Appendiceal goblet cell adenocarcinoma synchronous with ascending colon adenocarcinoma and severe anemia: A case report

Abstract

Rationale: Appendiceal goblet cell adenocarcinoma (AGCA) synchronous with colorectal cancer (CRC) is extremely rare, with only a few cases reported in the literature. The oncogenic mechanisms, diagnosis, and treatment of the coexistence of AGCA and CRC face significant challenges. This case report describes a patient diagnosed with ascending colon adenocarcinoma and severe anemia. Pathological examination after radical right hemicolectomy revealed goblet cell adenocarcinoma in the appendix. The patient subsequently received postoperative chemotherapy, and the prognosis was favorable.

Patient concerns: A 61-year-old female presented with abdominal pain and distension lasting over 6 months and was admitted to the hospital with a red blood cell count of 2.5 × 109/L and hemoglobin levels of 55.00 g/L.

Diagnoses: Abdominal computed tomography demonstrated thickening of the ascending colon, raising suspicion of a colon tumor, and no abnormality in the appendix. Colonoscopy confirmed the presence of a mass in the ascending colon, and the biopsy results suggested adenocarcinoma. The preoperative diagnosis was ascending colon adenocarcinoma with severe anemia.

Interventions: After a multidisciplinary discussion, the patient underwent radical right hemicolectomy under general anesthesia.

Outcomes: Postoperative pathology revealed ascending colon adenocarcinoma and AGCA. The patient subsequently received postoperative chemotherapy, and the prognosis was favorable.

Lessons: Synchronous AGCA with CRC are rare. The oncogenic mechanisms, diagnosis, and treatment of the coexistence of AGCA and CRC face significant challenges, and radical tumor resection combined with postoperative chemotherapy is an important treatment strategy. We contend that for patients with AGCA combined with ascending colon adenocarcinoma, radical right hemicolectomy is a reasonable approach, as it allows for the simultaneous radical resection of tumors in both locations.

Keywords: anemia; appendiceal goblet cell adenocarcinoma; colorectal cancer; right hemicolectomy; synchronous.

Figure 1.

Computed tomography image (transverse section) shows ascending colon tumor (red arrow).

Figure 2.

Computed tomography image (transverse section) shows a normal appendix (blue arrow), cecum (red arrow), and terminal ileum (white arrow).

Figure 3.

Colonoscopy image shows a tumor in the ascending colon with surface congestion and erosion.

Figure 4.

Differentiated adenocarcinoma of the ascending colon, within the muscularis propria, there are variably sized atypical glandular structures demonstrating infiltrative growth, accompanied by fibrous stromal proliferation and prominent lymphocytic infiltration (HE staining ×100 times).

Figure 5.

Within the muscularis propria of the appendix, there are abundant atypical cells arranged in nests, glandular-like structures, or cord-like patterns, with neoplastic cells exhibiting infiltrative growth within the muscular layer (HE staining ×100 times).

Figure 6.

Microscopic features of appendiceal goblet cell adenocarcinoma, The neoplastic cells demonstrate marked variation in size, resembling signet-ring cells and small intestinal goblet cells, with cytoplasm distended by abundant mucin and crescent-shaped nuclei displaced to the cellular periphery (HE staining ×400 times).