(12):3307-3312.
  2. Scully RE, Young RH, et al. Tumors of the Ovary, Maldeveloped Gonads, Fallopian Tube, and Broad Ligament. Atlas of Tumor Pathology, Third Series, Fascicle 23. AFIP: Washington, DC; 1998. pp. 81-105.
  3. Connor SJ, Hanna GB, Frizelle FA. Appendiceal tumors. Diseases of the Colon & Rectum 1998;41(1):75-80.
  4. Jun S, Shinsuke K, et al. Signet Ring Cell Carcinoma of the Appendix Manifesting as Colonic Obstruction and Ovarian tumors: Report of a Case. Surg Today 2009;39:235-240.
  5. Carl R, Louay H, et al. Cancers of the Appendix: Review of Literature. ISRN Oncology. vol. 2011 Article ID 728579, 6 pages, 2011.
  6. Rosai J, Ackerman LV. Female reproductive system: ovary. In: Rosai J, Ackerman L V, editors. Rosai and Ackerman’ s surgical pathology. 10th ed. Toronto: Elsevier Mosby; 2011. p. 1606-1607.
  7. Prat J. Ovarian carcinomas, including secondary tumors: diagnostically challenging areas. Modern Pathology 2005;18: S99-S111
  8. Wauters CC, Smedts F, et al. Keratins 7 and 20 as diagnostic markers of carcinomas metastatic to the ovary. Hum Pathol 1995;26:852-855.
  9. Berezowski K, Stastny JF, et al. Cytokeratins 7 and 20 and carcinoembryonic antigen in ovarian and colonic carcinoma. Mod Pathol 1996;9:426-429.
  10. Ueda G, Sawada M, et al. Immunohistochemical study of cytokeratin 7 for the differential diagnosis of adenocarcinomas in the ovary. Gynecol Oncol 1993;51:219-223.
  11. Lagendijk JH, Mullink H, et al. Tracing the origin of adenocarcinomas with unknown primary using immunohistochemistry: Differential diagnosis between colonic and ovarian carcinomas as primary sites. Hum Pathol 1998;29:491-497
  12. Gehrig PA, Boggess JE, et al. Appendix cancer mimicking ovarian cancer. Int J Gynecol Cancer. 2002;12:768-772.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.