PDF(Pubmed)
Abstract：
UNASSIGNED: Appendiceal signet-ring cell adenocarcinoma (ASCA) is rare and more aggressive in malignant appendiceal neoplasms. The presentation can be appendicitis, which is lack of specific symptom and makes early diagnosis difficult. There is no effective surveillance. Prognosis largely relies on timely detection. We report a case of ASCA incidentally diagnosed through pathological examination after appendectomy for appendicitis.
UNASSIGNED: The patient presented to our department with a progressive right lower quadrant abdominal pain lasting for 3 days. Physical examination revealed rigidity, tenderness, and rebound tenderness on the right lower quadrant. A computed tomography scan showed a thickened, inflamed appendix with peri-appendiceal fat stranding without noticeable appendiceal mass at initial evaluation. The diagnosis was considered acute appendicitis, and an appendectomy was performed. The appendix was inflamed, gangrenous and perforated, and no mass was found during the surgery. Surgical specimen was sent for physiological examination, which incidentally detected signet-ring cell in H&E staining. And immunohistochemistry confirmed the diagnosis of ASCA with small amount of neuroendocrine neoplasms.
UNASSIGNED: Early diagnosis of ASCA can incidentally be made on pathological specimen following appendectomy for appendicitis. A routine pathological examination should be emphasized, and appendectomy may not be the endpoint of the treatment. Hemicolectomy and adjuvant therapy might ensue upon the diagnosis of appendiceal neoplasm. The poor prognosis of ASCA makes a timely diagnosis significant. Basic research is promising to unravel the molecular mechanisms of pathogenesis, finding typical tumor markers for screening and novel effective therapies for advanced cases.
UNASSIGNED: The patient presented to our department with a progressive right lower quadrant abdominal pain lasting for 3 days. Physical examination revealed rigidity, tenderness, and rebound tenderness on the right lower quadrant. A computed tomography scan showed a thickened, inflamed appendix with peri-appendiceal fat stranding without noticeable appendiceal mass at initial evaluation. The diagnosis was considered acute appendicitis, and an appendectomy was performed. The appendix was inflamed, gangrenous and perforated, and no mass was found during the surgery. Surgical specimen was sent for physiological examination, which incidentally detected signet-ring cell in H&E staining. And immunohistochemistry confirmed the diagnosis of ASCA with small amount of neuroendocrine neoplasms.
UNASSIGNED: Early diagnosis of ASCA can incidentally be made on pathological specimen following appendectomy for appendicitis. A routine pathological examination should be emphasized, and appendectomy may not be the endpoint of the treatment. Hemicolectomy and adjuvant therapy might ensue upon the diagnosis of appendiceal neoplasm. The poor prognosis of ASCA makes a timely diagnosis significant. Basic research is promising to unravel the molecular mechanisms of pathogenesis, finding typical tumor markers for screening and novel effective therapies for advanced cases.
摘要：
■阑尾印戒细胞腺癌（ASCA）在恶性阑尾肿瘤中罕见且更具侵袭性。表现可能是阑尾炎，这是缺乏特异性的症状，使早期诊断困难。没有有效的监督。预后很大程度上依赖于及时发现。我们报告了一例阑尾炎阑尾切除术后通过病理检查偶然诊断为ASCA的病例。
■患者出现持续3天的进行性右下腹腹痛。体格检查显示僵硬，压痛,右下象限有回弹压痛。计算机断层扫描显示增厚，阑尾发炎，阑尾周围脂肪绞合，初始评估时无明显阑尾肿块。诊断为急性阑尾炎，并进行了阑尾切除术。阑尾发炎了,坏疽和穿孔，手术中没有发现肿块。手术标本送去做生理检查,在H&E染色中偶然检测到印戒细胞。免疫组化证实ASCA诊断为少量神经内分泌肿瘤。
■ASCA的早期诊断可以在阑尾炎阑尾切除术后的病理标本上进行。应强调常规病理检查，阑尾切除术可能不是治疗的终点。诊断阑尾肿瘤后可能会进行半结肠切除术和辅助治疗。ASCA的不良预后使及时诊断具有重要意义。基础研究有望揭示发病机制的分子机制，寻找典型的肿瘤标志物筛查和新的有效治疗晚期病例。
■患者出现持续3天的进行性右下腹腹痛。体格检查显示僵硬，压痛,右下象限有回弹压痛。计算机断层扫描显示增厚，阑尾发炎，阑尾周围脂肪绞合，初始评估时无明显阑尾肿块。诊断为急性阑尾炎，并进行了阑尾切除术。阑尾发炎了,坏疽和穿孔，手术中没有发现肿块。手术标本送去做生理检查,在H&E染色中偶然检测到印戒细胞。免疫组化证实ASCA诊断为少量神经内分泌肿瘤。
■ASCA的早期诊断可以在阑尾炎阑尾切除术后的病理标本上进行。应强调常规病理检查，阑尾切除术可能不是治疗的终点。诊断阑尾肿瘤后可能会进行半结肠切除术和辅助治疗。ASCA的不良预后使及时诊断具有重要意义。基础研究有望揭示发病机制的分子机制，寻找典型的肿瘤标志物筛查和新的有效治疗晚期病例。
