Right pelvic mass in a patient with a radically resected carcinoid of the appendix

CLINICAL PRESENTATION A 22-year-old male patient with a radiologically detected right pelvic mass presented without any symptoms. Two years before he underwent appendectomy due to acute appendicitis elsewhere, and a carcinoid was incidentally diagnosed. Our revised histological report confirmed a conventional carcinoid of the appendix, excluding a goblet cell carcinoid (adenocarcinoid). The tumour infiltrated the whole wall thickness without serosal invasion; margins were negative; the macroscopic size of the tumour had been omitted in the original pathology report. Immunohistochemical chromogranin-A, neuron specific enolase, and synaptophysin were positive. Follow-up was negative over the two subsequent years. Then abdominal ultrasound showed a 2 cm nodule on the medial side of the ascending colon on the transverse umbilical line. Somatostatin receptor scintigraphy was only positive at that site (fig 1). A CT scan showed a 4 cm mass in the right iliac fossa, near the caecum (fig 2). A colonoscopy was performed, and an extrinsic compression in the distal part of ileum was demonstrated. Plasma CgA and urinary 5-hydroxyindoleacetic acid were normal