背景:阑尾杯状细胞腺癌是一种罕见的诊断,具有腺癌和类癌的特征。常表现为慢性腹痛,阑尾炎,或者腹胀,它也可以在阑尾切除术中偶然发现。
方法:我院收治一名50岁右下腹疼痛患者,这是一个重症监护中心。计算机断层扫描(CT)扫描显示回肠狭窄,但内窥镜检查没有发现狭窄.他被怀疑患有肠梗阻,并用回肠管改善。腹腔镜手术显示阑尾肿瘤。组织学上,他被诊断为杯状细胞腺癌,提示肿瘤浸润的神经纤维损害蠕动。
结论:阑尾杯状细胞腺癌具有独特的组织学和不良预后。治疗通常包括手术和化疗。这个病例突出了术前诊断的挑战,肿瘤通过侵入肠壁和神经丛引起肠假性梗阻。观察到奥尔巴赫神经丛的广泛浸润,与肠狭窄的长度一致。
结论:本病例描述了阑尾杯状细胞腺癌,由于回肠端狭窄导致肠假性梗阻。它强调了在没有明显肿块的肠梗阻病例中考虑这种诊断的重要性。
BACKGROUND: Goblet cell adenocarcinoma of the appendix is a rare diagnosis with features of both adenocarcinomas and carcinoid tumors. Commonly presenting with chronic abdominal pain, appendicitis, or abdominal distention, it can also be incidentally discovered during appendectomies.
METHODS: A 50-year-old man with right lower abdominal pain was admitted to our hospital, which is a critical care center. A computed tomography(CT) scan showed ileal narrowing, but endoscopy found no strictures. He was admitted with suspected bowel obstruction and improved with an ileal tube. Laparoscopic surgery revealed a tumor of the appendix. Histologically, he was diagnosed goblet cell adenocarcinoma, suggesting tumor infiltration of nerve fibers impairing peristalsis.
CONCLUSIONS: Goblet cell adenocarcinoma of the appendix has unique histology and a poor prognosis. Treatment typically involves surgery and chemotherapy. This case highlights challenges in preoperative diagnosis, with the tumor causing bowel pseudo-obstruction by invading the intestinal wall and nerve plexus. Extensive infiltration of Auerbach\'s plexus was observed, consistent with the length of intestinal stenosis.
CONCLUSIONS: This case describes goblet cell adenocarcinoma of the appendix leading to bowel pseudo-obstruction due to ileal end stenosis. It emphasizes the importance of considering this diagnosis in cases of bowel obstruction without an obvious mass.