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病例报告:肝下阑尾炎合并肝脓肿作为阑尾原发性弥漫性大B细胞淋巴瘤的首发表现:首例报道病例

Case Report: subhepatic appendicitis complicated by hepatic abscess as the initial presentation of primary diffuse large B-cell lymphoma of the appendix: first reported case.

作者信息

Chen Hao, Yu Miao, Chang Zhanping, Li Yang, Fan Lei, Shang Dake, Zhang Huili

机构信息

General Surgery, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China.

Pathology Department, China Aerospace Science & Industry Corporation 731 Hospital, Beijing, China.

出版信息

Front Oncol. 2025 Jun 16;15:1591905. doi: 10.3389/fonc.2025.1591905. eCollection 2025.

Abstract

Subhepatic appendicitis complicated by hepatic abscess is an uncommon clinical condition due to anatomical variations in the appendix's position. Here, we report an unusual case of a 56-year-old male who initially presented with right abdominal pain and fever, misdiagnosed as bilateral kidney stones and urinary tract infection. Subsequent abdominal CT(Computed Tomography) scans revealed subhepatic appendicitis with a hepatic abscess located in segment VI of the liver. The patient underwent successful laparoscopic appendectomy and hepatic abscess drainage. Unexpectedly, histopathological examination of the appendix demonstrated diffuse large B-cell lymphoma (DLBCL), a rare form of primary appendiceal non-Hodgkin lymphoma. Immunohistochemistry confirmed the diagnosis, with tumor cells positive for CD20, CD79a, Bcl-6, and c-Myc, and a high Ki-67 proliferative index (>90%). This case highlights the diagnostic challenges associated with atypically positioned appendicitis and underscores the importance of pathological evaluation in detecting rare underlying malignancies.

摘要

肝下阑尾炎合并肝脓肿是一种因阑尾位置解剖变异而罕见的临床病症。在此,我们报告一例不寻常的病例,一名56岁男性最初表现为右腹痛和发热,被误诊为双侧肾结石和尿路感染。随后的腹部CT(计算机断层扫描)扫描显示肝下阑尾炎并伴有位于肝脏VI段的肝脓肿。患者成功接受了腹腔镜阑尾切除术和肝脓肿引流术。出乎意料的是,阑尾的组织病理学检查显示为弥漫性大B细胞淋巴瘤(DLBCL),这是原发性阑尾非霍奇金淋巴瘤的一种罕见形式。免疫组织化学证实了诊断,肿瘤细胞CD20、CD79a、Bcl-6和c-Myc呈阳性,且Ki-67增殖指数较高(>90%)。该病例凸显了非典型位置阑尾炎相关的诊断挑战,并强调了病理评估在检测罕见潜在恶性肿瘤中的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6d42/12206796/2388c5f13738/fonc-15-1591905-g001.jpg

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