Louisiana Via Research Day Book 2026

Case Studies: Section 1

Berony Geneste, OMS-III; Sabeen Wazir, OMS-III; Lydia Ta, OMS-III; Jude Aguilard, OMS-III; Savannah Newell, PhD; Stephen Wheelis, MD 1 VCOM-Louisiana 28 AN ATYPICAL PRESENTATION OF APPENDICEAL ADENOCARCINOMA IN POLYCYSTIC KIDNEY DISEASE BERONY GENESTE, SABEEN WAZIR, LYDIA TA, JUDE AGUILARD, SAVANNAH NEWELL, STEPHEN WHEELIS

Context: Appendiceal adenocarcinoma is a rare gastrointestinal malignancy that typically presents with nonspecific symptoms and is frequently misdiagnosed as acute or chronic appendicitis. Diagnostic delay is common, particularly in patients with comorbid conditions such as autosomal dominant polycystic kidney disease, where chronic abdominal symptoms and complex abdominal anatomy may obscure underlying malignancy. This case highlights how prolonged conservative management in the setting of polycystic kidney disease can delay definitive diagnosis and limit therapeutic options. Report of Case: An 81-year-old male with a history of end stage renal disease secondary to autosomal dominant polycystic kidney disease, hypertension, type II diabetes mellitus, and chronic normocytic anemia presented with recurrent right lower quadrant abdominal pain, low grade fever, anorexia, and marked leukocytosis. One year prior to presentation, the patient was diagnosed with suspected perforated appendicitis complicated by intraabdominal abscess formation and was managed conservatively with percutaneous drainage that remained in place long term.

After accidental drain removal and persistent inflammatory findings on repeat computed tomography imaging, the patient presented with a white blood cell count of 34.5 ×10³/µL. Imaging demonstrated a persistent inflammatory process involving the right lower quadrant and retroperitoneum. Attempts at interventional radiology guided drainage were unsuccessful due to a mass like obstruction, prompting exploratory laparotomy. Intraoperative findings included dense inflammatory adhesions, extensive purulence, a cecal fistula, and complete obliteration of the appendix. Resection of the terminal ileum and cecum demonstrated colonic adenocarcinoma with mucinous features, highly suspicious for primary appendiceal adenocarcinoma. Given the patient advanced age, extensive comorbidities, and intraoperative findings, curative surgical or oncologic intervention was not pursued. After shared decision making, the patient elected palliative care. Conclusions: Appendiceal malignancies comprise less than 1% of colonic cancers and are commonly identified incidentally or during evaluation for appendicitis, reflecting the low

clinical suspicion and nonspecific presentation described in the literature. Consistent with prior studies, mucinous neoplasms are frequently misdiagnosed as acute appendicitis or discovered incidentally, and unlike colorectal cancers, often present as surgical emergencies or chronic inflammatory processes, as seen in this patient. In contrast to most reported cases, this patient experienced a prolonged course following conservative appendicitis management, with chronic abscess formation and coexisting polycystic kidney disease likely obscuring diagnosis and contributing to advanced disease. Clinically, persistent or recurrent appendiceal pathology should prompt evaluation for malignancy to enable timely diagnosis and preserve curative options. Methods: A focused literature review was conducted using PubMed, PMC, NCBI Bookshelf, and major oncology and surgical journals. Search terms included appendiceal adenocarcinoma, appendiceal cancer presenting as appendicitis, chronic appendicitis malignancy, conservatively managed appendicitis cancer risk, polycystic kidney disease gastrointestinal malignancy, and appendiceal cancer PKD.

Case Studies: Section 1

IN THE PHOTO: Stephen DiGiuseppe, PhD

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2026 Research Recognition Day