EP288 - Unveiling a Rare Appendiceal Goblet Cell Adenocarcinoma: A Case from Saudi Arabia

ePoster Presenter(s)

• RA

  Rimaz Alanazi, Dr

  Medical intern
  Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia
  Jeddah, Makkah, Saudi Arabia

  Disclosure information not submitted.

Author(s)

• AS

  Anmar Faisal Semilan, Dr, n/a

  Consultant colorectal & general Suergery
  KFAFH
  Jeddah, Makkah, Saudi Arabia

  Disclosure information not submitted.
• AA

  Amal Alzahrani, Doctor

  General Surgery Resident
  Department of General Surgery, King Fahd Armed Forces Hospital, Jeddah
  Jeddah, Makkah, Saudi Arabia

  Disclosure information not submitted.
• EB

  Elham Bin abbas, Doctor

  Consultant Histopathologist/ Cytologist
  Department of Pathology and Medical Laboratory King Fahd Armed Forces Hospital, Jeddah
  Jeddah, Makkah, Saudi Arabia

  Disclosure information not submitted.
• WF

  Walaa Felemban, n/a

  Consultant
  .
  Jeddah, Makkah, Saudi Arabia

  Disclosure information not submitted.

Purpose/Background: Background: Appendiceal goblet cell adenocarcinoma (AGCA) is a rare malignancy combining adenocarcinomatous and neuroendocrine features, frequently discovered incidentally after appendectomy for presumed appendicitis. Preoperative diagnosis is challenging due to nonspecific clinical and radiological findings.

Methods/Interventions:

Case Presentation: We report a 45-year-old male who presented with acute right lower quadrant abdominal pain, nausea, and fever. CT imaging supported a diagnosis of acute appendicitis, and the patient underwent appendectomy. Histopathology unexpectedly revealed goblet cell adenocarcinoma, with tumor infiltration through the muscularis propria into periappendiceal tissue. Following diagnosis, he underwent right hemicolectomy, which confirmed a pT3 lesion with isolated tumor cells in regional lymph nodes [pN0(i+)]. Margins were negative. A multidisciplinary tumor board recommended adjuvant CAPEOX chemotherapy. The patient has remained recurrence-free under follow-up.

Results/Outcomes:

Discussion: AGCA typically mimics acute appendicitis and is rarely suspected preoperatively. Imaging is often inconclusive, with histopathology remaining essential for diagnosis. Management usually involves right hemicolectomy with lymph node evaluation, and adjuvant chemotherapy may be indicated depending on stage and pathological risk factors.

Conclusion/Discussion:

Conclusion: This case highlights the deceptive presentation of AGCA and underscores the need for histopathological vigilance in appendectomy specimens. Timely recognition, appropriate surgical management, and multidisciplinary care are critical for optimizing patient outcomes.

Figure 1.
Figure 1. Low-power histopathology of the appendiceal specimen showing diffuse infiltration of the appendiceal wall by irregular nests, clusters, and single goblet cells extending beyond the mucosa into the muscularis propria and periappendiceal tissue. (H&E stain, ×40)


Figure 2.
Figure 2. Intermediate-power view demonstrating neoplastic goblet cells arranged in irregular clusters within a mucinous background. The cells have eccentrically placed nuclei, abundant intracytoplasmic mucin, and mild-to-moderate nuclear atypia. (H&E stain, ×100)