Taking Caution at Road's End: Incidental Finding of Appendiceal Goblet Cell Tumor on Colonoscopy

Cancer of the appendix is an uncommon malignancy that is rarely diagnosed on colonoscopy. We present a case of incidentally discovered goblet cell adenocarcinoma of the appendix and the subsequent management. The patient initially presented with progressive epigastric pain in the setting of a family history of gastric cancer and personal history of colon polyps, for which surveillance was due. Bidirectional endoscopy was performed, from which biopsied tissue of an abnormal-appearing appendiceal orifice confirmed goblet cell adenocarcinoma. This case highlights the importance of identification of the appendiceal orifice in all colonoscopies and tissue sampling in cases of atypical-appearing anatomy.