Clinical Endoscopy

Case Report

Endoscopic Ultrasound-Guided Sampling of a Metastatic Mucinous Adenocarcinoma Mimicking a Gastric Subepithelial Tumor: Dae Chul Seo, Tae Hee Lee, Yoon Mi Jeen, Hyun Gun Kim, Eui Bae Kim, Sang Cheol Lee; Clin Endosc 2014;47(5):460-463. Published online September 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.5.460

Metastatic mucinous adenocarcinoma of appendix origin and mimicking a gastric subepithelial tumor (SET) is very rare. Endoscopic ultrasound (EUS)-guided sampling is a useful diagnostic method for SETs. However, the cytologic findings of metastatic mucinous adenocarcinoma are unfamiliar to many pathologists and gastroenterologists. These findings present a diagnostic challenge because the introduction of gastric epithelium and mucin into the specimen during the procedure can be misleading. This is the first reported experience of an EUS-guided sampling of a gastric SET in a patient with suspected appendiceal tumor, to make the diagnosis of a mucinous adenocarcinoma.

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A Case of Transduodenal Endoscopic Ultrasound-Guided Biopsy of an Appendiceal Lesion
Nihal Ijaz Khan, Abdullah Abbasi, Saurabh Chandan, Sagar Pathak, Charanjeet Singh, Muhammad K. Hasan
ACG Case Reports Journal.2024; 11(12): e01574. CrossRef

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A Case of Hamartomatous Polyp without Peutz-Jeghers Syndrome Arising from Appendix: Wee Sik Sohn, M.D., Ju Sang Park, M.D., Ji Eun Kim, M.D., Bong Hwan Kim, M.D., Seung Hee Yoo, M.D. and Eun Mee Han, M.D.*; Korean J Gastrointest Endosc 2010;41(1):36-40. Published online July 31, 2010

Abstract PDF: Peutz-Jeghers syndrome is a familial syndrome consisting of mucocutaneous pigmentation and gastrointestinal polyposis and appears to be inherited as a single pleiotropic autosomal dominant gene with variable and incomplete penetrance. Cases of hamartomatous polyps of the Peutz-Jeghers type without Peutz-Jeghers syndrome have only rarely been reported. Moreover, only one case of a Peutz-Jeghers polyp at the appendix has been reported; it was resected by appendectomy. We report here on a case of a 45 year old man who had a hamartomatous polyp of the Peutz-Jeghers type arising from the appendix. The polyp was successfully removed by endoscopic polypectomy. To our knowledge, this is the first case of a hamartomatous polyp of the Peutz-Jeghers type that originated from the appendix and that was resected endoscopically. (Korean J Gastrointest Endosc 2010;41:36-40)

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Appendiceal Mucocele-Induced Intussusception That Presented as a Huge Mass on the Hepatic Flexure Area: Hearn Kook Kim, M.D., Hyun Soo Kim, M.D., Ki Tae Suk, M.D., Hye Jung Kim, M.D., Kyong Won Park, M.D., Seung Whan Cha, M.D.*, Yosep Chong, M.D.^† and Mee-Yon Cho, M.D.^†; Korean J Gastrointest Endosc 2009;38(3):161-165. Published online March 30, 2009

Abstract PDF: Appendiceal intussusception is a rare disease entity and appendiceal mucocele is one of the causes of this disease. Although computed tomography, ultrasonography, barium enema and colonoscopy can be performed to make a preoperative diagnosis, only a few cases of appendiceal mucocele-induced intussusception have been precisely diagnosed by these diaggnostic tools. Most of all, few such cases have been confirmed by colonoscopic examination. Colonoscopic examination has a supplementary role for the differential diagnosis of acute or chronic appendicitis, tumor or abscess in the ascending colon and cecum that is caused by appendiceal intussusception. We report here on a case of intussusception that was caused by an appendiceal mucocele, and this showed a target appearing structure in the hepatic flexure and a cystic mass inside the intussusceptive lumen on abdominal CT, and a huge mass was discovered on the colonoscopic examination. (Korean J Gastrointest Endosc 2009;38:161-165)

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A Case of Crohn's Disease with an Initial Presentation of Granulomatous Appendicitis: Jae Myung Cha, M.D., Joung Il Lee, M.D., Kwang Ro Joo, M.D., Sung Won Jung, M.D., Hyun Phil Shin, M.D., Woo Young Hew, M.D. and Sung Il Choi, M.D.*; Korean J Gastrointest Endosc 2008;37(6):447-452. Published online December 30, 2008

Abstract PDF: Crohn's disease is a condition of chronic inflammation that potentially involves any location the in gastrointestinal tract; however, Crohn's disease with the primary lesion confined to just the appendix is very rare through out the world. Physicians may not be able the clinically differentiate Crohn's disease confined to the appendix from acute appendicitis, and it may not be distinguishable from granulomatous appendicitis of other causes, according to the histopathology. Therefore, clinical follow-up for assessing additional manifestations and sometimes further investigations are the only means of differentiating between granulomatous appendicitis of other causes and early Crohn's disease of the appendix. We experienced 26- year-old man who underwent ileocecectomy for a presumed diagnosis of an acute appendicitis, which pathologically resulted in a granulomatous appendicitis. The cause of the granulomatous appendicitis might have been Crohn's disease because the patient subsequently developed other manifestations of Crohn's disease, according to the follow-up colonoscopy findings. (Korean J Gastrointest Endosc 2008;37:447-452)

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A Case of Crohn's Disease Isolated to the Appendix, Presented with Weight Loss: Ki Sung Cho, M.D., Jin Woong Cho, M.D., Gum Mo Jung, M.D., Young Jae Lee, M.D., Ji Woong Kim, M.D., Myoung Jin Cho, M.D., Ji Hun Kang, M.D. and Mi Na Oh, M.D.; Korean J Gastrointest Endosc 2008;37(6):443-446. Published online December 30, 2008

Abstract PDF: Granulomatous appendicitis is a rare condition that accounts for less than 0.1∼0.2% of all the cases of appendicitis. The great majority of cases are subacute or recurrent appendicitis and they are treated with interval appendectomy. The remaining causes include Yersinia infection, foreign body reaction, infection by mycobacteria, fungi or parasites, and Crohn's disease isolated to the appendix. Crohn's disease isolated to the appendix has several characteristics such as slow progression, a low recurrence rate and a good prognosis. Crohn's disease isolated to the appendix has recently been called "Idiopathic Granulomatous Appendicitis", and some authors have tried to distinguish it from Crohn's disease involving the appendix. We experienced a case of isolated appendiceal Crohn's disease in a 39-year-old woman and we report on it here along with a review of relevant literature. (Korean J Gastrointest Endosc 2008;37:443-446)

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A Case of Acute Lower Gastrointestinal Bleeding from Appendiceal Ulcer: Dae Seung Lim, M.D., Sun Moon Kim, M.D., Mi Il Kang, M.D., Young Suk Kim, M.D., Seung Hyun Jung, M.D., Yong Moon Kim, M.D., Tae Hee Lee, M.D., Euyi Hyeog Im, M.D., Kyu Chan Huh, M.D., Young Woo Choi, M.D., Young Woo Kang, M.D. and Dae Kyung Ko, M.D.*; Korean J Gastrointest Endosc 2007;35(1):42-45. Published online July 30, 2007

Abstract PDF: The common causes of acute lower gastrointestinal bleeding include diverticulosis, colonic vascular ectasia, neoplasm and colitis. Acute lower gastrointestinal bleeding from the appendix is a very rare malady and the causes are reported as angiodysplasia, diverticulum, appendicitis and endometriosis. We report here on the case of a 47-year-old man, who was taking enteric coated aspirin, with severe lower gastrointestinal bleeding that was due to appendiceal ulcer. An active bleeding was identified as coming from the appendiceal orifice during colonoscopy. He was treated by simple appendectomy. Histologic evaluation showed ulceration with both acute and chronic inflammation, along with thickened vessel walls in the submucosa of the appendix.

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A Case of Metastatic Adenocarcinoma of the Appendix from Stomach Adenocarcinoma: Gyoung Jun Na, M.D., Chae Yong Yi, M.D., Hyun Choul Baek, M.D., Jeong Hoon Kim, M.D., Sang Hoon Bae, M.D., Dong Hyun Kim, M.D., In Soo Je, M.D., Byung Pyo Kwon, M.D., Tae Yeong Lee, M.D., Sang Hyun Kim, M.D., Chul Soo Song, M.D., Min Seok Kim, M.D.* and J; Korean J Gastrointest Endosc 2007;34(5):274-277. Published online May 30, 2007

Abstract PDF: Adenocarcinoma of the appendix is a rare neoplasm. Metastatic adenocarcinoma of the appendix from stomach adenocarcinoma is also a very rare finding. A 72-year-old man complained of right lower quadrant abdominal pain for 10 days, and he was diagnosed with acute appendicitis. Appendectomy was performed by a general surgeon. Adenocarcinoma was found on the postoperative biopsy. Subsequently, gastric adenocarcinoma was diagnosed on the gastroscopy with biopsy, and this was proven to be the original site of the appendiceal adenocarcinoma. (Korean J Gastrointest Endosc 2007;34: 274⁣277)

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Mucocele of the Appendix Secondary to Obstruction by Cecal Endometriosis: Hyun-Min Lim, M.D. and Won-Choong Choi, M.D.; Korean J Gastrointest Endosc 2007;34(2):111-114. Published online March 2, 2007

Abstract PDF: The mucocele of the appendix is an uncommon abnormality caused by a dilatation of the appendiceal lumen caused by the abnormal accumulation of mucus. It can be associated with other colorectal tumors. Endometriosis of the gastrointestinal tract is also rare, particularly in the cecum. An appendiceal mucocele is usually diagnosed by a radiological study or surgery, however, recently, a colonoscopy is becoming an important diagnostic tool for colon diseases. We report a case of appendiceal mucocele. It is believed that the condition developed as a result of an obstruction of the appendicecal lumen caused by endometriosis, and might have been the cause of the intermittent right lower quadrant pain experience by the patient, which was aggravated during the menstrual period.

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Colonoscopic Removal of an Inverted Appendix: Soon Je Kim, M.D., Joon Ho Wang, M.D. and Jae Dong Lee, M.D.; Korean J Gastrointest Endosc 2006;32(6):397-399. Published online June 30, 2006

Abstract PDF: An inverted appendix is a rare condition that occurs congenitally or is the result of surgery or intussusception associated with diseases such as appendix tumors, mucocele, fecalith, or worms. An inverted appendix produces similar abdominal symptoms to acute appendicitis, that vary from non-specific to acute or chronic pain in the right lower abdomen. There are no reports of this condition in Korea that the authors are aware of. We report a case 31-year-old male who visited our hospital complaining of pain in the right lower abdomen. A barium enema showed a moving tubular filling defect. An inverted appendix that appeared as a polyp was dissected by colonoscopy. (Korean J Gastrointest Endosc 2006; 32:397⁣399)

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A Case of Crohn's Disease Confined to the Appendix: Chang-Bai Lee, M.D., Sung-Ae Jung, M.D., Hye-Jung Yeom, M.D., Jong-Soo Lee, M.D., Yoo-Kyung Cho, M.D., Seong-Eun Kim, M.D., Ki-Nam Shim, M.D., Tae-Hun Kim, M.D., Kwon Yoo, M.D. and Il-Hwan Moon, M.D.; Korean J Gastrointest Endosc 2005;31(1):49-52. Published online July 30, 2005

Abstract PDF: Crohn's disease is a condition of chronic inflammation involving potentially any location in alimentary tract, but it is worldwide the rare when primary lesion with its extent is confined to the appendix alone. Because clinical manifestations of the Crohn's disease of the appendix dose not differ from those of acute appendicitis, it is difficult to diagnose preoperatively or intraoperatively, so it is usually diagnosed by postoperative pathologic examination. Because Crohn's disease confined to the appendix has favorable prognosis than typical Crohn's disease, it is considered a separate disease entity from Crohn's disease, and a new diagnostic term-"idiopathic granulomatous appendicitis"-has gained wide acceptance in recent years. We experienced a case of Crohn's disease confined to the appendix or idiopathic granulomatous appendicitis and review, we reported the care with review of the literatures. (Korean J Gastrointest Endosc 2005;31:49⁣52)

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62세 여자, 우하복부 통증: Korean J Gastrointest Endosc 2003;26(5):372-372. Published online May 30, 2003

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43세 여자, 궤양성 대장염 진단 중 발견된 충수 점액류: Korean J Gastrointest Endosc 2003;26(5):371-371. Published online May 30, 2003

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A Case of Acute Lower Gastrointestinal Bleeding from the Appendix: Won Seok Jeong, M.D., Yong Dae Kwon, M.D., Du Rang Kim, M.D., Kyoo Nam Hwang, M.D.,; Korean J Gastrointest Endosc 2003;26(1):39-42. Published online January 30, 2003

Abstract PDF: In spite of the recent advances in diagnostic technology in clinical gastroenterology, identifying the cause of acute lower gastrointestinal bleeding is still a challenging task. Hematochezia from the appendiceal bleeding is rare and associated diseases are appendiceal endometriosis, angiodysplasia, arteriovenous malformation, Crohn's disease, appendicitis, carcinoid, lymphoma, diverticulosis, and intussusception of the appendix. We experienced a 31-year-old male with acute lower gastrointestinal bleeding from the appendix. Colonoscopy could demonstrate an active hemorrhage from the orifice of the appendix. Mesenteric arteriography revealed active bleeding from the appendix, which was managed with gelfoam embolization. Next day, appendectomy was done because of recurrent bleeding. Surgically removed appendix could not dislose any abnormal lesion except a small mucosal break. (Korean J Gastrointest Endosc 2003; 26:39⁣42)

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충수병변이 선행된 비전형적 궤양성 대장염 1예 ( A Case of Atypical Ulcerative Colitis Initially Presented as the Appendiceal Lesion ): Korean J Gastrointest Endosc 1999;19(6):971-974. Published online November 30, 1998

Abstract PDF: Ulcerative colitis (UC) is an inflammatory disease primarily involving the colonic mucosa. The extension of classic UC is uniform and continuous with no intervening areas of normal mucosa. The rectum is usually involved and the inflammation extends proximally in a continuous fashion for a variable distance. However, as more patients get colonoscoped, it had been reported that there is a wide spectrum to what is called UC. There appear to be a few patients with otherwise typical UC but with rectal sparing. And also there are patients with classic distal UC who have an isolated area of cecal disease and segmental UC with skipped area. We have experienced a case of atypical UC initially presented as a isolated lesion around the appendiceal orifice with the segmental distribution of inflammatory change without an active inflammatory lesion in the rectum. It was considered that understanding of the significance of an isolated lesion in the appendix would contribute to the elucidation of the pathogenesis of UC. (Korean J Gastrointest Endosc 19: 971∼974, 1999)

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대장내시경으로 관찰된 충수돌기 Mucinous Cystadenoma 1예 ( A Case of Appendiceal Mucocele ): Korean J Gastrointest Endosc 1992;12(1):111-114. Published online November 30, 1991

Abstract PDF: The appendiceal mucocele is a rare disease and very difficult to get the diagnosis preoperatively because of the rartity of classical symptoms. With progress in diagnostic procedures such as colonofiberscopy, preoperative diagnosis of appendiceal mucocele has become possible. We experienced a case of appendiceal mucocele in 50 years old male who was admitted due to vague RLQ discomfort, and was diagnosed by colonofiberscopy and surgical specimen obtained by right hemicolectomy. So we present this case with a review of literatures.

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