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We herein present the case of a-58-year-old female with a metastasis of breast cancer to the appendix, which caused acute appendicitis. She had undergone a bilateral partial mastectomy with sentinel lymph node biopsy ten years earlier at another hospital. She had subsequently received radiation therapy, chemotherapy and endocrine therapy. There had been no sign of recurrence for five years after the surgical procedure. She was admitted to our hospital because of abdominal pain lately. Abdominal computed tomography showed a dilated and thickened wall of the appendix. She was diagnosed with acute appendicitis and underwent appendectomy. A histopathological examination revealed metastatic breast cancer of the appendix, and the patient received endocrine therapy using an aromatase inhibitor. Metastatic involvement of the appendix should be suspected in any patient with a previous history of breast cancer presenting with acute appendicitis, even if many years have passed after initial therapy.

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Background: Colonoscopic contact and repeated biopsies have been associated with an increased risk of cancer cell dissemination. We examined whether exfoliated cancer cells were detected during preoperative colonoscopic examination in patients with colorectal cancer. Methods: Twenty‐five patients with colorectal cancer were studied. Samples were collected by four methods: intestinal lavage solution, endoscope tip, forceps channel (n = 22) and biopsy forceps (n = 3). The collected suspensions were centrifuged, fixed in 95% ethanol, stained with Papanicolaou stain and examined microscopically. Viability of the exfoliated cancer cells was studied in five patients. Samples obtained by endoscope tip and forceps channel were suspended in RPMI 1640 medium supplemented with 10% fetal calf serum stained with trypan blue or fluorescent dye and examined. Results: Exfoliated cancer cells were detected in 18 of 25 patients (72%). The detection rate was 45.5% in intestinal lavage solution, 68.2% at the endoscope tip and 81.8% in the forceps channel. The detection rate of exfoliated cancer cells adhering to the colonoscope depended on endoscopic contact (P = 0.009). Trypan blue staining and fluorescent staining confirmed the presence of viable cells among the exfoliated cancer cells. Conclusion: Our findings indicate that cancer cells were exfoliated when the colonoscope passed through a stricture and after biopsy or passage of a colonoscope through a stricture, further manipulation of lesions should be avoided to reduce the risk of implantation metastasis.