Appendiceal adenocarcinoma arising from serrated lesions: A case report

doi:10.4251/wjgo.124384

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Case Report

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Nov 15, 2026; 18(11): 124384
Published online Nov 15, 2026. doi: 10.4251/wjgo.124384

Appendiceal adenocarcinoma arising from serrated lesions: A case report

Ying-Ling Liu, Wen-Jun Jiang, Jia-Qin Xu, Liang-Liang Huang, Jie Liu, Ye-Tao Wang

Ying-Ling Liu, Wen-Jun Jiang, Jia-Qin Xu, Jie Liu, Ye-Tao Wang, Department of Gastroenterology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China

Liang-Liang Huang, Department of Pathology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China

Author contributions: Liu YL, Jiang WJ, Xu JQ, and Liu J contributed to data curation and formal analysis; Huang LL contributed to pathological analysis; Wang YT contributed to conceptualization, data curation, formal analysis, investigation, and methodology, supervision, visualization, review and editing; and all authors thoroughly reviewed and endorsed the final manuscript.

AI contribution statement: During the preparation of this manuscript, the author(s) used an AI-based language polishing tool (DeepSeek) solely for the purpose of improving grammar, clarity, and readability. No AI tool was used to generate research data, draw scientific conclusions, or replace the intellectual contributions of the author(s). All content has been critically reviewed and approved by the author(s), who take full responsibility for the originality, accuracy, and integrity of the work submitted.

Supported by Research Project of the Chinese Digestive Early Cancer Physicians’ Joint Growth Program, No. GTCZ-2021-AH-34-0012.

Informed consent statement: Study participant provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Ye-Tao Wang, Chief Physician, Department of Gastroenterology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei 230001, Anhui Province, China. wangyt96@163.com

Received: June 16, 2026
Revised: July 20, 2026
Accepted: August 10, 2026
Published online: November 15, 2026
Processing time: 136 Days and 1.5 Hours

Abstract

BACKGROUND

The association between serrated lesions of the appendix and the development of appendiceal adenocarcinoma has been inadequately characterized in the existing literature. Moreover, the feasibility and safety of endoscopic resection for such malignancies remain underexplored. To our best knowledge, this case report firstly provides evidence that appendiceal adenocarcinoma can arise secondary to serrated lesions and demonstrates successful complete endoscopic resection.

CASE SUMMARY

A 70-year-old male patient with a medical history significant for hypertension was incidentally identified to have a polypoid lesion located in the appendiceal fossa during a routine physical examination. Subsequent outpatient colonoscopy revealed a polypoid protrusion accompanied by thickening of the surface glandular ducts. Histological analysis of biopsy specimens demonstrated mucinous epithelium with mild atypical hyperplasia, without evidence of invasive growth. Contrast-enhanced abdominal computed tomography imaging showed an elongated and thickened appendix. Endoscopic ultrasound examination revealed heterogeneous hypoechoic alterations. The patient underwent an endoscopic transcecal appendectomy, involving full-thickness resection performed with an insulated-tip electrosurgical knife. Hemostasis was successfully achieved via electrocoagulation, and the resultant full-thickness defect was closed using metal clips reinforced with nylon sutures. The postoperative course was uneventful, and the patient was discharged on postoperative day seven. Histopathological evaluation confirmed the presence of differentiated adenocarcinoma with mucinous components, invading the muscularis propria and focally extending to the serosal layer, without evidence of neural or vascular invasion, and with negative resection margins; lymph node assessment revealed no metastasis (0/1). Immunohistochemical analysis demonstrated asymmetric Ki-67 expression and diffuse cytokeratin 20 positivity, consistent with adenocarcinoma arising from a serrated lesion. The patient subsequently underwent additional surgical intervention (right hemicolectomy), which revealed no residual tumor.

CONCLUSION

Appendiceal adenocarcinoma can arise secondary to serrated lesions, and complete endoscopic resection via transcecal appendectomy appears technically feasible and safe in this selected case. Comprehensive endoscopic assessment and en bloc resection are recommended to achieve accurate pathological staging and exclude occult malignancy. However, larger studies are needed to establish the definitive role of this approach.

Keywords: Appendiceal neoplasms; Serrated lesions; Adenocarcinoma; Endoscopic mucosal resection; Transcecal appendectomy; Case report

Core Tip: To our best knowledge, this is the first reported case of appendiceal adenocarcinoma arising from serrated lesions that was successfully treated by endoscopic transcecal appendectomy. The technique avoids abdominal incision, reduces postoperative complications, and allows precise pathological staging. Immunohistochemistry (Ki-67 asymmetry, cytokeratin 20 positivity) was pivotal in confirming the serrated origin. This case highlights the need for complete resection of serrated lesions at the appendiceal orifice.