Taverna et al. BMC Cancer 2010, 10:62 http://www.biomedcentral.com/1471-2407/10/62 Page 2 of 4 Figure 1 Enhanced abdomen CT scan demonstrate a 6 cm × 2,5 cm anterior bladder mass. Figure 2 Enhanced abdomen CT scan reconstruction showing the bladder lesion at the level of the anterior wall. colonizing a mesenteric lymph-node. Appendectomy and right hemicolectomy with ileocolic anastomosis, lymphadenectomy and partial cystectomy limited to the anterior wall of the bladder was therefore performed. The definitive pathological examination revealed a muci- nous cystoadenocarcinoma of the appendix (2,5 cm × 3 cm × 2 cm) invading the caecal wall with metastasis of the anterior wall of the bladder (Figure 5A). Adjacent to the tumour in the intestinal mucosa foci of high grade dysplasia/adenocarcinoma in situ were also identified (Figure 5B). In addition, metastasis were found in 15/37 (40%) peri-colic lymph-nodes. The pathological staging was: pT4N2M1 (TNM classification), stage D (Dukes, Astler and Coller classification). A mutational analysis for k-Ras was done and the tumour resulted k-Ras mutated. A radiological tumour assessment after surgery showed a suspicion of disease persistence to the intra- abdominal lymph-nodes and to the pelvis (cystic lesion), with an increased of carcinoembryonic antigen (CEA) serum level (29 ng/ml). From May to October 2009 the patient received 12 cycles of a first line chemotherapy with fluorouracil, folic acid, irinotecan (FOLFIRI regi- ment), and bevacizumab. Radiological tumour assess- ment after 4 and 8 cycles showed stable disease with a reduction of CEA serum level (14 ng/ml and 10 ng/ml, respectively). The radiological tumour assessment at the end of chemotherapeutic treatment (November 2009) showed a volumetric progressive disease at the level of the pelvic cystic lesion (confirmed by cytological analy- sis), whereas a further reduction of CEA serum level (7 ng/ml) was observed. The patient is going to receive a second line chemotherapy with fluorouracil, folic acid (de GRAMONT regiment), and bevacizumab. At this time no further bladder lesions have been detected dur- ing a cystoscopy inspection. Conclusions Appendiceal adenocarcinoma is rare with a frequency of 0.08% of all surgically removed appendices. To our best knowledge it was reported few cases of appendiceal carci- noma infiltrating the bladder wall for spatial contiguity [1-11]. It is recognized that tumours of the pelvic organs (i.e. ovary, colon and rectum) may invade the urinary bladder [10,11]. In these cases symptoms presenting complaints urinary disease and eventually symptoms referable to the gastrointestinal tract [2]. All patients undergo appendectomy, segmental bladder resection or cystectomy and segmental caecal resection or right colectomy [5-9]. In our case the bladder neoplasia was Figure 3 The first pathological examination revealed a mucinous adenocarcinoma suspicious for primary of the bladder (A), infiltrating the full thickness of the visceral wall (B). Objective magnification: 20×.