Handler Marci, Anand Neil, Wei Lawrence, Snieckus Peter
Department of Radiology, Morristown Medical Center, Morristown, NJ, USA.
Sidney Kimmel Medical College, Jefferson University, Philadelphia, PA, USA.
J Radiol Case Rep. 2017 Apr 30;11(4):20-29. doi: 10.3941/jrcr.v11i4.3087. eCollection 2017 Apr.
Intra-abdominal and intra-pelvic pathologies initially presenting in extra-abdominal/pelvic locations is unusual. This spread predominantly occurs with infectious processes to sites including the buttock, thigh, and calf. The routes of extension into adjacent anatomically weak compartments include the pelvic outlet, greater sciatic foramen, obturator foramen, inguinal or femoral canal, weak bones, or along nerves and blood vessels. Malignant neoplasms of the appendix, while extremely rare and accounting for only 0.4% of all gastrointestinal cancers, is one of the intra-abdominal pathologies that can spread via these routes. Adenocarcinoma of the appendix accounts for 10-20% of primary appendiceal tumors. They usually present as acute appendicitis or as a right lower quadrant abdominal mass when associated with a mucocele. We report the unique case of mucinous appendiceal adenocarcinoma in a 57-year-old male who initially presented with a right thigh mass secondary to extension of the neoplasm from the right lower quadrant through the femoral canal. A similar presentation of a mucinous appendiceal cystadenoma has been previously reported, however, to our knowledge, this is the first case of a malignant appendiceal tumor extending into the thigh. We review the literature and discuss imaging findings and treatment of this tumor.
最初表现于腹外/盆腔部位的腹内和盆腔病变并不常见。这种扩散主要发生在感染性疾病中，扩散至包括臀部、大腿和小腿等部位。病变扩展至相邻解剖结构薄弱腔隙的途径包括骨盆出口、坐骨大孔、闭孔、腹股沟管或股管、骨质薄弱处，或沿神经和血管蔓延。阑尾恶性肿瘤极为罕见，仅占所有胃肠道癌症的0.4%，是可通过这些途径扩散的腹内病变之一。阑尾腺癌占原发性阑尾肿瘤的10% - 20%。当与黏液囊肿相关时，它们通常表现为急性阑尾炎或右下腹部肿块。我们报告了一例57岁男性黏液性阑尾腺癌的独特病例，该患者最初表现为右大腿肿块，是肿瘤从右下象限经股管蔓延所致。此前曾报道过黏液性阑尾囊腺瘤有类似表现，然而，据我们所知，这是首例恶性阑尾肿瘤蔓延至大腿的病例。我们回顾了文献并讨论了该肿瘤的影像学表现及治疗方法。
