Adenocarcinoma of the appendix vermiformis

Adenocarcinoma of the appendix is exceedingly rare. This paper adds reports of four appendiceal adenocarcinomas to the English language surgical literature. This small experience does not purport to establish the optimal surgical procedure for this disease. Rather, these cases epitomize the capricious behavior of this cancer, which is far more aggressive than generally thought. Recent survival studies have indicated improved prognosis if appendectomy is followed by right hemicolectomy. Case 1 reflects the highly lethal nature of some appendiceal cancers which progress despite early aggressive treatment. This appendiceal tumor was not ruptured, and seemingly an optimistic prognosis was warranted. The actual outcome was death in 3 1/2 years post‐operatively from hematogenous metastases to the lung, brain, and bone. Case 2 is is thought to be the first recorded instance of a correct preoperative diagnosis of carcinoma of the appendix. This carcinoma was treated by a primary right hemicolectomy, and the patient remains alive and well. Case 3 illustrates the benign course of this malignancy in some individuals. Though the treatment circumstances were so unfavorable as to simulate an experimental design to induce cancer spread, this patient has survived for 15 years without evidence of recurrent or metastatic cancer. Case 4 is a prototype of most reported adenocarcinomas of the appendix—a carcinoma in situ in an appendix removed at the time of pelvic surgery. This stage of appendiceal cancer is cured by a simple appendectomy. This fact is partially responsible for the controversy regarding the extent of bowel resection required to cure appendiceal cancer (Berman and Charles, 1967).