Hosokawa Yuka, Fujiyoshi Sunao, Imaizumi Ken, Shibata Kengo, Ichikawa Nobuki, Yoshida Tadashi, Homma Shigenori, Kudo Takeaki, Okazaki Nanase, Tomaru Utano, Taketomi Akinobu
Department of Gastroenterological Surgery 1, Hokkaido University Hospital, N-15 W-7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
Hamanasu Hospital, 4-1-141-1, Bannaguro, Ishikari, Hokkaido, 061-3284, Japan.
Surg Case Rep. 2024 Aug 7;10(1):183. doi: 10.1186/s40792-024-01984-w.
Appendiceal goblet cell adenocarcinoma (GCA) is a rare subtype of primary appendiceal adenocarcinoma with an incidence of 1-5 per 10,000,000 people per year. Appendiceal tumors are often diagnosed after appendectomy for acute appendicitis. Notably, however, there is currently no standard treatment strategy for GCA, including additional resection. We report a case of appendiceal GCA with perineural extension into the cecum, in which ileal resection was considered effective.
A 41-year-old man was diagnosed with acute appendicitis and underwent appendectomy. Histopathological findings revealed GCA (T3, Pn1). He was referred to our hospital for additional resection. Preoperative examination indicated a diagnosis of GCA cT3N0M0. Laparoscopic ileocecal resection and D3 lymph node dissection were performed 2 months after initial appendectomy. The patient had a good postoperative course and was discharged 8 days after surgery. Histopathological findings showed a GCA invading the cecum, despite an intact appendiceal stump, no lymph node metastasis, no vascular invasion, and no horizontal extension into the submucosa. Direct invasion of the tumor through the serosa was not observed, but perineural extension was conspicuous in the cecum, suggesting that the GCA extended into the cecum via perineural invasion. The resection margins were negative. The patient has survived free of recurrence for a year after ileocecal resection.
The current patient was diagnosed with appendiceal GCA following appendectomy for acute appendicitis. Despite intact of appendiceal stump and no evidence of lymph node or distant metastasis, he underwent laparoscopic ileocecal resection and D3 lymph node dissection 2 months after initial appendectomy, with a favorable outcome. Despite the detection of perineural invasion, the patient declined adjuvant therapy. This case suggests that extensive resection may be required in patients with appendiceal GCA, but the role of adjuvant therapy remains unclear.
阑尾杯状细胞腺癌（GCA）是原发性阑尾腺癌的一种罕见亚型，每年发病率为每1000万人中有1 - 5例。阑尾肿瘤常在因急性阑尾炎行阑尾切除术后被诊断出来。然而，值得注意的是，目前GCA尚无标准治疗策略，包括额外切除。我们报告一例阑尾GCA伴神经周围浸润至盲肠，其中回肠切除术被认为是有效的。
一名41岁男性被诊断为急性阑尾炎并接受了阑尾切除术。组织病理学检查结果显示为GCA（T3，Pn1）。他被转诊至我院进行额外切除。术前检查诊断为GCA cT3N0M0。在初次阑尾切除术后2个月进行了腹腔镜回盲部切除术及D3淋巴结清扫术。患者术后恢复良好，术后8天出院。组织病理学检查结果显示，尽管阑尾残端完整，但GCA侵犯了盲肠，无淋巴结转移、无血管侵犯且无水平方向的黏膜下层浸润。未观察到肿瘤通过浆膜的直接侵犯，但在盲肠中神经周围浸润明显，提示GCA通过神经周围侵犯扩展至盲肠。切缘阴性。回盲部切除术后患者已无复发存活一年。
本例患者在因急性阑尾炎行阑尾切除术后被诊断为阑尾GCA。尽管阑尾残端完整且无淋巴结或远处转移证据，但在初次阑尾切除术后2个月仍接受了腹腔镜回盲部切除术及D3淋巴结清扫术，结果良好。尽管检测到神经周围侵犯，但患者拒绝辅助治疗。该病例表明，阑尾GCA患者可能需要广泛切除，但辅助治疗的作用仍不明确。
