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Appendiceal adenocarcinoma is rare with variable presentations. Perforation of the appendix within prolapsed ostomy can have peritoneal spread for which intraperitoneal chemotherapy should be considered. Surveillance is essential for these patients.Anemia and leukopenia because of copper deficiency can be mistaken for myelodysplasia. Key issues, including response to G-CSF and oral copper, are discussed. This case illustrates a significant deleterious effect of excessive zinc consumption.The study shows that whole-exome sequencing is a pr