Carcinoma of the Appendix

THE patient was a woman of 62 years of age. The personal history revealed nothing relevant. The present affection dates back about eight months,. and was attributed by the patient to a fall. Following this fall she had pain in the epigastrium and had vomited frequently. The vomiting increased in frequency, and recently had been very copious. She was conscious of many gurgling and splashing sounds. She had been very constipated and had lost two and a half stones in weight. There is a history of one attack of muscular cramps in the limbs which were thought to be due possibly to an attack of tetany following the excessive vomiting. On examination she was antemic, wasted, and dehydrated. The abdominal wall was thin and the pylorus was palpable. The liver was not enlarged. A diagnosis of advanced pyloric stenosis was made, and it was therefore decided to treat by operation. The abdomen was opened under gas and oxygen combined with local infiltration of the abdominal wall. The stomach was not unduly enlarged, and the pylorus was normal. No lesion was found in the gall-bladder, liver, or pancreas. In the free edge of a large gastro-colic omentum, four distinct lumps were found, each about the size of a walnut, firm in consistency and a reddish brown in colour. The only other lesion found was in the appendix, which was somewhat enlarged and presented the same reddish-brown colour as the masses in the omentum. The appendix and the four lumps were removed and sent for pathological examination. The patient died fourteen days after operation. Dr. J. A. Fisher reported that the appendix was the seat of a primary adeno-carcinoma, and that the omentum tumours were secondary deposits. The following points are perhaps worthy of notice: The epigastric pain and vomiting were probably due to appendicular obstruction distal to the tumour, but it is difficult to account for the copiousness of the vomit and the amount of wasting. The manner in which the secondary deposits were stretched in a row along the free border of the omentum suggests that these four points of the omentum were in successive contact with the appendix, and that the secondaries grew by direct trans-ference of the tumour cells. The rarity of carcinoma of the appendix is in striking contrast to the frequency of its other pathological weaknesses. In a series of 13,000 appendices, Riemann reported seventeen cases …