A rare triad of appendiceal diverticula, appendiceal carcinoid, and colonic diverticula

Abstract

Appendiceal diverticulosis is a rare finding associated with appendiceal neoplasms. Both can masquerade as appendicitis in patients and are overlooked in differentials of right upper quadrant pain. A 37-year-old African American female presented with appendicitis-like symptoms to the emergency room with fever and leukocytosis. Appendectomy was performed with pathological evaluation revealing coexisting appendiceal diverticula and carcinoid of the appendix with lymphovascular invasion and mesoappendiceal involvement. In line with the National Comprehensive Cancer Network guidelines, right hemicolectomy with lymph node dissection was performed which was negative for neoplastic invasion but positive for colonic diverticulosis. While there have been many case reports of appendiceal diverticula with coexisting appendiceal carcinoid, a concurrent colonic diverticulum in the right hemicolectomy specimen during the oncologic resection of the appendiceal carcinoid has not been previously reported. We propose colonic diverticula as another possible feature that may be associated with appendiceal diverticula especially with an underlying appendiceal neoplasm.

Keywords: Appendiceal diverticula; appendiceal carcinoid; colonic diverticula; colorectal surgery; surgical oncology.

Figure 1.

CT scan of the abdomen showing an inflamed appendix with no peri-appendiceal wall thickening or fat stranding. No appendiceal diverticulitis was visible.

Figure 2.

Appendiceal diverticulosis gross histopathology. Appendiceal diverticulosis (arrow). No appendicitis was seen.

Figure 3.

Neuroendocrine cells in mucosa of appendix (magnification: 100×).

Figure 4.

Chromogranin stain of appendiceal specimen (magnification: 100×).