Published online Apr 15, 2025. doi: 10.4251/wjgo.v17.i4.100526
Revised: December 16, 2024
Accepted: January 23, 2025
Published online: April 15, 2025
Processing time: 218 Days and 13.6 Hours
Appendiceal signet-ring cell carcinoma (SRCC) with terminal ileum metastasis is extremely rare. There have been no reported cases in domestic and foreign literature.
In this case report, we present an 88-year-old man with appendiceal SRCC with terminal ileum metastasis. The tumour stage was stage pT4bN2M1bG3 IVB, and the Tumour, Node, Metastasis staging system was used. The patient was admitted to our hospital on 12 July, 2022 and underwent laparoscopic appendectomy under general anaesthesia after the examination. The pathological examination that took place 1 week after the operation showed that SRCC of the appendix invaded the whole layer, vessels and nerves of the appendix wall. It was suggested that the primary appendix should be considered after excluding metastasis. Based on the postoperative pathology findings, the patient underwent a secondary surgery on 2 August, 2022. The second pathological examination showed residual SRCC in the appendiceal area of the ileocecal region, which infiltrated the serosal fibres and adipose tissue of the ileocecal region to the surface mesothelium. The tumour infiltrated the whole layer of the ileum wall, serosa fibres, adipose tissue and the surface mesothelium. Postoperative follow-up showed no signs of tumour recurrence or metastasis.
In clinical practice, a heightened awareness of rare diseases, coupled with thorough intraoperative exploration and rapid pathological examination, enables more accurate judgments, potentially sparing patients from unnecessary secondary surgery and ensuring optimal treatment.
Core Tip: Signet ring cell carcinoma (SRCC) of the appendix is a rare malignant tumor, which accounts for only about 2.3% of all malignant tumors of the digestive system and 0.42% of all malignant tumors. Because of the rarity of SRCC, it is important to study its clinicopathologic features, diagnosis, and treatment methods in depth to improve patient outcomes. This case report reports an extremely rare case of SRCC of the appendix with metastases in the terminal ileum. It demonstrates the diagnosis and treatment process of this rare disease, emphasizes the importance of improving alertness to rare diseases in clinical practice, and the necessity of thorough intraoperative exploration and rapid pathological examination, which helps to more accurately determine the condition, avoid unnecessary secondary surgeries, and ensure that patients are optimally treated.