| 摘要: |
| ［摘要］ 目的 分析阑尾低级别黏液性肿瘤误诊为卵巢肿瘤13例患者的临床资料，以期提高临床医师对该病的认识，减少误诊、漏诊。方法 选择2010年1月至2019年12月南京医科大学附属常州第二人民医院收治的13例阑尾低级别黏液性肿瘤误诊为卵巢肿瘤女性患者的临床资料。分析其临床表现、辅助检查结果、治疗方法和预后。结果 13例阑尾低级别黏液性肿瘤患者临床表现不典型，以腹痛为首发症状8例，以检查时发现腹部包块为首发症状4例。8例患者术前行超声检查，考虑肿块来源于阑尾3例，卵巢3例，其他部位2例。10例患者术前行CT检查，考虑肿块来源于阑尾4例，卵巢5例，其他部位1例。13例患者术前均行癌胚抗原（CEA）、甲胎蛋白（AFP）、癌抗原125（CA125）和癌抗原199（CA199）肿瘤标志物检测，结果CEA升高4例，CA125升高3例，CA199升高2例，无患者AFP升高。13例患者均行手术治疗，行腹腔镜探查术7例，剖腹探查术6例，术后病理结果均证实为阑尾低级别黏液性肿瘤。随访至2020年2月，2例死亡，1例（为合并结肠癌患者）目前正在接受化疗，其余10例情况良好。结论 对以首发症状为腹痛或者腹部包块的中老年女性患者，如卵巢癌诊断不明确，应考虑阑尾黏液性肿瘤疾病的可能，应及时行手术探查，必要时于术前、术中请外科会诊，术中可行快速冰冻病理切片检查。超声、CT检查以及肿瘤标志物检测对于明确肿块性质有一定的参考意义。 |
| 关键词: 卵巢肿瘤 阑尾低级别黏液性肿瘤 误诊 |
| DOI：10.3969/j.issn.1674-3806.2022.08.11 |
| 分类号:R 711 |
| 基金项目:常州市卫生健康委重大科技项目（编号：ZD201812）；南京医科大学康达学院2018年度教育研究课题（编号：KD2018JYYJYB055） |
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| Analysis of clinical data of 13 patients with low-grade appendiceal mucinous neoplasm misdiagnosed as ovarian tumor |
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ZHONG A-hong, CHEN Yu-qing, JIANG Peng-cheng, et al.
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Department of Gynecology, the Affiliated Changzhou NO.2 People′s Hospital of Nanjing Medical University, Jiangsu 213000, China
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| Abstract: |
| ［Abstract］ Objective To analyze the clinical data of 13 patients with low-grade appendiceal mucinous neoplasm misdiagnosed as ovarian tumor and to improve clinicians′ understanding of the disease to reduce misdiagnosis and missed diagnosis. Methods The clinical data of 13 female patients with low-grade appendiceal mucinous neoplasm admitted to the Affiliated Changzhou NO.2 People′s Hospital of Nanjing Medical University from January 2010 to December 2019 were selected, all of whom were misdiagnosed with ovarian tumor. The patients′ clinical manifestations, auxiliary examination results, treatment methods and prognosis were analyzed. Results The clinical manifestations of the 13 patients with low-grade appendiceal mucinous neoplasm were atypical, among whom 8 patients presented with abdominal pain as the initial symptom, and 4 patients were found to have abdominal masses as the initial symptom during examination. Eight patients underwent preoperative ultrasonography, and the tumors were considered to be from the appendix in 3 cases, the ovary in 3 cases, and other sites in 2 cases. Preoperative computed tomography(CT) was performed on 10 patients, and the tumors were considered to be from the appendix in 4 cases, the ovary in 5 cases, and other sites in 1 case. All the 13 patients underwent preoperative detections of carcinoembryonic antigen(CEA), alpha-fetoprotein(AFP), cancer antigen(CA)125 and CA199 tumor markers. The results showed that CEA was elevated in 4 patients, and CA125 was elevated in 3 patients, and CA199 was elevated in 2 patients, and no patients had elevated APF. All the 13 patients underwent surgical treatment, among whom 7 patients underwent laparoscopic exploration and 6 patients underwent laparotomy. The postoperative pathological results confirmed that these tumors were low-grade appendiceal mucinous neoplasm. Follow-up was performed on the patients until February 2020, and 2 patients died. One patient(the patient complicated with colon cancer) is currently receiving chemotherapy, and the other 10 patients are in good condition. Conclusion For the middle-aged and elderly female patients whose initial symptom is abdominal pain or abdominal masses, if the diagnosis of ovarian cancer is not clear, the possibility of appendiceal mucinous tumor disease should be considered. Surgical exploration should be performed on the patients in time, and if necessary surgical consultations should be asked for before or during the operation. Intra-operative rapid frozen section of pathological examination can be carried out to confirm the diagnosis. Ultrasonography, CT examination and the detections of tumor markers have certain reference significance for determining the nature of the masses. |
| Key words: Ovarian tumor Low-grade appendiceal mucinous neoplasm Misdiagnosis |
