Clinical Analysis Of 18 Cases With Appendiceal Mucinous Adenocarcinoma

Objective: To improve awareness of appendiceal mucinous adenocarcinoma,promote early diagnosis,early treatment,select the suitable way of diagnosis and treatment.Methods: To retrospectively analyze the progression features pathological characteristics treatment and prognosis of 18 appendiceal mucinous adenocarcinoma cases were confirmed by the pathologic examination postoperative who were treated in the First Affiliated Hospital of Dalian Medical University from March 1998 to September 2015.Results: 18 patients were confirmed by the postoperrative pathology.(1)7 males and11 females,age 28 to 79,mean age 66.8,average hospital stay 24.3 days.(2)11 cases have right lower quadrant abdominal pain,accounted for 61.1%(11/18);7 cases have pelvic and hypogastrium mass,accounted for 27.8%(7/18),1 case have uterine prolapse and abdominal distension.(3)The initial diagnosis of appendicitis in 4 cases,accounted for 22.2%(4/18);intraperitoneal place accupying,malignant can not be eliminate in 10 cases,accounted for 55.5%(10/18);pelvic and hypogastrium mass,malignant can not be eliminate in 4 cases,accounted for 22.2 %(4/18).(4)Abdominal? pelvic and gynecological ultrasonography examination accounted for 50%(9/18),which have diagnostic value accounted for 66.7%(6/9);preoperative abdominal CT san accounted for 77.8%(14/18),only one patient underwent enhanced scan,the 14 cases whounderwent CT san have diagnosis value accounted in 92.8%(13/14),preoperative abdominal X-ray examination 1 patient,accounted for 5.56%(1/18);preoperative colonoscopy examination in 2 cases,accounted for 11.1%(2/18).(5)15 patients have the preoperative tumor marker dates in the 18 cases,CEA positive in 9 cases,accounted for 60%(9/15);CEA amd CA19-9 all positive in 5 cases,accounted for 30%(5 / 15);CEA,CA19-9,CA125 all positive in 2 cases.(6)18 patients were underwent surgical treatment,right hemicolectomy in 6 cases,ileocecal tumor resection(intestinal anastomosis)in 3 cases,combine uterus?ovaries? omentum,and appendix resection in3 cases,both appendiceal tumor resection and appendectomy in 3 cases,both laparoscopic investigation switch to laparotomy ? appendiceal mucocele rsection,combine appendix and small intestine resection,combine ovarian and appendix resection in 1 case.None of the 18 cases undrwent chemotherapy intraoperative or other therapeutic measures during the hospitalization.(7)18 cases of the surgical patients,1case was considered malignant and didn't underwent forzen biopsy examination during the operative.10 cases underwent the frozen biopsy examination in the 17 cases,accounted for 55.6%(10 / 17),6 cases of tumor cells being found clearly,accounted for60%(6/10),malignant can not be eliminate in 1 case,accounted for 10%(1/10),misdiagnosed as appendiceal mucocele in 3 cases,accounted for 30%;7 cases(44.4%,7/17)didn't underwent the frozen biopsy examination,3 cases just underwent appendectomy among these;pathology detected three cases of intestinal metastatic lymph nodes,ovaries ?pelvic ? omentum detect of metastatic nodules in 5 cases,appendiceal perforation in 3 cases.(8)4 patients accepted to postoperative follow-up,follow-up rate 22.2%(4/18).One patient died due to extensive metastasis after appendectomy 18 months later;3 patients survive at present,including two cases of female patients with appendiceal mucinous adenocarcinoma underwent the combine uterus?ovaries?omentum and appendix resection,respectively survive 6 years and 4months ? 2 years and 8 months postoperation,1 case of male patients with well-differentiated mucinous adenocarcinoma,no postoperative chemotherapy,survive5 years and 3 months at present.Conclusion: Primary appendiceal mucinous tumor clinical rare,as the main pathological type of appendiceal mucinous tumors,the appendiceal adenocarcinoma is also relatively rare in clinical.Diagnosis early is difficult,and more depends on introperative or postoperative pathological diagnosis.Once the diagnosed of appendiceal mucinous adenocarcinoma be comfirmed,the Right Hemicolectomy should be chosen,the patients with peritoneal metastasis recommend cytoreductive surgery and hyperthermic intraperitoneal chemotherapy and regularly chemotherapy.