Appendicitis masquerading as malignancy

Radiological investigations such as computed tomography (CT) and magnetic resonance imaging (MRI) may reinforce the suspicion of malignancy and have a profound impact on parental counselling and treatment. Calcification, seen in one case, is also suggestive of malignancy in this context. 1 However, germ cell tumours are uncommon, with an incidence of 4 per million, 2 and ovarian tumours account for only 30% of these. 3 In contrast, appendicitis is the most common surgical emergency in childhood and it is estimated that an appendix mass is discovered in 10% of children at presentation. 4 Recognised presenting features include abdominal pain, fever, bowel disturbance, and urinary symptoms, which were present in our cases to varying degrees. There are few reported cases of inflammatory appendix masses masquerading as pelvic tumours in children. 6 Conversely pelvic tumour has been reported to mimic complex appendicitis in adults. 7 This series indicates that pelvic tumours cannot be reliably distinguished from inflammatory appendix masses despite expert ultrasonography.