Komal Lakhani, MD
New York, New York
Komal Lakhani, MD1, Isabella Bergagnini, DO1, Dan Hogan, DO1, Varun Kesar, MD2, Arun Swaminath, MD1
1Lenox Hill Hospital, New York, NY; 2Carilion Clinic, Roanoke, VA
Introduction: Goblet Cell Carcinoid (GCC) is a rare neoplasm comprising 0.3-0.9% of appendectomy specimens and less than 14% of all malignant masses of the appendix. While abdominal pain is a common presenting complaint of GCC, rarely does it manifest as an acute perforated appendicitis, as depicted in the case below.
Case Description/Methods: A 66 year old male with a medical history of hypertension, heart failure, endocarditis, chronic alcoholic pancreatitis presented with RLQ pain 3 days prior with associated fevers, chills, nausea, vomiting and maroon colored stools. His vitals were stable with exam notable for diffuse lower abdominal tenderness and no rebound tenderness. Labs demonstrated a mild leukocytosis of 11.7 and negative blood cultures. CT abdomen and pelvis revealed a small appendiceal abscess and acute appendicitis for which he was treated with intravenous fluids and antibiotics, then was discharged on day 3 with oral antibiotics. 7 days later, he was readmitted with intractable nausea and vomiting. Repeat CT revealed mild improvement in acute appendicitis with labs notable for a leukocytosis of 14 for which he was restarted on antibiotics. Six days later, he underwent a laparoscopic appendectomy as repeat CT was concerning for persistent appendicitis with necrosis[Fig-1]. Intra-operatively, the appendix was found to be ruptured. Pathology of appendiceal specimen revealed GCC [Fig-2]. His hospital course was also complicated by septic shock and respiratory failure requiring intubation, and acute tubular necrosis requiring hemodialysis. The patient eventually improved and underwent a staging right hemicolectomy which identified lymphovascular invasion and node positivity [Fig-3].
Discussion: GCC, a rare appendiceal malignancy of both neuroendocrine and glandular histological features, accounts for less than 5% of all primary tumors of the appendix. Presentation varies from no symptoms to overt gastrointestinal bleeding, with acute appendicitis as the most common initial manifestation. While GCC is of a more aggressive phenotype compared to its benign carcinoid tumor counterpart, prognosis is generally favorable. However in 15-30% of cases, metastasis to the ovaries, pelvis, abdominal cavity, ribs, vertebra and lymph nodes has been observed. Surgery is typically the treatment of choice with tumors < 2 cm confined to the appendix requiring only an appendectomy. For larger tumors with nodal involvement, right hemicolectomy within 3 months after appendectomy followed by chemotherapy is warranted.
Citation: Komal Lakhani, MD; Isabella Bergagnini, DO; Dan Hogan, DO; Varun Kesar, MD; Arun Swaminath, MD. P1084 - GOBLET CELL CARCINOID: AN UNUSUAL PRESENTATION OF ACUTE ABDOMINAL PAIN. Program No. P1084. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.