Yoshihara Yuki, Kagiya Takuji, Sakamoto Yoshiyuki, Morohashi Hajime, Miura Takuya, Yokoyama Kazuki, Hakamada Kenichi
Dept. of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine.
Gan To Kagaku Ryoho. 2024 Aug;51(8):849-851.
The patient was a 35-year-old man who saw his first doctor with the chief complaint of painful urination. A contrast- enhanced CT scan of the abdomen revealed a diagnosis of abscess-forming appendicitis with inflammatory spread to the bladder, and conservative treatment was decided. Since antibiotic treatment failed to reduce the size of the abscess, he underwent surgery. The bladder wall was highly inflamed, only appendectomy was performed. Pathology revealed appendiceal mucinous carcinoma invading the bladder, so he was referred to our department. Because a total cystectomy was required for curative resection and there was concern about seeding associated with the initial surgery, he was judged to be unresectable, and received chemotherapy. After 6 courses of CAPOX+bevacizumab therapy, he was able to have a bladder- sparing curative resection because of the absence of distant metastasis and shrinkage of the tumor. He remains stable without recurrence 6 months after surgery. We herein report, with some discussion of the literature, this case of bladder-invading appendiceal mucinous carcinoma arising from abscess-forming appendicitis, for which a curative resection was possible after chemotherapy.
该患者为一名35岁男性,因尿痛为主诉首次就诊。腹部增强CT扫描显示诊断为形成脓肿的阑尾炎,炎症蔓延至膀胱,遂决定采取保守治疗。由于抗生素治疗未能缩小脓肿大小,他接受了手术。膀胱壁高度发炎,仅进行了阑尾切除术。病理显示阑尾黏液癌侵犯膀胱,因此他被转诊至我科。由于根治性切除需要进行全膀胱切除术,且担心初次手术会导致种植转移,他被判定无法切除,并接受了化疗。经过6个疗程的CAPOX+贝伐单抗治疗后,由于无远处转移且肿瘤缩小,他得以进行保留膀胱的根治性切除。术后6个月,他病情稳定,无复发。我们在此报告这例由形成脓肿的阑尾炎引起的侵犯膀胱的阑尾黏液癌病例,并结合文献进行一些讨论,该病例在化疗后实现了根治性切除。