Koizumi Noriaki, Matsumoto Tatsuya, Kamada Yosuke, Fujiki Hiroshi, Sakakura Chouhei
Dept. of Surgery, Akashi City Hospital.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1458-1460.
A 49-year-old male patient, who presented with abdominal pain, was suspected of having acute appendicitis. Abdominal computed tomography revealed a swollen appendix, accompanied by a 40 mm low-density mass located behind the appendix. He was diagnosed with an appendiceal mucinous neoplasm, and laparoscopic ileocecal resection was performed. A soft tumor was found proximal to the swollen appendix and was adhered tightly to the iliopsoas muscle. The tumor cells were exfoliated carefully, and the tumor was excised en bloc without any injury. Histopathological examination revealed a low- grade appendiceal mucinous neoplasm(LAMN)accompanied by extra-appendiceal mucin extrusion due to the lack of epithelial lining. Because LAMN is potentially malignant, surgical excision was performed as first-line therapy. In the surgical management of LAMN, preventing intraoperative rupture is essential to avoid pseudomyxoma peritonei. To achieve this, a magnified laparoscopic surgery may be useful. Although no definitive guidelines describing the indications of lymph node dissection or the appropriate extent of resection exist, laparoscopic ileocecal resection may be used to manage cases of LAMN.
一名49岁男性患者，因腹痛就诊，怀疑患有急性阑尾炎。腹部计算机断层扫描显示阑尾肿胀，阑尾后方伴有一个40毫米的低密度肿块。他被诊断为阑尾黏液性肿瘤，并接受了腹腔镜回盲部切除术。在肿胀的阑尾近端发现一个柔软的肿瘤，该肿瘤与髂腰肌紧密粘连。小心地剥除肿瘤细胞，将肿瘤完整切除，未造成任何损伤。组织病理学检查显示为低级别阑尾黏液性肿瘤（LAMN），由于缺乏上皮衬里，伴有阑尾外黏液渗出。由于LAMN具有潜在恶性，手术切除作为一线治疗方法。在LAMN的手术治疗中，防止术中破裂对于避免腹膜假黏液瘤至关重要。为实现这一点，放大腹腔镜手术可能会有所帮助。尽管目前尚无描述淋巴结清扫指征或合适切除范围的明确指南，但腹腔镜回盲部切除术可用于处理LAMN病例。
