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Contrast-enhanced CT demonstrated a cecal mass with systemic metastasis, including cutaneous lesions, bone involvement, peritoneal dissemination and ascites. Colonoscopy showed a circumferential elevated cecal lesion. Right hemicolectomy confirmed poorly differentiated adenocarcinoma arising from the appendix with BRAFV600E mutation and microsatellite instability-high. Chemotherapy was initiated and she remained alive under treatment.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/advanced-appendiceal-cancer-with-systematic-metastasis-without-gastrointestinal-symptoms-found-by-subcutaneous-tumor-case-report/381737/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/advanced-appendiceal-cancer-with-systematic-metastasis-without-gastrointestinal-symptoms-found-by-subcutaneous-tumor-case-report/381737.png","ImageObject",300,407,{"name":92,"@type":93},"eBook King","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Why was the patient diagnosed with advanced appendiceal cancer despite no gastrointestinal symptoms?","Question",{"text":112,"@type":113},"The diagnosis was made after cutaneous metastasis was detected: a subcutaneous nodule in the left axilla led to CT findings of a cecal mass and systemic metastases, prompting further evaluation.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What metastatic sites were identified in this case?",{"text":117,"@type":113},"Imaging showed systemic metastasis including cutaneous lesions, bone metastases, peritoneal dissemination, and ascites.",{"name":119,"@type":110,"acceptedAnswer":120},"What key pathology and molecular features were reported after surgery?",{"text":121,"@type":113},"The cecal mass was poorly differentiated adenocarcinoma arising from the appendix, with a BRAFV600E mutation and microsatellite instability-high status.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},381737,1790471778,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},962088006270,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","doi: 10.2169/internalmedicine.0597-22  \nIntern Med 62: 2655-2660, 2023  \n[http://internmed.jp](http://internmed.jp)  \n【CASE REPORT】  \n\n| Advanced Appendiceal Cancer with Systematic Metastasis without Gastrointestinal Symptoms Found by Subcutaneous\u003Cbr>Tumor |  |\n| --- | --- |\n| Satoshi Nakamura 1, Yorinari Ochiai 1, Yuki Nishihara 2, Anri Koyanagi 3, Yasurou Miura 3, Daisuke Kikuchi 1, Yutaka Takazawa 3, Hiroya Kuroyanagi 2 and Shu Hoteya 1 |  |\n| Abstract:\u003Cbr>An 86-year-old woman with a subcutaneous nodule in her left axilla visited our hospital. She had no gastrointestinal symptoms, but contrast-enhanced computed tomography revealed a cecal mass and systemic metastasis, including cutaneous, bone, peritoneal dissemination and ascites. Colonoscopy revealed a circumferential, elevated cecal lesion. She underwent right hemicolectomy to prevent colon obstruction. The pathological diagnosis was poorly differentiated adenocarcinoma (por1>tub2>muc) arising from the appendix with a BRAFV600E mutation and microsatellite instability-high. Chemotherapy was administered, and she is currently still alive and undergoing chemotherapy. We describe a rare case of advanced appendiceal cancer without gastrointestinal symptoms diagnosed due to cutaneous metastasis.\u003Cbr>Key words: appendiceal cancer, cutaneous metastasis, systematic metastasis, BRAF mutation, high microsatellite instability\u003Cbr>(Intern Med 62: 2655-2660, 2023)\u003Cbr>(DOI: 10.2169/internalmedicine.0597-22) |  |\n| metastasis without gastrointestinal symptoms. |  |\n| \u003Cbr>Introduction\u003Cbr>\u003Cbr>Case Report |  |\n| Colorectal cancer (CRC) is the world’s fourth-most |  |\n| deadly cancer and is associated with approximately 900,000 | An 86-year-old woman visited an orthopedic surgeon at |\n| deaths each year. In addition to the aging population and | another hospital for pain in her left shoulder, but the cause |\n| diet of high-income countries, other risk factors, including | was unknown. She was aware of a subcutaneous nodule in |\n| obesity, lack of exercise and smoking, increase the risk of | the left axilla and visited the dermatology department at our |\n| CRC (1) . Most people with early-stage CRC have no symp- | hospital. Computed tomography (CT) performed by our der- |\n| toms; therefore, CRC is sometimes discovered as a result of | matologist examined the suspected axillary lymph node |\n| workplace or community examinations. Common symptoms | swelling and revealed a cecal mass. Following this, the der- |\n| of advanced CRC include bleeding from the anus and con- | matologist introduced her to our department, and she was |\n| stipation. | admitted for an examination of the cecal mass. |\n| CRC commonly metastasizes to the liver and lungs, while | No abnormalities were found in her vital signs at the time |\n| subcutaneous or cutaneous metastases are scarce (2) . For al- | of admission. Her physical findings included multiple nod- |\n| most all cancers, cutaneous involvement often suggests a | ules in the left axilla and subcutaneous nodules in the lateral |\n| poor prognosis (3, 4) . | chest (Fig. 1) . There were no abnormal findings in her head |\n| We herein report a rare case of advanced appendiceal can- | and neck or abdomen, and her heart and breath sounds were |\n| cer with systemic metastasis diagnosed due to cutaneous | normal. She had a medical history of aplastic anemia, pre- |\n\n1 Department of Gastroenterology, Toranomon Hospital, Japan, 2 Department of Gastroenterological Surgery, Toranomon Hospital, Japan and 3 Department of Pathology, Toranomon Hospital, Japan  \nReceived: July 10, 2022; Accepted: December 14, 2022; Advance Publication by J-STAGE: February 8, 2023  \nCorrespondence to Yorinari Ochiai, [y.ochiai.1987@gmail.com](y.ochiai.1987@gmail.com)  \nFigure 1. Cutaneous metastasis in the lateral chest. A 15-mm milky-white subcutaneous nodule with a well-defined border was found in the lateral chest.  \nFigure 2. Computed tomography (CT) showing appendiceal cancer and systematic metasta","cbCaivaBp05oQ16k","https://ap.wps.com/l/cbCaivaBp05oQ16k","pdf",1792947,"English","# Case Report\n## Introduction\n## Case Presentation\n## Laboratory Data\n## Imaging and Diagnosis","[{\"question\":\"Why was the patient diagnosed with advanced appendiceal cancer despite no gastrointestinal symptoms?\",\"answer\":\"The diagnosis was made after cutaneous metastasis was detected: a subcutaneous nodule in the left axilla led to CT findings of a cecal mass and systemic metastases, prompting further evaluation.\"},{\"question\":\"What metastatic sites were identified in this case?\",\"answer\":\"Imaging showed systemic metastasis including cutaneous lesions, bone metastases, peritoneal dissemination, and ascites.\"},{\"question\":\"What key pathology and molecular features were reported after surgery?\",\"answer\":\"The cecal mass was poorly differentiated adenocarcinoma arising from the appendix, with a BRAFV600E mutation and microsatellite instability-high status.\"}]","Advanced Appendiceal Cancer with Systematic Metastasis without Gastrointestinal Symptoms Found by Subcutaneous Tumor - Case Report | PDF",1790246818,15]