Acute Appendicitis Due to Metastasis of Prostatic Adenocarcinoma: A Case Report

Abstract

Acute appendicitis due to metastasis of prostatic carcinoma is very rare, and only five cases of metastasis of prostatic carcinoma are described in the literature. We report the case of a 73-year-old man with a history of an adenocarcinoma of the prostate with multiple bone metastases. The patient was admitted to the emergency department with symptoms and signs of an acute appendicitis which was confirmed by computed tomography (CT). Laparoscopic surgical exploration was performed, affirming an acute appendicitis with a suspicious lesion in the appendix base. Due to the location of the lesion, an ileocecectomy was performed. Histopathological and immunohistochemical examinations of the specimen showed an extrinsic infiltration of the appendix by adenocarcinoma metastasis expressing the prostate-specific antigen (PSA). These results confirmed an acute appendicitis caused by metastasis of prostatic adenocarcinoma.

Prostate cancer metastasis mimicking appendicitis—A rare but important differential diagnosis in PET/CT imaging

“…Only a small percentage of disseminated prostate cancer shows metastasis in the digestive system or the peritoneum, [1] and even more uncommonly carcinomatosis in relation to the appendix. In all previously reported cases of prostatic metastasis in the appendix, the patients presented with acute appendicitis and had an appendectomy performed from which metastasis was confirmed through histopathological assessment of the surgical specimen [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. Acute appendicitis is found to be the most frequent initial manifestation of appendiceal tumors, seen in 30%-50% of patients [15] .…”

“…These image findings could equally come as a result of the extension of the metastasis or from a superimposed appendicitis [15] . Preoperative CT scans from previously reported cases of acute appendicitis secondary to prostate cancer metastasis predominantly show dilated appendix, periappendicular stranding and/or wall thickening [ 2 , [3] , [4] , [5] , [6] , 7 , [8] , [9] , [10] ]. Christou et al present a patient with an identical initial staging and Gleason score to the patient in the present report [2] .…”

“…Carcinomatosis in relation to the appendix is even more uncommon and not well described in the literature. To the best of our knowledge, only 11 cases of prostate cancer with a metastatic affinity for the appendiceal tissue have been reported worldwide, all located in the appendiceal lumen [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] ].…”