Metastatic Carcinoma Breast Presenting as Appendicular Abscess

Breast cancer is the most common cancer in females worldwide and presents mostly as a hard painless lump in breast. Authors report a case of a 59-year-old female who presented to emergency department with complaints of pain and lump in right iliac fossa, high grade fever with chills and rigor, multiple episodes of vomiting. She was febrile having tachycardia with normal blood pressure. Examination revealed a firm tender lump in right iliac fossa with guarding of abdomen. Incidental finding of a large left sided breast lump was noted. Radiological investigations revealed appendicular abscess. She was undertaken for emergency diagnostic laparoscopy followed by appendectomy. Surprisingly, histopathology revealed deposits of ductal carcinoma in appendix. She developed faecal fistula at incision site. On further evaluation of left breast lump it was diagnosed as locally advanced breast carcinoma. Patient was managed with neo-adjuvant chemotherapy followed by left sided Modified Radical Mastectomy (MRM) and adjuvant chemotherapy. She was on regular follow- up since then. Appendicular metastasis is one of the rare sites of metastasis of breast malignancy and presentation as appendicular abscess made the diagnosis and management challenging.