Odom Rebecca, Roche Keelin F, Burns Bracken
Surgery, Quillen College of Medicine East Tennessee State University, Johnson City, USA.
Cureus. 2022 Jun 10;14(6):e25832. doi: 10.7759/cureus.25832. eCollection 2022 Jun.
Appendiceal neoplasms are uncommon; most are identified by pathologic examination after appendectomy for presumed appendicitis or as an incidental finding. When found incidentally, patients are typically asymptomatic. If the neoplasm has perforated, patients may present with symptoms that mimic acute appendicitis. In advanced disease, patients may have systemic symptoms associated with peritoneal disease, including abdominal distension, weight loss, and diffuse abdominal pain. Because of their rarity, as well as rapidly evolving research on the subject, the nomenclature of appendiceal mucinous neoplasms has proven challenging. This lesion was identified as a low-grade appendiceal mucinous neoplasm (LAMN), previously termed mucoceles or mucinous cystadenomas. LAMNs are non-invasive neoplasms that have the potential to proliferate outside the appendix in a malignant fashion. All mucinous appendiceal neoplasms can perforate and spread mucin production throughout the abdominal cavity, known as pseudomyxoma peritonei (PMP). The presence of PMP designates LAMNs as malignant, though the neoplasm itself is non-invasive. When appendiceal neoplasms have peritoneal involvement, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the standard of care. Complete cytoreduction has been shown to be an independent predictor of survival. Here we describe a case of a 30-year-old male involved in a motor vehicle collision with a grade IV splenic laceration, who is also found to have a large appendiceal mass. His traumatic injuries required emergent intervention, which delayed treatment of his malignancy.
阑尾肿瘤并不常见；大多数是在因疑似阑尾炎行阑尾切除术后经病理检查发现，或为偶然发现。偶然发现时，患者通常无症状。如果肿瘤已穿孔，患者可能出现类似急性阑尾炎的症状。在疾病晚期，患者可能出现与腹膜疾病相关的全身症状，包括腹胀、体重减轻和弥漫性腹痛。由于其罕见性，以及该领域研究的快速发展，阑尾黏液性肿瘤的命名已被证明具有挑战性。该病变被确定为低级别阑尾黏液性肿瘤（LAMN），以前称为黏液囊肿或黏液性囊腺瘤。LAMN是一种非侵袭性肿瘤，有可能以恶性方式在阑尾外增殖。所有阑尾黏液性肿瘤都可能穿孔，并在整个腹腔内扩散黏液分泌，称为腹膜假黏液瘤（PMP）。PMP的存在将LAMN定义为恶性肿瘤，尽管肿瘤本身是非侵袭性的。当阑尾肿瘤累及腹膜时，细胞减灭术联合热灌注化疗（CRS-HIPEC）是标准的治疗方法。完全细胞减灭已被证明是生存的独立预测因素。在此，我们描述一例30岁男性，因机动车碰撞导致IV级脾破裂，同时还发现有一个大的阑尾肿物。他的创伤性损伤需要紧急干预，这延误了对其恶性肿瘤的治疗。
