Oka Keishi, Ueda Masami, Ikenaga Masakazu, Tanida Tsukasa, Taguchi Daisuke, Fukushima Shoko, Yoshida Shoma, Yukimoto Ryohei, Iede Kiyotsugu, Tsuda Yujiro, Nakashima Shinsuke, Matsuyama Jin, Yamada Terumasa
Dept. of Gastroenterological Surgery, Higashiosaka City Medical Center.
Gan To Kagaku Ryoho. 2022 Dec;49(13):1714-1716.
We report a case of a female in her fifties with early appendiceal adenocarcinoma coexisting with high-grade appendiceal mucinous neoplasm(HAMN)with a review of the literature. The patient presented to our hospital because of an enlarged appendix noted by contrast-enhanced CT performed for hematuria. Contrast-enhanced CT showed that the appendix had swollen to 10 mm and mucus had accumulated inside, which had no evidence of obvious malignancy. She was followed up on CT once a year. Four years after her first visit, she underwent laparoscopic appendectomy for a definitive diagnosis. There were no adhesions or inflammation in her abdominal cavity, and the appendix root was dissected with an automatic anastomosis device. Her resected specimen macroscopically showed mild wall thickening, but no obvious neoplastic lesion. Pathological examination revealed that in many areas centered on the tip of the appendix, highly columnar atypical epithelium with enhanced mucus production was densely proliferated in the form of glandular tubular and papillary. The nuclei of the proliferating epithelium were large and the fission image was conspicuous, but they remained in the mucosa. Pathological examination diagnosed as HAMN according to the WHO classification. The atypical epithelium in a small area at the tip was particularly strong in nuclear atypia, and showed a strong positive diffusely in p53, which was an image of well-differentiated tubular adenocarcinoma. The pathological diagnosis was V, Type 0-Ⅱb, 2 mm, tub1 in HAMN, pTis, Ly0, V0, Pn0, pPM0, pDM0, pRM0, R0. Six months have passed since the operation, but no recurrence has been observed.
我们报告一例五十多岁女性，患有早期阑尾腺癌并伴有高级别阑尾黏液性肿瘤（HAMN），并对相关文献进行综述。该患者因血尿行增强CT检查发现阑尾肿大而就诊于我院。增强CT显示阑尾已肿大至10mm，内部有黏液积聚，无明显恶性迹象。此后每年对其进行CT随访。首次就诊四年后，她接受了腹腔镜阑尾切除术以明确诊断。其腹腔内无粘连或炎症，阑尾根部用自动吻合装置进行了切除。切除标本肉眼可见轻度壁增厚，但无明显肿瘤病变。病理检查显示，以阑尾尖端为中心的多个区域，高柱状非典型上皮细胞黏液分泌增多，呈腺管状和乳头状密集增生。增生上皮细胞核大，核分裂象明显，但仍局限于黏膜层。根据世界卫生组织分类，病理检查诊断为HAMN。阑尾尖端小面积的非典型上皮细胞核异型性尤为明显，p53弥漫性强阳性，呈高分化管状腺癌表现。病理诊断为HAMN，V型，0-Ⅱb型，2mm，tub1，pTis，Ly0，V0，Pn0，pPM0，pDM0，pRM0，R0。术后已过去六个月，未观察到复发。
