A rare case of brain metastases from appendiceal carcinoma: A case report

Introduction: Primary appendiceal carcinoma is a rare form of gastrointestinal (GI) cancer, accounting for less than 1% of all GI tumors, with few cases involving metastatic disease. Here, we report a case, described infrequently in literature, of a brain mass found to be metastases from appendiceal carcinoma. Case Report: We report the case of a 76-year-old male with a past medical history (PMH) of chronic lymphocytic leukemia (CLL) and appendiceal carcinoma who was transferred to our hospital after a witnessed seizure. Appendiceal carcinoma was previously diagnosed via colonoscopy for which he had surgical intervention and initially was managed expectantly. He was later noted to have an elevated carcinoembryonic antigen (CEA) with new soft tissue implants on computed tomography (CT). Omental biopsy confirmed presence of adenocarcinoma and systemic chemotherapy was initiated. The patient presented to an outside hospital where he had a pathologic fracture of the left humerus. On day of scheduled surgical repair he had a witnessed seizure. Magnetic resonance imaging (MRI) brain revealed a lesion in the left frontal lobe. The patient underwent craniotomy and resection of the lesion with final pathology revealing metastatic adenocarcinoma. Conclusion: Although cerebral metastases are seen in approximately 5% of patients with GI cancers, local spread to peritoneal sites is more common. Distal spread is less likely to occur, documented in only 2% of appendiceal carcinoma cases. Due to this, there is no standard treatment regimen. It is important to recognize that although rare, appendiceal carcinoma does have the potential to metastasize to the brain and cause life-threatening sequelae.