| Popis: |
Adenosquamous carcinoma has been described throughout the gastrointestinal tract, most commonly within the rectum associated with the dentate line. Adenosquamous carcinoma of the appendix is a very rare occurrence, having been reported in five cases previously within published English literature. We present a case of adenosquamous carcinoma arising in the vermiform appendix. The patient is a 42 year old male who presented to the Emergency Department with a five week history of vomiting, diarrhoea, weight loss and anorexia. An abdominal X-ray showed a small bowel obstruction with dilated bowel loops and air fluid levels. An abdomino-pelvic CT scan showed a heterogeneous mass situated approximately 20 cm from the ileocaecal valve which had central low density suggesting necrosis. At surgery, tumour was noted lying 10 cm from the ileocaecal junction which was adherent to the retroperitoneum and an adjacent small bowel loop with associated bulky lymphadenopathy. Macroscopic examination revealed a 7 cm necrotic mass centred in the mesenteric fat that appeared to arise from the appendix. The lesion extended to the ulcerated mucosa of the adherent small bowel. Microscopic examination showed an infiltrating carcinoma composed of glandular and squamous elements. The tumour was seen to be arising from appendiceal mucosa which showed dysplastic mucinous epithelium. Metastatic deposits comprised exclusively of the adenocarcinoma component were present in two of 32 lymph nodes. |
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