Kindie Endeshaw Asaye, Addisu Girma Damtew, Taddesse Eyoel Negash, Addis Nigat Amsalu, Yigzaw Getachew Shiferaw
University of Gondar College of Medicine and Health Sciences, Ethiopia.
University of Gondar College of Medicine and Health Sciences, Ethiopia.
Int J Surg Case Rep. 2025 Jan;126:110767. doi: 10.1016/j.ijscr.2024.110767. Epub 2024 Dec 23.
Mucinous appendiceal neoplasms are unique tumors in which >50 % of the tumor volume is composed of extracellular mucin. They may present as an unruptured mucin-filled appendix or, more commonly, with peritoneal metastases after rupture or transmural invasion of the primary tumor. This case report describes a case of presumed ovarian malignancy with final pathologic diagnosis of low grade appendiceal mucinous neoplasm. Due to its rarity, we decided to report it.
A 37-year-old patient presented with a compliant of abdominal swelling. Abdominopelvic ultrasound was done and showed huge right and left complex cystic ovarian masses having thick septa. For this, she underwent total abdominal hysterectomy, omentectomy and bilateral salpingo-oophorectomy. On laparotomy there was also incidental finding of ruptured mucin-filled appendix for which appendectomy was done. Histopathology examinations from all resected specimens revealed the diagnosed LAMN. Two weeks after surgical resection, she was started on FOLFOX chemotherapy regimen.
Incidence of low grade appendiceal mucinous neoplasm is increasing. In addition to the increasing incidence, lack of early detection and impeded access to optimal multi-disciplinary treatment may worsen survival outcomes. Developing quality diagnostic services in the proper health context is crucial for early diagnosis and successful therapy of LAMN patients, and applying a resource-sensitive approach to prioritize essential treatments based on effectiveness and cost-effectiveness is key to overcoming barriers in low- and middle-income countries.
A recognition of mucinous material and abnormal appearing appendix should prompt the surgeon to consider performing an appendectomy to obtain primary pathologic diagnosis.
黏液性阑尾肿瘤是一种独特的肿瘤，其肿瘤体积的50%以上由细胞外黏液组成。它们可能表现为未破裂的充满黏液的阑尾，或者更常见的是，在原发性肿瘤破裂或透壁侵犯后出现腹膜转移。本病例报告描述了一例疑似卵巢恶性肿瘤，最终病理诊断为低级别阑尾黏液性肿瘤。由于其罕见性，我们决定报告此病例。
一名37岁患者因腹部肿胀前来就诊。进行了腹盆腔超声检查，显示左右两侧巨大的复杂囊性卵巢肿块，伴有厚分隔。为此，她接受了全腹子宫切除术、大网膜切除术和双侧输卵管卵巢切除术。剖腹手术时还意外发现了破裂的充满黏液的阑尾，并进行了阑尾切除术。所有切除标本的组织病理学检查显示诊断为低级别阑尾黏液性肿瘤（LAMN）。手术切除两周后，她开始接受FOLFOX化疗方案。
低级别阑尾黏液性肿瘤的发病率正在上升。除了发病率增加外，缺乏早期检测以及难以获得最佳的多学科治疗可能会使生存结果恶化。在适当的医疗环境中发展高质量的诊断服务对于LAMN患者的早期诊断和成功治疗至关重要，而采用资源敏感型方法根据有效性和成本效益对基本治疗进行优先排序是克服低收入和中等收入国家障碍的关键。
认识到黏液物质和外观异常的阑尾应促使外科医生考虑进行阑尾切除术以获得初步病理诊断。
