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中华医学超声杂志(电子版) ›› 2022, Vol. 19 ›› Issue (01) : 47 -50. doi: 10.3877/cma.j.issn.1672-6448.2022.01.009

腹部超声影像学

阑尾黏液性肿瘤超声误漏诊分析
崔晨1, 朱淑娥1,()   
  1. 1. 102100 北京市延庆区医院(北京大学第三医院延庆医院)超声诊断科
  • 收稿日期:2020-06-24 出版日期:2022-01-01
  • 通信作者: 朱淑娥

Causes of misdiagnosis and missed diagnosis of mucinous neoplasms of the appendix by ultrasound

Chen Cui1, Shu'e Zhu1,()   

  1. 1. Department of Ultrasound, Yanqing District Hospital (Yanqing Hospital, the Third Hospital of Peking University), Beijing 102100, China
  • Received:2020-06-24 Published:2022-01-01
  • Corresponding author: Shu'e Zhu
引用本文:

崔晨, 朱淑娥. 阑尾黏液性肿瘤超声误漏诊分析[J]. 中华医学超声杂志(电子版), 2022, 19(01): 47-50.

Chen Cui, Shu'e Zhu. Causes of misdiagnosis and missed diagnosis of mucinous neoplasms of the appendix by ultrasound[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2022, 19(01): 47-50.

目的

探讨阑尾黏液性肿瘤的超声表现,以期提高超声对其的诊断能力。

方法

回顾性分析2013—2019年在北京市延庆区医院经手术病理证实的10例阑尾黏液性肿瘤病例的超声声像图特征,分析误诊及漏诊情况。

结果

10例经手术病理证实为阑尾黏液性肿瘤的患者中,术前3例超声诊断或怀疑为阑尾黏液性肿瘤(30.0%,3/10),6例超声诊断为急性阑尾炎(60.0%,6/10),1例超声诊断为右下腹囊性包块,阑尾来源可能(10.0%,1/10)。10例患者的超声表现均为阑尾管径增宽,管壁增厚,其中5例阑尾管腔内可见沉积物,1例管腔内可见块状强回声,4例阑尾管壁结构不清合并周围积液。

结论

阑尾黏液性肿瘤是一种少见疾病,超声表现具有一定的特异性,超声医师应掌握其临床及超声特点,提高对该疾病的认识,可提高本病的超声诊断率。

Objective

To improve the ultrasound diagnosis of appendiceal mucinous neoplasms (AMNs) by investigating their ultrasound manifestations.

Methods

A retrospective study was performed on the ultrasonic images of ten cases of AMNs diagnosed by pathology at Yanqing District Hospital from 2013 to 2019.

Results

Of the ten cases included, only three were diagnosed or suspected as having AMNs by ultrasound (30.0%, 3/10), six were diagnosed with acute appendicitis (60.0%, 6/10), and one was diagnosed with cystic mass of the right lower abdomen (10.0%, 1/10). The ultrasonic characteristics of the ten cases were enlarged diameter and thickened wall of the appendix. Five cases had sediment in the lumen of the appendix, one had calcification in the lumen, and four had unclear wall structures surrounded by effusion.

Conclusion

AMNs are rare, and they have some characteristics on ultrasonography. Improving the knowledge on AMNs and being familiar with their clinical and sonographic characteristics are conductive to the accurate of diagnosis.

图1 被误诊的阑尾黏液性肿瘤患者超声声像图特征。图a示阑尾管腔扩张,管壁增厚,管壁上可见多发结节(箭头所示);图b示阑尾管腔内可见等回声沉积物(箭头所示);图c示阑尾管腔内可见点状及条带样强回声(箭头所示,++为测量键);图d示阑尾管腔周围可见积液样回声(箭头所示,++为测量键)
1
Fournier K, Rafeeq S, Taggart M, et al. Low grade appendiceal mucinous neoplasm of uncertain malignant potential (LAMN-UMP): prognostic factors and implications for treatment and follow-up [J]. Annals Surgical Oncologl, 2017, 24(1): 1-7.
2
Asenov Y, Korukov B, Penkov N, et al. Appendiceal mucocele - case report and review of the literature [J].Chirurgia (Bucur), 2015, 110(6): 565-569.
3
Jedrzkiewicz J, Tateishi Y, Kirsch R, et al. Impact of referral center pathology review on diagnosis and management of patients with appendiceal neoplasms [J]. Arch Pathol Lab Med, 2020, 114(6): 764-768.
4
El-Esawy BH, El Hafez AA, Abdelazia AM. Clinicopathological criteria defining mucinous appendiceal tumors from 2476 appendectomies: a single-center retrospective study [J]. J Gastrointest Cancer, 2018, 51(1): 10-16.
5
Shaib WL, Martin LK, Choi M, et al. Hyperthermic intraperitoneal chemotherapy following eytoreductive surgery improves outcome in patients with primary appendiceal mucinous adenocarcinoma: a pooled analysis from three tertiary care centers [J]. Oncologist, 2015, 20(8): 907-914.
6
Ramaswamy V. Pathology of mucinous appendiceal tumors and pseudomyxoma peritonei [J]. Indian J Surg Oncol, 2016, 7(2): 258-267.
7
Carr NJ, Bibeau F, Bradley RF, et al. The histopathological classification, diagnosis and differential diagnosis of mucinous appendiceal neoplasms, appendiceal adenocarcinomas and pseudomyxoma peritonei [J]. Histopathology, 2017, 71(6): 847-858.
8
Misdraji J. Mucinous epithelial neoplasms of the appendix and pseudomyxoma peritonei [J]. Mod Pathol, 2015, 28 Suppl 1: S67-S79.
9
Baumgartner JM, Tobin L, Heavey SF, et al. Predictors of progression in high-grade appendiceal or colorectal pefitone carcino matosis after eytoreductive surgery and hyperthermic intraperitoneal chemotherapy [J]. Ann Surg Oncol, 2015, 22(5): 1716-1721.
10
Kwag KS, Kim HJ, Jang SK, et al. Sonographic findings of malignant appendix tumors in seven cases [J]. J Med Ultrasound, 2018, 26(1): 52-55.
11
Xiao J, Li P, Lui W. Analysis of clinical characteristics of low-grade appendiceal mucinous neoplasm (LAMN): a retrospective cohort study of 51 LAMN patients [J]. J Invest Surg, 2021, 34(6): 1-7.
12
Shaib WL, Assi R, Shamseddine A, et al. Appendiceal mueinous neoplasms: diagnosis and management [J]. Oncologist, 2017, 22(9): 1107-1116.
13
Yehya M, Denson M, Moszczynski Z. Multi-origin mucinous neoplasm: should we prophylactically remove the appendix in the setting of mucinous ovarian tumors? [J]. Int J Surg Case Rep, 2020, 66: 326-329.
14
栾好梅, 苗立英, 葛辉玉, 等. 超声在阑尾黏液性肿瘤诊断中的价值 [J]. 中国超声医学杂志, 2014, 30(9): 814-817.
15
Gündoğar Ö, Kımıloğlu E, Komut N, et al. Evaluation of appendiceal mucinous neoplasms with a new classification system and literature review [J]. Turk J Gastroenterol, 2018, 29(9): 532-542.
16
Leshchinskiy S, Ali N, Akselrod D. The onion skin sign of appendiceal mucocele [J]. Abdom Radiol, 2018, 43(9): 2527-2528.
17
Van Hooser A, Williams TR, Myers DT. Mucinous appendiceal neoplasms: pathologic classification, clinical implications, imaging spectrum and mimics [J]. Abdom Radiol (NY), 2018, 43(11): 1561-1569.
18
Yilmaz M, Akbulut S, Kutluturk K, et al. Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis [J]. World J Gastroenterol, 2013, 19(25): 4015-4022.
19
Yu XR, Mao J, Tang W, et al. Low-grade appendiceal mucinous neoplasms confined to the appendix: clinical manifestations and CT findings [J]. J Investig Med, 2020, 68(1): 75-81.
20
王晓曼, 贾立群, 杨蕊. 超声在儿童消化道重复畸形诊断中的应用 [J/CD]. 中华医学超声杂志(电子版), 2011, 8(5): 1092-1098.
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