84 year-old man undergoing colonoscopy for evaluation of anemia. There was a sessile mass in the tip of the cecum, surrounding a structure protruding into the lumen. This structure ultimately proved to be the appendix, which was partially retracted into the cecum, but which was not obstructed by the surrounding tumor. Closer inspection revealed the protruding structure to have a lumen, the opening of which can be seen tangentially in the middle image, and which is demonstrated in the image on the right by the passage of a closed forceps a few millimeters into the lumen of the appendix. The sessile mass proved to be an adenocarcinoma, which was found to be metastatic to liver.