原发性阑尾肿瘤11例临床分析

目的　探讨原发性阑尾肿瘤的临床特点、早期诊断及治疗要点。方法　回顾性分析我院 1 992～ 2 0 0 2年的 1 1例原发性阑尾肿瘤的临床资料。结果　阑尾良性肿瘤 :粘液囊肿 2例。阑尾恶性肿瘤 :阑尾类癌 6例 ,阑尾腺癌 3例。均行手术治疗 ,其中 5例行二期右半结肠切除术。结论　阑尾肿瘤临床少见 ,术前诊断困难 ,应提高认识。对术中可疑者 ,应做术中快速病理检查 ,以选择适当的手术方式 ,提高手术预后     

Mucus-secreting tumors of the appendix: a preoperative diagnosis is possible. Apropos of 2 cases

The authors present two cases of pseudo tumoral type Mucus Secreting Tumours (MST) of the appendix. In this type (32% of the cases), the clinical presentation, barium enema, ultrasonography and most importantly CT scan generally confirm the preoperative diagnosis. We found three advantages this preoperative diagnosis. 1) Primarily it allows selection of a large surgical approach that permits full exploration of the abdominal cavity especially the ovaries (2-18% associated lesions); 2) also it allows a histopathological examination (frozen section) of the appendix to be performed during the operation; 3) and finally the surgical treatment will depend on the operative findings and the result of the histopathological examination: in the benign forms simple appendicectomy will be sufficient but the malignant forms (12% of the cases) should be treated by right hemicolectomy.     

阑尾类癌七例报道——附文献复习

目的 探讨阑尾类癌的病理特征与治疗方法.方法 回顾性分析我院于1980年～2005年间收治的7例和同期国内文献报告的37例共44例阑尾类癌的临床病理资料.结果 阑尾类癌发生在尖端者31例,中段者9例,根部者4例;肿瘤直径＜1cm者35例,1～2cm者7例,＞2cm者2例;肿瘤浸润黏膜下层者38例,肌层者2例,浆膜层者4例;有局部淋巴结转移者3例,无转移者41例.组织学观察绝大多数表现为典型类癌.所有病例术后随访1～15年,未见肿瘤转移、复发.结论 阑尾类癌绝大多数发生在尖端,体积小,局限于黏膜下层,表现为良性类癌,单纯阑尾切除术是其主要治疗方式;肿瘤直径＞2cm、浸润浆膜或有转移者应视为恶性,应选择右半结肠切除术.     

阑尾滤泡树突状细胞肉瘤的临床与病理

目的 探讨阑尾滤泡树突状细胞肉瘤（follicular dendritic cell sarcoma,FDCS）的生物学行为特征,诊断要点和临床治疗.方法 对1例阑尾FDCS术后8个月腹腔内复发患者的手术标本进行病理形态学观察、免疫组化检测.结果 两次手术切除的肿瘤的组织病理学形态一致.免疫组化：CD21、CD35、S-100、Vimentin、CD68和FN呈阳性反应;CD117、CD34、SMA、Actin、NSE和CK呈阴性反应.病理学诊断：阑尾FDCS,腹腔内复发.结论 FDCS是一种非常罕见的肿瘤,大多发生于淋巴结,少数可见于淋巴结外.手术切除是治疗FDCS的主要方法.     

Pseudomyxoma peritonei: new concept and new therapeutic approach

Pseudomyxoma peritonei is a rare disease, usually diagnosed after the discover of "jelly belly" by laparotomy. With the progress of immunohistochemistry, most authors now acknowledge the appendix to be the principal origin of this disease. Pseudomyxoma peritonei need to considered as border line malignant disease because of its inevitable persistence and progression without adapted therapeutic approach: cytoreductive surgery combined with perioperative intraperitoneal chemotherapy (intraperitoneal chemohyperthermia and/or immediate postoperative intraperitoneal chemotherapy) into specialized centres. The principal prognostic factors are the prior surgical history, the completeness of cytoreduction and especially the histopathologic grade.     

An association of mucocele and carcinoid tumour of the appendix

The carcinoid tumour of the appendix and the mucocele are entities rather infrequent in children and are normally diagnosed in the course of an appendicectomy that is, in most of the cases, curative. The association of both processes is unusual. The authors present a case of carcinoid tumour of the appendix associated to mucocele in a male, aged 10 patient, who underwent an appendicectomy by suspicion of an acute appendicitis. The histologic study confirmed the presence of a mucocele of the appendix associated to a carcinoid tumour with a 0,7 cm diameter. The serum serotonin and chromogranin A assessment was normal, and the TAC and colonoscopic examination resulted in no meaningful findings. The appendicectomy itself was curative, deeming it the appropiated treatment in tumours under 2 cm diameter.     

Unusual duplication of appendix and cecum: extension of the Cave-Wallbridge classification

Duplicated appendix has, to date, been classified into 3 types. The authors present a type of duplicated appendix not previously described. Surgical exploration was done in a 14-year-old girl who had an acute abdomen. Surgical exploration showed a duplicated appendix that arose from the normal appendix and ended in a thick-walled, inflamed, perforated muscular pouch. Duplicated appendix is a treatable condition that rarely occurs with colonic duplication and which should be considered in the differential diagnosis of lower abdominal pain.     

Mucocele of the appendix. Two case reports

The authors present two cases of mucocele of the appendix and discuss them in relation to the literature and the clinical features of this disease. They clarify the definition of mucocele as an intraluminal accumulation of mucus in the appendix, and concentrate on the observable pathological processes, agreeing on the higher frequency of mucinous cystadenoma and the possibility that mucocele can develop into peritoneal pseudomyxoma or degenerate into cystadenocarcinoma. They also note that most diagnoses are made intra-operatively during appendectomy, and that, in cases suspected preoperatively, thorough investigation with imaging techniques is very important in order to plan the best treatment.     

原发性阑尾恶性肿瘤的诊治分析：附17例报告

目的探讨原发性阑尾恶性肿瘤的临床特点、治疗方法及预后。方法回顾性分析东南大学医学院附属徐州医院1993年3月至2008年11月的17例原发性阑尾恶性肿瘤的临床和病理资料。结果所有患者无一例术前确诊,均在术中及术后病理确诊,其中黏液腺癌6例,类癌9例,恶性淋巴瘤2例。3例术中快速病理回报后行右半结肠切除术,13例患者术后3     

Mucinous cystadenocarcinoma of the appendix complicated with spontaneous cutaneous fistula

Mucocele of the appendix is a relatively rare disease characterized by a cystic dilatation of the appendiceal lumen with stasis of mucus inside. Appendiceal mucocele with a cutaneous fistula is an extremely rare clinical entity, only four such cases being described in the medical literature. We report an additional case of cystadenocarcinoma of the appendix with spontaneous cutaneous fistula. The patient is an 80-year old woman, who originally presented with a skin ulcer in the right lower abdominal quadrant with mucus discharge during the last month. Abdominal ultrasonography and computed tomography demonstrated cystic mass with mixed echogenity and density originating from the appendix, involving the abdominal wall, without signs of ascites or metastasis. A right hemi-colectomy, lymphadenectomy and resection of the skin fistula was performed. The histological findings revealed moderately differentiated mucinous cystadenocarcinoma of the appendix. The postoperative period was uneventful and the patient discharged on the 11th POD. During 12 month follow-up period the patient is free of disease recurrence. The authors present the literature review, diagnostic features and the treatment policy of this extremely rare condition.     

Primary carcinoma of the appendix.

Primary adenocarcinoma of the appendix is rare and less than 200 cases are on record. The present material consisted of 20 cases collected from different hospitals. The cases are described in respect of sex and age-distribution, symptoms, treatment and prognosis. Of 7 patients with malignant mucocele, 6 subjected to appendectomy only, were still alive 5 years after the operation. Of 12 patients with colonic type of adenocarcinoma, 3 had been treated with appendectomy only. Of these, 2 were still alive 5 years after the operation. The remaining 9 patients had undergone right hemicolectomy. Only one of them was alive 5 years after the operation. A compilation of a further 39 cases garnered from the literature, however, showed that 60% had survived at least 5 years after right hemicolectomy, compared with 46% after appendectomy alone. Appendectomy alone is probably a sufficiently radical operation for malignant mucocele provided the tumor has not grown through the submucosa and that it is confined to the tip of the appendix. Right hemicolectomy is indicated for the colonic type of adenocarcinoma.     

High time to make choice: preventive or curative appendectomy?]

The authors advocate prophylactic appendectomy in conditions of wide application of laparoscopic surgery, refer to literature data on the absence of life-important functions in appendix and any functional disturbances after appendectomy. Taking into account high rate of development and difficulties in the diagnosis of acute appendicitis, favourable clinical and economical results of laparoscopic appendectomy, the authors suggest wider use of preventive removal of the appendix, especially in definite groups of population.     

Strangulated appendix epiploica in paraumbilical hernia: preoperative diagnosis and laparoscopic treatment

Appendix epiploica can occasionally cause acute abdominal pain. The usual presentations are torsion or primary epiploic appendicitis. Strangulation inside a paraumbilical hernia with acute abdominal pain is seldom reported in the literature. The authors report a case of preoperative diagnosis and laparoscopic treatment of strangulated appendix epiploica in paraumbilical hernia that presented as acute abdominal pain.     

Laparoscopic appendicectomy: an 8-year clinical experience

BACKGROUND: For more than a century, open appendectomy through a laparotomy has been the golden standard for the surgical removal of the appendix. Nowadays, many surgeons question the utility of laparoscopic surgery to perform appendectomies because it is commonly stated that the appendix can be removed through a small surgical incision carrying a minimal surgical trauma to the patient. Although open appendectomy is really safe, on the other hand it carries a considerable risk of postoperative complications, is associated with postoperative pain and affects patient s normal activity. Laparoscopic appendectomy was first described in 1983 and, in many studies, it is described to be better than open standard technique for the treatment of appendiceal diseases. The aim of the present study is the retrospective analysis of laparoscopic appendectomies performed in a 8-year period. METHODS: The authors report on 129 patients who underwent laparoscopic appendectomy. RESULTS: Conversion rate was 0.7 %, while the laparoscopic procedure was completed in 96 female and 32 male patients. The position of the appendix was behind the cecum in 37 cases, associate diseases were found in 15 cases. Mean operative time was 51 minutes; kind of laparoscopic instrumentation affected the operation time. Histologically there were 71 (55.5 %) focal appendicitis, 22 (17.1 %) suppurative appendicitis, 11 (8.6 %) gangrenous appendicitis, 18 (14.1 %) chronic appendicitis showing signs of previous suppurative episodes and 6 (4.7 %) normal appendix. There were neither in-hospital morbidity nor mortality. Follow-up showed reduced postoperative pain, short hospital stay, fast return to complete social activity. CONCLUSIONS: The authors conclude that laparoscopic technique can be considered a safe and effective procedure for the removal of the appendix as it has the advantage of allowing faster postoperative recovery; moreover the author recommend a wider and routinely use for appendectomy.     

Simplified technique for laparoscopic appendectomy

In this article, a simplified technique for laparoscopic appendectomy is described in which the base of the appendix is firstly divided, and then ligated with an endoloop. An endoloop is then passed over the appendix onto the mesoappendix and tightened to secure the blood supply. The appendix can then be freed and removed. This technique has been used by the authors in difficult cases, and has produced excellent results.     

Inflammatory pseudo-tumour of the appendix and acute appendicitis: a case report

Inflammatory myofibroblastic tumour (IMT) is a rare benign lesion of unknown aetiology. It mimics, clinically and radiologically, malignant tumours (especially sarcoma). It was initially described in the lung, but it was subsequently recognised that virtually any anatomic location can be involved. IMTs of the gastro-intestinal tract are rare and there have been only nine confirmed cases involving the appendix to date. We presented a 20-year-old male patient with a diagnosis of IMT that caused acute appendicitis. An appendectomy is the most efficient treatment in cases where the lesion is limited to the appendix. Being aware of such an entity and being careful in the differential diagnosis of the appendiceal masses, especially the large masses, may prevent overtreatment.     

Torsion of the testis and spermatic cord in children]

The authors report 16 cases of torsion of the testis and 3 cases with twisting of the testicular appendix. Fifteen children with torsion of the testis and one child with twisting of the testicular appendix were operated upon. Late results were followed up in 14 cases within the terms from 6 months to 7 years. Atrophy of the testis was not observed in children, operated upon in earlier terms of the affection, irrespective of the degree of the torsion. In late patients' admission to the hospital even small size torsions resulted in testicular atrophy in 4 cases. To improve the results of treatment in children with torsion of the testis early operative interventions are greatly advocated.     

Carcinoid Tumors of the Gastrointestinal Tract

The charts of 135 patients with gastrointestinal carcinoid tumors diagnosed over a 22-year period at 2 hospitals are reviewed and the clinical and pathological aspects discussed. Carcinoids occur most commonly in the appendix, jejunoileum, and rectum. Those smaller than 1 cm in diameter provide evidence of malignant potential only occasionally; lesions in the 1-1.9 cm range do this quite variably, and tumors 2 cm and larger are almost always invasive or metastatic or both. All gastrointestinal carcinoids except those of the appendix enlarge, invade, and metastasize predictably if given sufficient time. Most carcinoids except those of the rectum have already been adequately treated surgically when diagnosed by the pathologist. Local excision is effective treatment for noninvasive rectal carcinoids smaller than 2 cm in diameter, but those that have invaded or grown to 2 cm should undergo more radical resection. In general, gastrointestinal carcinoids carry better prognoses than do adenocarcinomata, and even in the presence of distant metastases long-term survival occurs in a significant number of patients. The frequent concomitance of associated malignant diseases accounts for as many or more deaths in these patients than the carcinoids themselves.     

Primary malignant lymphoma of the appendix

A 70-year-old Japanese woman with primary malignant lymphoma in the appendix was treated. The diagnosis was established after surgery. Histologically, the tumor was malignant lymphoma, lymphocytic, well differentiated, according to the Rappaport's classification which is a good prognostic type of extranodal malignant lymphoma. The patient was treated by ileocecal resection and without radiochemotherapy. The 36-month follow-up revealed neither evidence of recurrence nor metastases.     

Primary malignant lymphoma of the appendix

A 70-year-old Japanese woman with primary malignant lymphoma in the appendix was treated. The diagnosis was established after surgery. Histologically, the tumor was malignant lymphoma, lymphocytic, well differentiated, according to the Rappaport's classification which is a good prognostic type of extranodal malignant lymphoma. The patient was treated by ileocecal resection and without radiochemotherapy. The 36-month follow-up revealed neither evidence of recurrence nor metastases.