Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2015; 21(7): 2206-2209
Published online Feb 21, 2015. doi: 10.3748/wjg.v21.i7.2206
Lymphangitic spread from the appendiceal adenocarcinoma to the ileocecal valve, mimicking Crohn’s disease
Tricia Murdock, Nicholas Lim, Maryam Zenali
Tricia Murdock, Maryam Zenali, Department of Pathology, University of Vermont-College of Medicine/Fletcher Allen Health Care, Burlington, VT 05401, United States
Nicholas Lim, Department of Medicine-Gastroenterology, University of Vermont-College of Medicine/Fletcher Allen Health Care, Burlington, VT 05401, United States
Author contributions: Murdock T and Zenali M contributed to concept and design, analysis and interpretation of data, drafting and revising paper critically for important intellectual content; Lim N contributed to analysis and interpretation of data, revising article for important intellectual content; Zenali M contributed to final approval of the version to be published.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tricia Murdock, MD, Department of Pathology, University of Vermont-College of Medicine/Fletcher Allen Health Care, 111 Colchester Avenue, Burlington, VT 05401, United States. tricia.murdock@vtmednet.org
Telephone: +1-802-8470000 Fax: +1-802-847415
Received: March 27, 2014
Peer-review started: March 27, 2014
First decision: April 15, 2014
Revised: May 31, 2014
Accepted: September 12, 2014
Article in press: September 16, 2014
Published online: February 21, 2015
Processing time: 321 Days and 10.9 Hours
Abstract

Due to the anatomical peculiarity of the appendix, diagnosis of tumors arising from this area can be challenging by clinicoradiologic means. We report a case of a rare primary appendiceal signet ring carcinoma with an uncommon presentation. An 86-year-old woman was admitted to our hospital with subacute epigastric pain. Computed tomography demonstrated bowel wall thickening with fat stranding in the ileocecal region. The leading diagnostic consideration was inflammatory bowel disease. Upon colonoscopy, a swollen, distorted ileocecal valve was identified. The remaining colon was otherwise unremarkable. Extensive biopsy sampling of the ileocecal region and colon was performed. A lymphangitic signet ring carcinoma within the ileocecal region was diagnosed on biopsy; there was no dysplasia or carcinoma of the remaining biopsies. By cytomorphology and immunoprofile, a lymphangitic signet ring carcinoma of appendiceal origin was the primary consideration, further confirmed upon subsequent laparotomy. This case represents an unusual pattern of appendiceal tumor spread with localized, lymphangitic involvement, creating a milieu which closely simulates Crohn’s disease on imaging modalities.

Keywords: Signet ring carcinoma; Crohn’s disease; Inflammatory bowel disease; Appendiceal signet ring carcinoma; Computed tomography

Core tip: Appendiceal signet ring carcinoma (ASRC) is rare and can be confused with other pathologic processes. This aggressive tumor progresses rapidly with frequent extra-appendiceal spread at the time of diagnosis. It’s clinical and radiologic manifestations are non-discrete and can present as ascities, an ovarian mass or appendicitis. The basis of the paper is to address the peculiar and evasive nature of this tumor. Herein we report a case of ASRC, presenting as confined lymphangitic spread within the illeocecal region, clinically mimicking Crohn’s disease.