Wakui Noritaka, Fujita Mitsuru, Yamauchi Yoshiya, Takeda Yuki, Ueki Nobuo, Otsuka Takafumi, Oba Nobuyuki, Nishinakagawa Shuta, Takezoe Toshiko, Hiroyoshi Junko, Kono Yoshiharu, Katahira Seiichiro, Minagawa Masami, Takeda Yasushi, Shiono Saori, Kojima Tatsuya
Departments of Internal Gastroenterology and Hepatology, Tokyo Rosai Hospital, Tokyo 143-0013, Japan.
Exp Ther Med. 2013 Jul;6(1):3-8. doi: 10.3892/etm.2013.1094. Epub 2013 Apr 30.
A 63-year-old woman was admitted to hospital with pain in the right lower quadrant. Abdominal computed tomography (CT) revealed a 60-mm cystic mass at a site corresponding to the appendix. The mass wall on the appendicular ostium was thickened and enhanced by contrast, while calcification was observed in the mass wall on the appendicular tip. No projection was observed in the mass cavity. On abdominal ultrasonography (US), the mass wall on the appendicular ostium was thickened and projections were observed at two sites in the mass cavity. On contrast-enhanced US (CEUS), only one of these projections was enhanced. Based on the thickened and contrast-enhanced wall of the mass on the appendicular ostium on CT and US, as well as the contrast enhancement of a projection on US, the mass was diagnosed as mucinous cystadenocarcinoma of the appendix. Ileocecal resection was subsequently performed on day 10. A detailed examination of the surgical specimen revealed carcinoma cells in the mass wall on the appendicular ostium. The contrast-enhanced projection was identified as granulation tissue that had grown to come into contact with the tumor, while the non-contrast-enhanced projection was identified as solidified mucus. US enabled successful visualization of projections in the mass cavity that were not visible on abdominal CT. CEUS also proved useful for assessing blood flow in these projections.
一名63岁女性因右下腹疼痛入院。腹部计算机断层扫描（CT）显示在与阑尾相对应的部位有一个60毫米的囊性肿块。阑尾开口处的肿块壁增厚且在增强扫描时有强化，而阑尾尖端的肿块壁可见钙化。肿块腔内未见凸起。腹部超声检查（US）显示阑尾开口处的肿块壁增厚，肿块腔内两个部位可见凸起。在对比增强超声检查（CEUS）中，这些凸起中只有一个有强化。基于CT和US上阑尾开口处肿块壁增厚且有对比增强，以及US上一个凸起有对比增强，该肿块被诊断为阑尾黏液性囊腺癌。随后在第10天进行了回盲部切除术。对手术标本的详细检查发现阑尾开口处的肿块壁中有癌细胞。有对比增强的凸起被确定为生长并与肿瘤接触的肉芽组织，而无对比增强的凸起被确定为凝固的黏液。US能够成功显示腹部CT上不可见的肿块腔内的凸起。CEUS也被证明有助于评估这些凸起内的血流情况。
