Chen C, Zhang Y
Gynecology Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100006, China.
Zhonghua Zhong Liu Za Zhi. 2021 Apr 23;43(4):472-476. doi: 10.3760/cma.j.cn112152-20200320-00230.
To explore the clinicopathologic features and prognosis of female appendiceal mucinous tumor misdiagnosed as gynecological neoplasm. The clinical data of 12 cases of suspected gynecological neoplasm but confirmed as appendiceal mucinous tumor by operation and pathology in Beijing Obstetrics and Gynecology Hospital hospital from 2010 to 2019 were collected. The clinicopathologic features, treatment and prognosis of these patients were analyzed. The median age of 12 patients was 58 years old and the clinical manifestations were atypical, including 5 cases with gastrointestinal symptoms, 6 cases with touched lesion in the right adnexal area, 3 cases with pseudomyxoma of peritonei, and 4 cases with increased serological tumor markers and ascites. Before operation, ultrasonic diagnosis showed cystic or cystic-solid mass in the right adnexal region in all cases. Pelvic and abdominal enhanced CT and/or enhanced MRI were performed in 5 cases. Two cases indicated possible origin of appendix and 1 case indicated lymphatic cystic tumor. Laparoscopic or laparotomy exploration was performed in all patients, during the operation 7 cases were performed appendectomy, 4 cases were performed tumor cell reduction and 1 case was treated in another hospital after laparotomy exploration. Eleven cases were diagnosed as low-grade appendiceal mucinous tumor and 1 case as appendiceal mucinous adenocarcinoma by postoperative pathology. Among the 11 patients with low-grade appendiceal mucinous tumor, 9 cases had no recurrence, 1 case lost follow-up, 1 case died of breast cancer and 1 case died 18 months after the operation. Gynecologists should improve their ability to differentiate appendiceal mucinous tumor from gynecological neoplasm. They can include ultrasonic diagnosis and CT scanning into their preoperative physical examination to improve their examination ability, and strive for specialist or surgical treatment to achieve the best result.
探讨误诊为妇科肿瘤的女性阑尾黏液性肿瘤的临床病理特征及预后。收集2010年至2019年在北京妇产医院手术及病理确诊为阑尾黏液性肿瘤但术前疑似妇科肿瘤的12例患者的临床资料,分析其临床病理特征、治疗及预后。12例患者年龄中位数为58岁,临床表现不典型,其中5例有胃肠道症状,6例右侧附件区可触及肿物,3例有腹膜假黏液瘤,4例血清肿瘤标志物升高伴腹水。术前超声检查均提示右侧附件区囊性或囊实性肿物。5例行盆腔及腹部增强CT和/或增强MRI检查,2例提示可能起源于阑尾,1例提示淋巴管囊肿。所有患者均行腹腔镜或开腹探查,术中7例行阑尾切除术,4例行肿瘤细胞减灭术,1例开腹探查后转外院治疗。术后病理诊断11例为低级别阑尾黏液性肿瘤,1例为阑尾黏液腺癌。11例低级别阑尾黏液性肿瘤患者中,9例无复发,1例失访,1例死于乳腺癌,1例术后18个月死亡。妇科医生应提高鉴别阑尾黏液性肿瘤与妇科肿瘤的能力,可将超声检查及CT扫描纳入术前体格检查以提高检查能力,并争取专科或手术治疗以取得最佳效果。