Louis Mena, Gibson Brian, Chambers James
General Surgery, Northeast Georgia Medical Center Gainesville, Gainesville, USA.
Trauma and Acute Care Surgery, Northeast Georgia Medical Center Gainesville, Gainesville, USA.
Cureus. 2024 Oct 4;16(10):e70808. doi: 10.7759/cureus.70808. eCollection 2024 Oct.
Mucinous neoplasms of the appendix, including low-grade appendiceal mucinous neoplasms (LAMNs), are rare but significant due to their potential for peritoneal dissemination. These tumors are often discovered incidentally during imaging or surgery for unrelated conditions. The presence of mucinous material in the peritoneum raises concern for pseudomyxoma peritonei, necessitating careful intraoperative and postoperative management. A 52-year-old male presented with testicular pain, leading to a diagnosis of seminoma. Staging computerized tomography (CT) revealed a dilated appendix with a surrounding fluid collection, suggestive of a ruptured mucocele. Exploratory laparotomy uncovered a large mucinous mass encasing the appendix, with mucinous deposits in the peritoneum. Final pathology confirmed an invasive mucinous adenocarcinoma, well-differentiated, arising in the background of a low-grade mucinous appendiceal neoplasm. The invasive component extended into the subserosa (pT3), while the LAMN component involved the serosa (pT4a). When mucin is found intraoperatively, surgeons should consider appendectomy with possible conversion to an open approach for thorough exploration. Emergency HIPEC is unnecessary; instead, it should be planned electively after complete cytoreduction. The prognosis depends on the extent of the disease and the success of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC).
阑尾黏液性肿瘤，包括低级别阑尾黏液性肿瘤（LAMNs），虽罕见但因其有腹膜播散的可能而意义重大。这些肿瘤常在因无关病症进行影像学检查或手术时偶然发现。腹膜内黏液物质的存在引发了对腹膜假黏液瘤的担忧，这就需要在术中及术后进行仔细管理。一名52岁男性因睾丸疼痛就诊，诊断为精原细胞瘤。分期计算机断层扫描（CT）显示阑尾扩张，周围有液体积聚，提示黏液囊肿破裂。剖腹探查发现一个包裹阑尾的大黏液性肿块，腹膜内有黏液沉积。最终病理证实为侵袭性黏液腺癌，高分化，起源于低级别阑尾黏液性肿瘤背景。侵袭成分延伸至浆膜下层（pT3），而LAMN成分累及浆膜（pT4a）。术中发现黏液时，外科医生应考虑行阑尾切除术，并可能转为开放手术以进行彻底探查。急诊腹腔热灌注化疗（HIPEC）并非必要；相反，应在完全细胞减灭术后择期安排。预后取决于疾病范围以及细胞减灭术联合腹腔内热灌注化疗（HIPEC）的成功与否。
