Low-Grade Appendiceal Mucinous Neoplasm: A Rare Cause of Acute Abdomen

闌尾低度惡性黏液瘤—罕見之急性腹痛原因

王愷晟(Kai-Chen Wang) ； 陳成賢(Cheng-Hsien Chen) ； 陳志誠(Cheng-Zhi Chen) ； 黃玄遠(Hsuan-Yuan Huang) ； 尤昭傑(Jau-Jie You) ； 林倉祺(Tsang-Chi Lin) ； 陳宏彰(Hong-Chang Chen) ； 黃燈明(Ting-Ming Huang)

《中華民國大腸直腸外科醫學會雜誌》 23卷4期 (2012/12) Pp. 183-189

https://doi.org/10.6312/SCRSTW.2012.23(4).10029

摘要

目的　「闌尾低度惡性黏液瘤」是一種十分罕見的闌尾腫瘤。患者可能以急性腹痛為臨床表現。雖然配合電腦斷層、腹部超音波與大腸境的檢查，術前診斷仍有其困難性。在本篇報告中，我們收集彰化基督教醫院近十年來的案例進行分析，並回顧相關之研究文獻。方法　本研究是採取回溯性分析。案例來自於本院2000年1月至2011年8月間經病理檢驗證明為「闌尾低度惡性黏液瘤」之15位患者。我們記錄並分析其臨床表現、腹部超音波檢查報告、大腸鏡報告、電腦斷層之發現、病理報告、術前診斷與手術方法。結果　在十年間本院總共有15患者。其中8位（53.3%）是女性。平均確定診斷之年齡為67歲（47-85歲）。最常見之臨床表現為腹痛（93.3%）。其中6位接受腹部超音波檢查的患者，發現到腹內有囊狀腫塊，與囊壁鈣化的現象。有13位患者接受電腦斷層檢查，影像顯示外膜完整之囊腫。有10位患者接受闌尾切除術。有5位接受右側結腸切除手術，其中一位患者檢體中同時發現大腸腺癌。結論　「闌尾低度惡性黏液瘤」在術前不易診斷，其確診往往有賴於手術中直接觀察與手術後之檢體病理分析。儘管手術切除是最直接的治療方法，但仍須小心保持腫瘤之完整性，以避免腫瘤破裂造成黏液瘤細胞擴散。因其可能同時與其他種類的癌症同時存在（如大腸癌或卵巢癌），術後的檢查如大腸鏡與骨盆檢查是必需的。

關鍵字

闌尾低度惡性黏液瘤 ； 闌尾腫瘤 ； 急性腹痛

並列摘要

Purpose. Low-grade appendiceal mucinous neoplasm (LAMN) is a rare type of appendiceal cancer. Patients with LAMN may initially present with acute abdominal pain. Despite the use of CT, ultrasound or colonoscopy, preoperative diagnosis is difficult. In this study, we retrospective analyze cases of LAMN diagnosed in the past 10 years in Chang-Hua Christian Hospital and review the associated literature.Materials and Methods. This study retrospectively analyzed 15 patients who underwent surgery and was histopathologically confirmed LAMN at Chang-Hua Christian Hospital between January 2000 to August 2011. Patient charts and data on patient demographics; clinical features; ultrasonography (US), colonoscopy and computed tomography (CT) findings; pathology reports; pre-operative diagnosis and operative method were reviewed.Results. The were 15 cases of LAMN at Chang-Hua Christian Hospital over the past ten years. In our review, there were eight (53.3%) female patients. The median age was 67 years (47-85 years), and the most common presentation was abdominal pain (93.3%). On US in six patients, findings were abdominal cystic mass and cyst wall calcification. The CT finding was well-encapsulated cystic mass in thirteen patients. Appendectomy was performed in ten patients. Right hemicolectomy was performed in five patients, and there was one patient found concomitant colon adenocarcinoma in the specimen.Conclusion. LAMN is difficult to diagnose before operation. The actual diagnosis is usually made intraoperatively or during histopathologic examination of the excised specimen. Although surgical treatment is straightforward, proper management of the incidentally found lesion requires understanding of the potential complications of widespread peritoneal disease. It should be kept in mind that LAMN may coexist with other neoplasms, and follow-up colonoscopy and pelvic examination is warranted for the high association with other colon and ovarian malignancies.

並列關鍵字

Low-grade appendiceal mucinous ； neoplasm ； Appendiceal caner ； Acute abdominal pain