Yao Min-Quan, Jiang Yu-Peng, Wang Yuan-Yu, Mou Yi-Ping, Fan Jin-Xing
Department of Gastrointestinal Surgery, Tongxiang First People's Hospital, Jiaxing 314500, Zhejiang Province, China.
Department of General Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
World J Clin Cases. 2024 Jan 16;12(2):361-366. doi: 10.12998/wjcc.v12.i2.361.
Low-grade appendiceal neoplasms (LAMN) are characterized by low incidence and atypical clinical presentations, often leading to misdiagnosis as acute or chronic appendicitis before surgery. The primary diagnostic tool for LAMN is abdominal computed tomography (CT) imaging. Surgical resection remains the cornerstone of LAMN management, necessitating en bloc tumor excision to minimize the risk of iatrogenic rupture. Laparoscopy, known for its minimal invasiveness, reduced postoperative discomfort, and expedited recovery, is a safe and reliable approach for LAMN treatment. Despite the possibility of pseudomyxoma peritonei development, appendectomy and partial appendectomy generally result in negative tumor margins and favorable outcomes, which can be attributed to the disease's slow growth and lower malignancy.
A 71-year-old male patient was admitted to our hospital with a pelvic space-occupying lesion detected 1 mo prior. Physical examination showed a soft abdomen without tenderness or rebound and no palpable masses. No shifting dullness was noted, and digital rectal examination revealed no palpable mass. Enteroscopy revealed a raised, smooth-surfaced mass measuring 3.0 cm in the cecum. Abdominal contrast-enhanced CT showed a markedly thickened and dilated appendix with visible cystic shadows. Laparoscopic surgery was performed and revealed a significantly dilated appendix, leading to laparoscopic resection of the appendix and part of the cecum. Post-surgical pathologic analysis confirmed LAMN. The patient received symptomatic and supportive post-operative care and was discharged on postoperative day 4 without complications such as abdominal bleeding, intestinal obstruction, or incision infection. No tumor recurrence was observed during a 7-mo follow-up period.
LAMN is a rare disease that lacks specific clinical manifestations. Abdominal CT plays a crucial role in diagnosing LAMN, and laparoscopic surgery is a safe and effective diagnostic and therapeutic approach.
低度阑尾肿瘤（LAMN）发病率低且临床表现不典型，术前常被误诊为急性或慢性阑尾炎。LAMN的主要诊断工具是腹部计算机断层扫描（CT）成像。手术切除仍然是LAMN治疗的基石，需要整块切除肿瘤以尽量降低医源性破裂的风险。腹腔镜手术以其微创性、术后不适减轻和恢复加快而闻名，是治疗LAMN的一种安全可靠的方法。尽管有发生腹膜假黏液瘤的可能，但阑尾切除术和部分阑尾切除术通常能实现肿瘤切缘阴性且预后良好，这可归因于该疾病生长缓慢且恶性程度较低。
一名71岁男性患者因1个月前发现盆腔占位性病变入院。体格检查显示腹部柔软，无压痛或反跳痛，未触及肿块。未发现移动性浊音，直肠指检未触及肿块。肠镜检查发现盲肠有一个隆起、表面光滑的3.0厘米肿块。腹部增强CT显示阑尾明显增厚、扩张，可见囊性阴影。行腹腔镜手术，发现阑尾明显扩张，遂行腹腔镜阑尾及部分盲肠切除术。术后病理分析确诊为LAMN。患者术后接受了对症及支持治疗，术后第4天出院，未出现腹部出血、肠梗阻或切口感染等并发症。在7个月的随访期内未观察到肿瘤复发。
LAMN是一种罕见疾病，缺乏特异性临床表现。腹部CT在LAMN的诊断中起关键作用，腹腔镜手术是一种安全有效的诊断和治疗方法。
