Mixed composition carcinomas of the large intestine are rare. The aggressiveness of these malignant tumors depends on the components of the tumor. We present the case of a middle-aged man who developed an acute surgical abdomen due to perforation of a mixed composition carcinoma with a dominant small cell component. To the best of our knowledge this is the first case report of a composite cecal carcinoma with lymph node metastases from both the small cell and adenocarcinoma components. Case History A 47-year-old gentleman was admitted with severe crampy right lower quadrant pain, nausea & fever of one-day duration. He had an episode of severe watery diarrhea approximately 12 hours after the onset of abdominal pain. On examination all the vital signs were normal except for pyrexia (38 O c) and tachycardia. Local examination revealed the classical clinical findings of acute appendicitis with severe local peritonitis. His hematological and biochemical parameters on admission were as follows: hemoglobin 11.8g/dl, white cell count 18.5 x10 9 /l, and c-reactive protein 256mg/l. All other investigations were normal. He was scheduled for an emergency appendectomy. When examined under anesthesia, there was a firm irregular 10x10 cm intra abdominal palpable lump in the right iliac fossa. The surgery was cancelled and a conservative approach was adopted. Subsequent CT of the abdomen revealed (Figure 1) a mass in the cecal area extending to the pelvis, with streaking of the surrounding fat.
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