Fujii Yusuke, Hida Koya, Sugimoto Akihiko, Nishijima Ryohei, Fujimoto Masakazu, Hoshino Nobuaki, Maekawa Hisatsugu, Okamura Ryosuke, Itatani Yoshiro, Obama Kazutaka
Department of Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
Department of Diagnostic Pathology, Kyoto University Hospital, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
Surg Case Rep. 2024 Jun 13;10(1):144. doi: 10.1186/s40792-024-01936-4.
Neoplasms derived from remnant appendix are rarely described, with most cases arising from the appendiceal "stump". Here, we present two surgical cases of appendiceal neoplasms derived from appendiceal "tip" remnants.
The first patient was a 71-year-old man who had undergone laparoscopic appendectomy for acute appendicitis 12 years prior. During appendectomy, the appendiceal root was ligated, but the appendix was not completely removed due to severe inflammation. At the most recent presentation, computed tomography (CT) was performed to examine choledocholithiasis, which incidentally revealed a cystic lesion of approximately 90 mm adjacent to the cecum. A retrospective review revealed that the cystic lesion had increased in size over time, and laparoscopic ileocecal resection was performed. Pathology revealed no continuity from the appendiceal orifice to the cyst, and a diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) was made from the appendiceal tip remnant. The patient was discharged without complications. The second patient was a 65-year-old man who had undergone surgery for peritonitis due to severe appendicitis 21 years prior. During this operation, the appendix could not be clearly identified due to severe inflammation; consequently, cecal resection was performed. He was referred to our department with a chief complaint of general fatigue and loss of appetite and a cystic lesion of approximately 85 mm close to the cecum that had increased over time. CT showed irregular wall thickening, and malignancy could not be ruled out; therefore, laparoscopic ileocecal resection with D3 lymph node dissection was performed. The pathological diagnosis revealed mucinous adenocarcinoma (TXN0M0) arising from the remnant appendiceal tip. The patient is undergoing follow-up without postoperative adjuvant chemotherapy, with no evidence of pseudomyxoma peritonei or cancer recurrence for 32 months postoperatively.
If appendicitis-associated inflammation is sufficiently severe that accurate identification of the appendix is difficult, it may remain on the apical side of the appendix, even if the root of the appendix is ligated and removed. If the appendectomy is terminated incompletely, it is necessary to check for the presence of a residual appendix postoperatively and provide appropriate follow-up.
源自阑尾残端的肿瘤鲜有报道，大多数病例起源于阑尾“残端”。在此，我们报告两例源自阑尾“尖端”残端的阑尾肿瘤手术病例。
首例患者为一名71岁男性，12年前因急性阑尾炎接受了腹腔镜阑尾切除术。阑尾切除术中，阑尾根部被结扎，但由于炎症严重，阑尾未被完全切除。在最近一次就诊时，为检查胆总管结石进行了计算机断层扫描（CT），偶然发现盲肠附近有一个约90毫米的囊性病变。回顾性分析显示，囊性病变随时间推移增大，遂进行了腹腔镜回盲部切除术。病理检查显示阑尾开口与囊肿无连续性，根据阑尾尖端残端诊断为低级别阑尾黏液性肿瘤（LAMN）。患者无并发症出院。第二例患者为一名65岁男性，21年前因严重阑尾炎并发腹膜炎接受了手术。此次手术中，由于炎症严重，无法清晰辨认阑尾；因此，进行了盲肠切除术。他因全身乏力和食欲不振为主诉被转诊至我科，且盲肠附近一个约85毫米的囊性病变随时间增大。CT显示壁不规则增厚，不能排除恶性；因此，进行了腹腔镜回盲部切除并D3淋巴结清扫术。病理诊断为源自阑尾尖端残端的黏液腺癌（TXN0M0）。患者正在接受随访，未进行术后辅助化疗，术后32个月无腹膜假黏液瘤或癌症复发迹象。
如果阑尾炎相关炎症严重到难以准确辨认阑尾，即使阑尾根部已结扎并切除，阑尾仍可能留在阑尾尖端一侧。如果阑尾切除术未彻底完成，术后有必要检查是否存在残留阑尾并进行适当随访。
