Terada Tadashi
Department of Pathology, Shizuoka City Shimizu Hospital, Miyakami 1231, Shimizu-Ku, Shizuoka 424-8636, Japan.
Case Rep Gastrointest Med. 2014;2014:837860. doi: 10.1155/2014/837860. Epub 2014 Dec 3.
Appendiceal diverticulosis is a rare condition. Herein reported is a case of appendiceal diverticulosis and diverticulitis clinically masquerading as appendiceal carcinoma. A 62-year-old woman presented with abdominal pain. US and CT showed a tumor measuring 5 × 4 × 4 cm in vermiform appendix. Colon endoscopy showed mucosal elevation and irregularity in the orifice of vermiform appendix. A biopsy of the appendiceal mucosa showed no significant changes. Clinical diagnosis was appendiceal carcinoma and wide excision of terminal ileum, appendix, cecum, and ascending colon was performed. Grossly, the appendix showed a tumor measuring 5 × 3 × 4 cm. The appendiceal lumen was opened, and the appendiceal mucosa was elevated and irregular. The periappendiceal tissue showed thickening. Microscopically, the lesion was multiple appendiceal diverticula. The diverticula were penetrating the muscle layer. The mucosa showed erosions in places. Much fibrosis, abscess formations, and lymphocytic infiltration were seen in the subserosa. Abscesses were also seen in the diverticular lumens. Some diverticula penetrated into the subserosa. The pathologic diagnosis was appendiceal diverticulitis. When they encounter an appendiceal mass, clinicians should consider appendiceal diverticulitis as a differential diagnosis.
阑尾憩室病是一种罕见疾病。本文报道一例临床上伪装成阑尾癌的阑尾憩室病和憩室炎病例。一名62岁女性因腹痛就诊。超声和CT显示阑尾有一个大小为5×4×4cm的肿物。结肠镜检查显示阑尾开口处黏膜隆起且不规则。阑尾黏膜活检未见明显异常。临床诊断为阑尾癌，遂行末端回肠、阑尾、盲肠和升结肠广泛切除。大体检查显示阑尾有一个大小为5×3×4cm的肿物。打开阑尾腔，阑尾黏膜隆起且不规则。阑尾周围组织增厚。显微镜下，病变为多发阑尾憩室。憩室穿透肌层。黏膜局部有糜烂。浆膜下可见大量纤维化、脓肿形成及淋巴细胞浸润。憩室内也可见脓肿。部分憩室穿透至浆膜下。病理诊断为阑尾憩室炎。临床医生遇到阑尾肿物时，应将阑尾憩室炎作为鉴别诊断之一。
