EP786 - Goblet Cell Carcinoma of the Appendix: A Case Series and Literature Review

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Purpose/Background: Goblet cell adenocarcinoma (GCA) of the appendix is a rare and aggressive appendiceal neoplasm, for which there is currently limited evidence to guide prognosis and treatment

Methods/Interventions: n/a (case series/literature review)

Results/Outcomes: Case #1: 54 year old male presented with acute appendicitis, which was managed initially with antibiotics after shared medical decision making with the patient. Due to increasing pain, the patient was taken for laparoscopic appendectomy, with intraoperative findings of acute perforated appendicitis. Pathological analysis of the resected appendix revealed well-differentiated goblet cell carcinoma with extension into the subserosa along with lymphovascular invasion and perineural invasion; the margins were positive at the base of the appendix (cT3NxM0). A completion colonoscopy, and a complete staging CT were performed, which found no evidence of distant disease. A completion right hemicolectomy was then performed with negative margins and negative nodal metastasis. His final staging was pT3N0M0, high risk stage II. Adjuvant monotherapy with capecitabine is planned for this patient for a course of 6 months.

Case #2: 44 year old male presented with appendicitis, and underwent laparoscopic appendectomy with intraoperative findings of perforated appendicitis. This was complicated by a postoperative readmission ten days later for sepsis and an post-surgical intra-abdominal abscess at the site of appendectomy which was treated with percutaneous drainage. The appendectomy pathology specimen showed goblet cell adenocarcinoma (T3NXM0 with negative margins) with lymphovascular and perineural invasion. An interval right hemicolectomy was performed with final pathology showing negative margins and no lymph node involvement (pT3N0M0, high risk stage II). Of note, a Meckel’s diverticulum was found and resected intraoperatively. Pathology of this small bowel specimen found well differentiated neuroendocrine tumor with negative margins. Adjuvant CAPOX therapy was utilized for this patient for a planned 3 month course.

Conclusion/Discussion: Currently there is limited data available to support the surgical and medical management of goblet cell appendiceal neoplasms. The American Society of Colorectal Surgery (ASCRS) Clinical Practice Guidelines has stated that goblet cell tumors should generally be treated in a similar manner to classic appendiceal adenocarcinomas. While grading, staging, and management of appendiceal goblet cell adenocarcinoma is an evolving area of research, right hemicolectomy is frequently performed following index appendectomy, both for staging and curative intent. This case series aims to offer two examples of the use of right hemicolectomy and adjuvant chemotherapy in the management of GCA, as well as highlight the areas of evolving research surrounding goblet cell appendiceal neoplasms.