PDF(Pubmed)
Abstract：
Appendicular mucinous neoplasms, constituting less than 1% of gastrointestinal tract neoplasms, are heterogeneous entities. They may be asymptomatic, discovered incidentally, or present as large tumors due to mucin accumulation. The lack of standardized treatment complicates management. Imaging studies, particularly CT scans, are crucial for diagnosis and follow-up. This case report presents two clinical cases of women in their sixth and seventh decades of life with a history of lower gastrointestinal bleeding, mild anemia in laboratory studies, and incomplete colonoscopies. The diagnosis, confirmed through CT scans, led to the decision for surgical intervention in both cases, involving laparoscopic right hemicolectomy with ileotransverse anastomosis. Subsequently, histopathological reports confirmed the diagnosis of high-grade appendicular mucinous neoplasms, and a follow-up plan was established with imaging studies every six months with no recurrence at two years. Over 50% of appendicular tumors are mucinous neoplasms originating from low-grade mucinous neoplasms. Given the low lymph node invasion (2%), appendectomy may suffice if the entire tumor is excised. Extensive resections or right hemicolectomy are reserved for larger tumors or high-grade neoplasms to minimize local recurrence risk. Mucinous neoplasms with acellular mucin and peritoneal invasion may require cytoreduction or right hemicolectomy, while those with mucinous epithelium may need hyperthermic intraperitoneal chemotherapy (HIPEC) due to the risk of local recurrence, worsened by the presence of extra appendiceal epithelial cells. Disease-free and overall survival depend on treatment and initial lesion characterization. A five-year survival rate of 86% is reported for low-grade mucinous neoplasms. Follow-up approaches lack an ideal standard, generally involving physical examinations and imaging studies every six months to one year during the first six years.
摘要：
阑尾粘液性肿瘤，占不到1％的胃肠道肿瘤，是异构实体。他们可能无症状，偶然发现，或由于粘蛋白积累而表现为大肿瘤。缺乏标准化治疗使管理复杂化。影像学检查,尤其是CT扫描,对诊断和随访至关重要。该病例报告介绍了两例临床病例，其中六岁和七岁的妇女有下消化道出血史，实验室研究中的轻度贫血，结肠镜检查不完整。诊断,通过CT扫描证实,导致了在这两种情况下进行手术干预的决定，包括腹腔镜右半结肠切除术与回肠吻合术。随后，组织病理学报告证实了高度阑尾粘液性肿瘤的诊断，并制定了随访计划,每6个月进行一次影像学检查,2年无复发.超过50％的阑尾肿瘤是源自低度粘液性肿瘤的粘液性肿瘤。鉴于低淋巴结侵犯（2％），如果切除整个肿瘤，阑尾切除术可能就足够了。对于较大的肿瘤或高级别肿瘤保留广泛切除或右半结肠切除术，以最大程度地减少局部复发风险。伴有无细胞黏液蛋白和腹膜浸润的黏液性肿瘤可能需要细胞减灭术或右半结肠切除术，而患有粘液上皮的患者可能需要腹腔热化疗（HIPEC），因为有局部复发的风险，由于额外的阑尾上皮细胞的存在而恶化。无病生存期和总生存期取决于治疗和初始病变特征。据报道，低度粘液性肿瘤的五年生存率为86％。后续方法缺乏理想的标准，在头六年中，通常每六个月至一年进行一次体格检查和影像学检查。
