Soto Llanes Jesús Omar, Dosal Limón Samanta Kin, Iberri Jaime Ana Jimena, Zambrano Lara Mario, Jiménez Bobadilla Billy
General Surgery, General Hospital of Mexico Dr. Eduardo Liceaga, Mexico City, MEX.
General Medicine, General Hospital of Mexico Dr. Eduardo Liceaga, Mexico City, MEX.
Cureus. 2024 Jan 25;16(1):e52908. doi: 10.7759/cureus.52908. eCollection 2024 Jan.
Appendicular mucinous neoplasms, constituting less than 1% of gastrointestinal tract neoplasms, are heterogeneous entities. They may be asymptomatic, discovered incidentally, or present as large tumors due to mucin accumulation. The lack of standardized treatment complicates management. Imaging studies, particularly CT scans, are crucial for diagnosis and follow-up. This case report presents two clinical cases of women in their sixth and seventh decades of life with a history of lower gastrointestinal bleeding, mild anemia in laboratory studies, and incomplete colonoscopies. The diagnosis, confirmed through CT scans, led to the decision for surgical intervention in both cases, involving laparoscopic right hemicolectomy with ileotransverse anastomosis. Subsequently, histopathological reports confirmed the diagnosis of high-grade appendicular mucinous neoplasms, and a follow-up plan was established with imaging studies every six months with no recurrence at two years. Over 50% of appendicular tumors are mucinous neoplasms originating from low-grade mucinous neoplasms. Given the low lymph node invasion (2%), appendectomy may suffice if the entire tumor is excised. Extensive resections or right hemicolectomy are reserved for larger tumors or high-grade neoplasms to minimize local recurrence risk. Mucinous neoplasms with acellular mucin and peritoneal invasion may require cytoreduction or right hemicolectomy, while those with mucinous epithelium may need hyperthermic intraperitoneal chemotherapy (HIPEC) due to the risk of local recurrence, worsened by the presence of extra appendiceal epithelial cells. Disease-free and overall survival depend on treatment and initial lesion characterization. A five-year survival rate of 86% is reported for low-grade mucinous neoplasms. Follow-up approaches lack an ideal standard, generally involving physical examinations and imaging studies every six months to one year during the first six years.
阑尾黏液性肿瘤占胃肠道肿瘤的比例不到1%，是一种异质性疾病。它们可能无症状，偶然发现，或因黏液积聚而表现为大肿瘤。缺乏标准化治疗使管理变得复杂。影像学检查，尤其是CT扫描，对诊断和随访至关重要。本病例报告介绍了两名六七十岁女性的临床病例，她们有下消化道出血史，实验室检查有轻度贫血，结肠镜检查不完全。通过CT扫描确诊后，两例均决定进行手术干预，采用腹腔镜右半结肠切除术加回肠横结肠吻合术。随后，组织病理学报告证实为高级别阑尾黏液性肿瘤，并制定了随访计划，每六个月进行一次影像学检查，两年内无复发。超过50%的阑尾肿瘤是起源于低级别黏液性肿瘤的黏液性肿瘤。鉴于淋巴结侵犯率低（2%），如果完整切除整个肿瘤，阑尾切除术可能就足够了。对于较大的肿瘤或高级别肿瘤，应进行广泛切除或右半结肠切除术，以尽量降低局部复发风险。伴有无细胞黏液和腹膜侵犯的黏液性肿瘤可能需要减瘤或右半结肠切除术，而伴有黏液上皮的肿瘤可能因局部复发风险而需要进行热灌注腹腔化疗（HIPEC），阑尾外上皮细胞的存在会使这种风险恶化。无病生存期和总生存期取决于治疗和初始病变特征。据报道，低级别黏液性肿瘤的五年生存率为86%。随访方法缺乏理想的标准，在前六年通常每六个月至一年进行一次体格检查和影像学检查。
