appendix adenocarcinoma
Introduction
Introduction to appendix adenocarcinoma Appendicealadenocarcinoma is a rare appendic disease that was first reported by Berger (1882). Appendectomy adenocarcinoma accounts for 0.08% of the appendectomy specimens. The median age of onset is high, about 50 years old. This feature has a certain significance in clinical diagnosis. basic knowledge The proportion of illness: 0.002%-0.005% Susceptible people: good for people around 50 years old Mode of infection: non-infectious Complications: intestinal obstruction
Cause
The cause of appendix adenocarcinoma
Causes:
The cause of the disease is still unclear.
Pathogenesis:
1. Pathological classification, appendical adenocarcinoma has two types of mucosa type and colon type. (1) mucosal type: also known as cystadenocarcinoma, originated from cystic adenoma, mostly well-differentiated cells, very similar to ovarian cystadenocarcinoma, easy to rupture and disseminated in the abdominal cavity, leading to peritoneal pseudomyxoma, easy after surgery relapse. (2) Colon type: a polypoid or ulcerated tumor that originates from a tubular or tubular villous adenoma, similar to the adenocarcinoma of the colon, and metastasized along the lymphatic and bloodways.
2. Transfer route
Appendectomy adenocarcinoma occurs in the root of the appendix, so it is easy to invade the ileocecal area and the colon. The main routes of transfer are:
1 lymphatic pathway, colon type is the most common, once the tumor invades the submucosal layer, it is easy to along the appendix mesenteric lymph node, ileocecal lymph node, right colonic artery lymph node, and even abdominal aortic lymph node metastasis.
2 blood transfer, can be transferred to the liver along the portal system, and further transferred to tissues and organs throughout the body.
3 direct infiltration and planting, can invade adjacent mesentery, cecum, ureter, and even pelvic cavity implant transfer, mucosal type is prone to this type of metastasis, intraoperative can be seen from several to hundreds of large to eggs, as small as sesame jelly Nodules, often accompanied by ascites, colonic adenocarcinoma with abdominal metastasis is mainly mucinous adenocarcinoma, followed by differentiated adenocarcinoma, which occurs in advanced patients.
Prevention
Appendix adenocarcinoma prevention
To improve the survival rate of the disease, the preoperative diagnosis rate is the key, and it is quite difficult to do this. Mayo Clinic reported that a group of patients with appendix adenocarcinoma were not diagnosed before surgery, and only 42% of the patients were diagnosed. It is discovered after postoperative pathological examination. Therefore, clinicians should be alert to the possibility of adenocarcinoma when dealing with appendicitis. In the operation, the appendix should be cut open to check for the presence or absence of a mass. For suspicious cases, it should be frozen and sliced in time. The confirmed patients were urged to undergo a right-sided partial colectomy. In addition, the well-differentiated appendix adenocarcinoma needs close follow-up after surgery to seek timely treatment before the formation of peritoneal pseudomyxoma. It is reported in the literature that 35% to 60% of patients may Intestinal or extraintestinal tumors will occur at the same time or at different times, so it is necessary to pay attention to preoperative diagnosis to prevent missed diagnosis, intraoperative exploration to exclude abdominal tumors, and postoperative follow-up findings of metachronous tumors.
Complication
Appendix adenocarcinoma complications Complications, intestinal obstruction
Perforation of the appendix
Because the wall of the appendix is thin, the lumen is narrow, and the secretions are blocked and the tumor is infiltrated, and the perforation of the appendix is easy. The local peritoneal irritation can occur in the clinic, which can easily lead to the implantation of tumor cells in the abdominal cavity.
2. Intestinal obstruction
In cases of mucosal adenocarcinoma with abdominal metastasis, mechanical or functional intestinal obstruction may result from tumor compression or invasion of the intestine. If not actively treated, the patient may die due to intestinal obstruction.
Symptom
Appendix gland cancer symptoms Common symptoms Right lower quadrant pain, weight loss, abdominal pain, abdominal pain, appendix abscess, appendix perforation, weak appetite, ascites
1. Abdominal pain and lumps
Right lower abdominal pain or right lower abdomen mass is the main manifestation of this disease. Because the tumor narrows or even occludes the root of the appendix, the excretion of the appendix cavity is blocked, the mucus accumulates, and the infection can also occur, which increases the pressure in the cavity and similar appendicitis. The performance is often wrapped in the omentum and adheres to the surrounding tissue to form a mass, so it is easily misdiagnosed as appendix abscess before surgery.
2. Consuming symptoms
Can show the symptoms of consumption of malignant tumors, such as weight loss, fatigue, ascites, decreased appetite and so on.
3. Perforation of the appendix and intestinal obstruction
The perforation rate of appendix adenocarcinoma is high, up to 39% to 55%, which may be concealed from the disease, the rate of misdiagnosis is high, the tumor is large at the time of diagnosis, and the wall of the appendix is thin, the lumen is small, the stretch is small, and the adenocarcinoma More often in the proximal end and block the lumen, the secretions can not be efflux and the pressure is increased to cause rupture and perforation. Of course, it is not excluded that the tumor invades the colon and appears to be necrotic and perforated. The perforation is easy to cause postoperative intraperitoneal implantation, but the literature does not report Will affect the patient's prognosis, a small number of cases may be associated with intestinal obstruction.
For those over 40 years old, long-term right lower abdominal pain or painless mass, anti-inflammatory, symptomatic treatment did not improve or shrink or even aggravate or increase, with anemia, weight loss, and even ascites; or wound prolongation after appendectomy Even the formation of fistulas, suspected of this disease, feasible X-ray barium enema, B-ultrasound, CT and other examination and diagnosis, can not obtain pathological diagnosis before surgery, also need laparotomy.
Examine
Examination of appendix adenocarcinoma
Blood test
In the case of acute inflammation of the appendix, there may be an increase in white blood cell count. When systemic wasting symptoms occur, the patient may have a decrease in hemoglobin, but there is no specificity in the diagnosis of primary appendicitis.
2. Histopathological examination
Pathological examination of the tumor under the fiber enteroscopy can confirm the diagnosis.
3. X-ray barium enema
It can be seen that the cecum segment is subjected to an external pressure curved or filling defect, and the mucosal folds are disordered or even disappeared, and the intestinal wall is stiff.
4.B-ultrasound
It can be found in the right lower quadrant, and the boundary is unclear, showing a low echo. When the tumor is small, only the appendix may be thickened.
5. CT, MRI examination can be found.
6. Fiber colonoscopy
It can be seen that the cecal external pressure bulge, part of the mucous membrane erosion, edema, severe cases can touch the mass.
Diagnosis
Diagnosis and differentiation of appendix adenocarcinoma
The symptoms of this disease are not specific, and are easily misdiagnosed as acute and chronic appendicitis or appendix abscess. The local mass is often suspected due to acute appendicitis. The disease should be confirmed by intraoperative frozen section examination.
Appendectomy adenocarcinoma should be differentiated from cecal cancer, ovarian tumor, appendix carcinoid and so on.
