Primary Appendiceal Adenocarcinoma Masquerading as Chronic Pelvic Pain

Douglas N. Brown, MD, Christina L. Jones, DO, Difu Wu, MD, Joseph M. Gobern, MD

Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center Bethesda, Bethesda, MD, USA (Drs. Brown, Jones, Gobern). Department of Pathology, Walter Reed National Military Medical Center Bethesda, Bethesda, MD, USA (Dr. Wu).

ABSTRACT

Introduction: Primary appendiceal adenocarcinoma is an exceedingly rare malignancy of the gastrointestinal tract that most often presents with a clinical picture consistent with acute appendicitis. These appendiceal tumors are frequently diagnosed intraoperatively and are almost never diagnosed preoperatively. In contrast, chronic pelvic pain is a commonly encountered clinical condition that has a plethora of possible etiologies that are often treated medically. In the atypical patient presentation, laparoscopy provides the ultimate diagnostic modality in addition to providing a viable therapeutic surgical option.

Case Description: We present a case of primary appendiceal adenocarcinoma masquerading as chronic pelvic pain in a 32-year-old female patient and discuss the importance of diagnostic laparoscopy in the diagnosis and management of this unusual clinical scenario.

Discussion: Though rare in the young female patient, the possibility of malignancy must always be entertained within the differential diagnosis of chronic pelvic pain. When medical therapy for presumed chronic pelvic pain fails a 3- to 6-month empiric trial, the patient should undergo a full re-evaluation including diagnostic laparoscopy. It is important for the gynecologist and gynecologic oncologist to be familiar with the clinical and pathologic features in addition to the surgical management of these malignancies because primary appendiceal adenocarcinomas may masquerade as chronic pelvic pain.

Key Words: Appendiceal adenocarcinoma, Chronic pelvic pain, Laparoscopy.

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