ADENOCARCINOMA WITH SIGNET RING CELLS OF CECAL APPENDIX IN A PATIENT WITH TRANSVERSE COLON DUPLICATION: CASE REPORT

Case presentation Male, 56 years old, with abdominal pain and distension, nausea and change in bowel habit with watery diarrhea for 5 days. Epilepsy patient. No previous abdominal surgery. No family background. On examination, he appeared dehydrated, abdomen distended and painful on diffuse palpation, with signs of peritonitis. Empty rectal ampule. Abdomen tomography requested, which showed an area of thinering and distortion of the path of the mesenteric vessels in the mesogastria, with air-fluid levels in colic segments upward, with the possibility of acute obstructive abdomen. Exploratory laparotomy indicated with findings of tumor in the cecum and duplication in the transverse colon. Right hemicolectomy and ileo-transtomic anastomosis performed. Patient with good evolution, discharge on the 7th postoperative day. Anatomopathological study with findings of adenocarcinoma with signet ring cells in the cecal appendix and mesogastria. Presence of a 14 cm tubular fragment with mucosa of a usual colonic appearance, with continuous light with the transverse colon, corresponding to intestinal duplication.

Discussion Primary appendix neoplasms have a prevalence of 0.5 to 1% of cases. Primary signet ring cell adenocarcinoma comprises 4% of them, with an overall survival of 18% in 5 years, the lowest when compared to mucinosal adenocarcinoma and others. In 93% of cases, it presents metastases to adjacent areas. The intraoperative finding of tubular duplication of the transverse colon is a most common diagnosis in childhood. It has its first description in the 18th century and can occur throughout the gastrointestinal tract, either in a spherical or tubular form, with tubular duplication being the rarest. This variation results from embryonic developmental disturbances and may present with intussusception, volvulus, and obstruction. It can be associated with malignant neoplasms, most commonly adenocarcinoma.

Conclusion Adenocarcinoma with signet ring cells of the appendix is a rare entity with a high mortality risk, requiring differential diagnosis and histopathological study to ensure proper management and follow-up. In cases of intestinal duplication, due to its potential for complications, surgical treatment is the preferred approach for symptomatic patients. An individualized assessment of each case is necessary to determine whether resection of only the duplicated segment or an extended resection of additional segments is warranted based on intraoperative findings.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025