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A Case Report of Huge Appendiceal Mucinous Cystadenocarcinoma-Sonographic and Radiographic Appearance
一巨大闌尾黏液囊狀腺癌病例報告：超音波和放射線影像
摘要
闌尾黏液囊腫是少見的疾病，在所有闌尾切除術中約佔0.3%。黏液囊狀腺癌是其中屬於惡性的囊腫，約佔所有黏液囊腫的9%。良性和惡性兩者的臨床症狀和影像表現均類似，一般統稱為闌尾黏液囊腫。囊腫內的黏液如散佈到腹膜腔，常會引起腹腔假黏液瘤。在惡性的闌尾黏液囊腫，這種腹腔假黏液瘤會不斷復發，造成腸阻塞而致死。正確的影像診斷有助於治療方式的選擇，尤應避免經皮抽吸或引流，以免造成人為的併發症。多數闌尾黏液囊腫不大，臨床症狀和傳統影像檢查不具特異性，因此以往不易得到正確的術前診斷。超音波和電腦斷層問世以後，闌尾黏液囊腫的術前診斷就容易多了。本文報告一罕見的，十七公分大的闌尾黏液囊狀腺癌。由於它的超音波影像具有囊狀的特徵和特殊的層狀內部回音，電腦斷層影像顯示部份病灶與盲腸相連，使我們能做出正確的術前診斷。
並列摘要
Appendiceal mucoceles are uncommon, comprising about 0.3% of cases receiving appendectomy. Mucinous cystadenocarcinoma is the malignant variety and accounts for about 9% of the mucoceles. Spontaneously or incidentally intraperitoneal spillage of the contents of the mucocele can result in pseudomyxoma peritonei, which will recur repeatedly in the malignant cases, causing morbidity and mortality due to intestinal obstruction. Correct image diagnosis is crucial to avoid iatrogenic complication. However, most appendiceal mucoceles are small, causing symptoms and signs that are either nonspecific or very similar to walled-off periappendiceal abscess. It is therefore difficult to reach the correct diagnosis preoperatively with clinical data and conventional images only; however, this has become much easier with the utilization of sonography and computed tomography. We report a rare case of a 17-cm mucinous cystadenocarcinoma of appendix, which was diagnosed correctly before operation by its cystic nature and peculiarly laminated internal echoes on sonography, and by its intimate relationship with cecum on computed tomography.