"A 69-year-old male patient, with no relevant past medical history, was admitted to University Hospital Center of Oporto (Oporto, Portugal) with acute right lower quadrant abdominal pain with less than 24 hours of evolution. No other symptoms associated.
At physical examination, the patient was distressed, with body temperature of 37°C, hemodynamically stable, no signs of respiratory distress. The abdominal examination revealed the presence of positive Rovsing and Blumberg signs and no palpable masses. Laboratory tests were performed, yielding the following results: white blood cell count, 10.3 × 10^3 cells/μL; neutrophil proportion, 77.2%; hemoglobin level, 14.4 g/dl; platelet count 149 × 10^3 cells/μl; C-reactive protein 32.77 mg/l; sodium 141 mmol/l; creatinine 1.06 mg/dl. Without changes in the coagulation study. Abdominal ultrasound and CT scan revealed the findings consistent with appendicitis.
The patient underwent to a laparoscopic appendectomy. Intraoperatively, an acute suppurative appendicitis with localized abscess was diagnosed. The resection of the appendix was completed. The patient completed antibiotherapy course and was discharged 5 days after, with no complications.
The histopathological exam of the specimen showed acute appendicitis with morphologic aspects and immunohistochemistry (chromogranin A and CD56 +) well matched with neuroendocrine tumor of the appendiceal tip (pT1R0-G1), measuring 6 mm at the maximum dimension, infiltrating the muscular layer. The mitotic activity of the lesion was low (<2 mitosis/10× magnification). Coexisting acute suppurative appendicitis was also present.
The case was discussed in a multidisciplinary oncologic reunion and was decided for surveillance.
Soure: Journal of Surgical Case Reports, Volume 2019, Issue 3, March 2019, rjz086