A case report of primary signet-ring cell carcinoma of the vermiform appendix

Abstract

We here report a 41-year-old woman with an appendical signet-ring cell carcinoma operated by laparoscopic surgery followed by radical right hemicolectomy. She complained right lower abdominal pain, however she had not shown any specific inflammatory sign or symptom (WBC 5,500/mm3, CRP 0.05mg/dl). Although the diagnosis that suggested malignant tumor was not reached by computed tomography (CT) and ultrasonography (US), she was operated to treat her abdominal pain, which she was treated by antibiotics for 3 days. Histological examination showed appendical signet-ring cell carcinoma with positive surgical margin. Additionally, she operated radically at 17 th days after the first operation, and final reports showed the peritoneal dissemination in the adipose tissue around resected margin even if the depth of tumor invasion reached until proper muscularis. These findings suggest the adverse effect due to dissemination durind operative period. We propose the careful indication for laparoscopic surgery if the existence of appendical malignant tumor is doubted. ©2006 The Japanese Society of Gastroenterological Surgery.