Appendiceal schwannoma: a rare cause of perforated appendici
The present case has been reported in BMJ. An 82-year-old woman presented to the emergency department with an acute abdomen. CT imaging revealed a proximal appendiceal mass with distal appendicitis. She underwent a laparoscopic appendicectomy with partial caecectomy and subsequent histopathology confirmed an appendiceal schwannoma.

The woman presented with a 1-day history of acute abdominal pain localised to the lower quadrants, worse on mobilisation, loss of appetite and fever. She denied any previous abdominal pain, nausea or vomiting, bowel or bladder symptoms. There was no history of weight loss, generalised fatigue or other symptoms of chronic anaemia. She had been well in the preceding weeks. Her medical history was significant for a cerebrovascular accident, hypertension and hypercholesterolaemia. She had never had previous abdominal surgery.

On examination the patient had a temperature of 37.7°C. There were no signs of haemodynamic instability. Her abdomen was rigid with severe tenderness on palpation, worse in the right lower quadrant. Generalised percussion tenderness was present.

A CT scan revealed a 23 mm proximal appendiceal mass with associated distal appendiceal dilatation and surrounding inflammation. The patient underwent an urgent laparoscopic appendicectomy, partial caecectomy and washout. A partial caecectomy was performed given the intraoperative appearances of a thickened appendix base and radiological evidence of a proximal mass in order to ensure a tumour-free margin.

The appendix was perforated with copious amounts of pus; however, the caecum appeared normal. Her recovery was uneventful and she was discharged with outpatient follow-up.

Histopathology demonstrated characteristic features of a schwannoma including spindle cell morphology, nuclear palisading, Verocay bodies and positive S-100 and negative CD34 and CD117 staining. Although the tumour bulged into the mesoappendix, all margins were clear.

Learning points
• This case highlights a relatively common tumour, in an unusual location, presenting as acute appendicitis.

• Even though it is a benign and completely excised tumour, it serves as an important reminder to consider the various aetiologies of acute appendicitis preoperatively and intraoperatively as this may determine surgical technique and follow-up.

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