[Clinicopathologic characteristics of appendiceal mucinous tumor misdiagnosed as gynecological neoplasms]

Zhonghua Zhong Liu Za Zhi. 2021 Apr 23;43(4):472-476. doi: 10.3760/cma.j.cn112152-20200320-00230.
[Article in Chinese]


Objective: To explore the clinicopathologic features and prognosis of female appendiceal mucinous tumor misdiagnosed as gynecological neoplasm. Methods: The clinical data of 12 cases of suspected gynecological neoplasm but confirmed as appendiceal mucinous tumor by operation and pathology in Beijing Obstetrics and Gynecology Hospital hospital from 2010 to 2019 were collected. The clinicopathologic features, treatment and prognosis of these patients were analyzed. Results: The median age of 12 patients was 58 years old and the clinical manifestations were atypical, including 5 cases with gastrointestinal symptoms, 6 cases with touched lesion in the right adnexal area, 3 cases with pseudomyxoma of peritonei, and 4 cases with increased serological tumor markers and ascites. Before operation, ultrasonic diagnosis showed cystic or cystic-solid mass in the right adnexal region in all cases. Pelvic and abdominal enhanced CT and/or enhanced MRI were performed in 5 cases. Two cases indicated possible origin of appendix and 1 case indicated lymphatic cystic tumor. Laparoscopic or laparotomy exploration was performed in all patients, during the operation 7 cases were performed appendectomy, 4 cases were performed tumor cell reduction and 1 case was treated in another hospital after laparotomy exploration. Eleven cases were diagnosed as low-grade appendiceal mucinous tumor and 1 case as appendiceal mucinous adenocarcinoma by postoperative pathology. Among the 11 patients with low-grade appendiceal mucinous tumor, 9 cases had no recurrence, 1 case lost follow-up, 1 case died of breast cancer and 1 case died 18 months after the operation. Conclusions: Gynecologists should improve their ability to differentiate appendiceal mucinous tumor from gynecological neoplasm. They can include ultrasonic diagnosis and CT scanning into their preoperative physical examination to improve their examination ability, and strive for specialist or surgical treatment to achieve the best result.

目的: 分析误诊为妇科肿瘤的女性阑尾黏液性肿瘤患者的临床病理特征和预后。 方法: 收集2010—2019年北京妇产医院收治的12例初诊为妇科肿瘤、经手术和病理证实为阑尾黏液性肿瘤患者的临床病理资料,分析患者的临床病理特征、治疗和随访情况。 结果: 12例患者的中位年龄为58岁。患者的临床表现不典型,消化道症状5例,妇科查体可触及右附件区肿物6例,合并腹膜假黏液瘤3例。腹水伴血清学肿瘤标志物升高4例。全组患者术前超声均提示右附件区囊性或囊实性肿物。术前行盆腹腔增强CT和(或)增强MRI检查5例,2例提示阑尾来源可能,1例提示淋巴管囊性肿瘤。全组患者行腹腔镜或开腹探查术,术中仅行阑尾切除术7例,行肿瘤细胞减灭术4例,1例探查术后于外院行手术治疗。术后病理诊断为低级别阑尾黏液性肿瘤11例,阑尾黏液性腺癌1例。11例低级别阑尾黏液性肿瘤无复发9例,失访1例,死亡1例(死因乳腺癌),1例阑尾黏液性腺癌患者术后18个月死亡。 结论: 妇科医师应提高对阑尾黏液性肿瘤与妇科肿瘤鉴别诊断的能力,术前查体结合超声和CT检查,可以提高术前诊断能力,争取专科或联合外科治疗,以期获得最佳治疗。.

Keywords: Appendiceal mucinous neoplasms; Gynecological neoplasms; Misdiagnosis; Pseudomyxoma peritonei.

MeSH terms

  • Appendiceal Neoplasms* / diagnostic imaging
  • Appendiceal Neoplasms* / surgery
  • Appendix*
  • Diagnostic Errors
  • Female
  • Genital Neoplasms, Female*
  • Gynecology*
  • Humans
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Peritoneal Neoplasms*
  • Pseudomyxoma Peritonei* / diagnostic imaging
  • Pseudomyxoma Peritonei* / surgery