S1783 Recurrent Metastatic Appendiceal Adenocarcinoma Presenting as Non-Specific Colitis – A Case Report

Abstract

Introduction: Malignancies of the appendix are rare and there is a known association of appendicular carcinoid of the appendix and Crohn's disease. Appendicular carcinoid can be mixed with mucinous adenocarcinoma in both primary and metastatic lesions. We present an unusual case of a patient who presented with nonspecific colitis as a manifestation of recurrent metastatic appendiceal adenocarcinoma. Case Description/Methods: A 57-year-old male patient presented with 2 weeks of left lower quadrant pain, diarrhea, and hematochezia. Two years prior to this presentation, he had a perforated appendicitis due to poorly differential adenocarcinoma and goblet cell carcinoid. He was then found to have peritoneal metastasis treated with omentectomy, right hemicolectomy, multiple peritonectomy, and hyperthermic intraperitoneal chemotherapy. He also had multiple intra-abdominal abscesses requiring drainage and a Colo-cutaneous fistula requiring closure. A CT scan showed distal sigmoid colon and rectal thickening. Colonoscopy with biopsies of the terminal ileum showed mild acute inflammation, atypical submucosal glands suspicious for mucinous adenocarcinoma and acute colitis of the entire colon and rectum. After ruling out infectious etiologies, he was started on a prednisone taper with significant improvement in his symptoms. He was then referred to an outside institution for surgical considerations. However, he continued to have intermittent abdominal pain workup revealed a new peritoneal nodule consistent with his prior adenocarcinoma. He was given FOLFOX and bevacizumab for chemotherapy for metastatic disease as he was not a surgical candidate. Discussion: Appendicular carcinoid can be associated with Crohn’s colitis and this has been reported in the literature. This a unique case in which patient had a nonspecific inflammatory colitis which responded well to corticosteroid treatment and imaging identified recurrence of appendicular mucinous adenocarcinoma. If infectious etiologies for non-specific colitis have been excluded, thorough evaluation needs to be performed to rule out metastatic disease in patients with appendicular adenocarcinoma and/or carcinoid as treatment options can vary.