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1Limited, local, extracolonic spread of mucinous appendiceal adenocarcinoma after perforation with formation of a malignant appendix-to-sigmoid fistula: Case report and literature review显示文摘A 68-year-old man presented with progressive right lower quadrant abdominal pain and tenderness without rebound tenderness, and with constipation during the prior 9 mo. Abdomino-pelvic computed tomography and magnetic resonance imaging demonstrated a dilated appendix forming a fistula to the sigmoid colon. Open laparotomy revealed a bulky abdominal tumor involving appendix, cecum, and sigmoid, and extending up to adjacent viscera, without ascites or peritoneal implants. The abdominal mass was removed en bloc, including resection of sigmoid colon, cecum(with preservation of ileocecal valve), appendix, right vas deferens, testicular vessels, and minimal amounts of anterior abdominal wall; and shaving off of small parts of the walls of the urinary bladder and small bowel. Gross and microscopic pathologic examination revealed an appendix-to-sigmoid malignant fistula secondary to perforation of mucinous adenocarcinoma of the appendix with minimal local spread(stage T4). However, the surgical margins were clear, all 13 resected lymph nodes were cancer-free, and pseudomyxoma peritonei or peritoneal implants were not present. The patient did well during 1 year of follow-up with no clinical or radiologic evidence of local recurrence, metastases, or pseudomyxoma peritonei despite presenting with extensive stage T4 cancer that was debulked without administering chemotherapy, and despite presenting with malignant appendiceal perforation. This case illustrates the non-aggressive biologic behavior of this low-grade malignancy. The fistula may have prevented free spillage of cancerous cells and consequent distant metastases by containing the appendiceal contents largely within the colon.Seifeldin Hakim Mitual Amin Mitchell S Cappell 2016World Journal of Gastroenterology2016,22,38:4
2腹膜假性黏液瘤诊治体会显示文摘腹膜假性黏液瘤(PMP)分为原发性和继发性两种,继发性主要源于阑尾黏液囊肿、卵巢黏液性囊腺瘤或囊腺癌,为一种低度恶性病变。产生黏液的腺癌或囊肿破裂,瘤细胞不经淋巴管或血管扩散,而种植于腹膜或腹腔内脏器表面形成弥漫性转移灶,一般不发生脏器实质性浸润。病灶破裂聚集于腹腔中成为胶冻样黏液,导致腹腔广泛种植并不断产生黏液性物质,纤维组织增生产生广泛粘连。目前,临床上无特异性治疗方法,主要是通过手术去除病因。但该病在术后极容易复发,姜喜远 谢远哲 王艳华 沈丕杰 2015中国老年学杂志2015,35,15:0
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