Tumori mucinoase ale apendicelui diagnosticate drept apendicită acută

Ghidirim Gheorghe; Mişin Igor; Rojnoveanu Gheorghe; Vozian Marin; Guţu Eugen; Mişina Ana; Danci Alexandru

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626

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GHIDIRIM, Gheorghe, MIŞIN, Igor, ROJNOVEANU, Gheorghe, VOZIAN, Marin, GUŢU, Eugen, MIŞINA, Ana, DANCI, Alexandru. Tumori mucinoase ale apendicelui diagnosticate drept apendicită acută. In: Chirurgia (București, Romania), 2018, nr. S1(113), pp. 217-218. ISSN 1221-9118.

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Chirurgia (București, Romania)

Numărul S1(113) / 2018 / ISSN 1221-9118

Tumori mucinoase ale apendicelui diagnosticate drept apendicită acută

Appendiceal mucinous neoplasms diagnosed as acute appendicitis

Pag. 217-218

Ghidirim Gheorghe¹, Mişin Igor¹, Rojnoveanu Gheorghe¹, Vozian Marin¹, Guţu Eugen², Mişina Ana³, Danci Alexandru⁴

¹ IMSP Institutul de Medicină Urgentă,
² Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu“,
³ IMSP Institutul Mamei şi Copiluluii,
⁴ IMSP Spitalul Republican al Asociaţiei Curativ-Sanatoriale şi de Recuperare

Disponibil în IBN: 12 decembrie 2021

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Rezumat

Scop: Descrierea cazurilor de neoplasme mucinoase ale apendicelui (NMA) diagnosticate drept apendicitã acutã.
Material æi metode: Analiza pacienåilor diagnosticaåi preoperator cu apendicitã acutã æi intra- æi postoperator cu NMA cu potenåial
malign redus æi sporit, trataåi pe parcurs a 18 ani. În studiu au fost incluæi 13 pacienåi (6F, 7B; vârsta medie 55.69±5.1 ani) cu NMA.
Procedeele chirurgicale de primã etapã au fost: apendicectomie (n=11), drenarea colecåiei periapendiculare (n=1) æi hemicolonectomie
dreaptã+excizia implantelor+rezectie de oment. Examenul histopatologic a relevat NMA cu potenåial malign redus în 6 cazuri:
mucocel simplu sau chistadenom mucinos (n=5), mucocel cu endometriozã (n=1) æi MA cu potenåial malign sporit: chistadenocarcinom
mucinos (n=7).
Rezultate: În toate cazurile de NMA cu potenåial malign sporit pacienåii au dezvoltat pseudomixom peritoneal (n=5) sau extraperitoneal
(n=2) peste 22.43±11.48 luni. Aceæti pacienåi au beneficiat de intervenåie citoreductivã cu chimioterapie intraperitonealã
hipertermicã æi 5 zile de chimioterapie postoperatorie intraperitonealã cu 5-FU (750 mg/m2). Au decedat 2 pacienåi peste 28 æi 4 luni
dupã intervenåiile citoreductive.
Concluzie: Mucocelul apendicular prezintã simtomatologie nespecificã æi simuleazã frecvent apendicita acutã, iar diagnosticul
preoperator cert este dificil. Mucocelul apendicular cu potenåial malign sporit posedã potenåial de progresare spre pseudomixom
peritoneal/extraperitoneal. Din acest motiv se impune monitorizarea în dinamicã a acestor pacienåi æi în cazuri selectate – atitudine
terapeuticã mai agresivã.

Purpose: To describe the cases of appendiceal mucinous neoplasms (AMN) treated diagnosed as acute appendicitis.
Material and Methods: Review of the patients diagnosed preoperatively with acute appendicitis and intra- and postoperatively with
low-grade and high-grade appendiceal tumors during the last 18 years. Thirteen patients (6F, 7M; mean age 55.69±5.1 years) with
AMN were included in study. The first stage procedures included: appendectomy (n=11), external drainage of periappendiceal
abscess (n=1) and right hemicolectomy + implants excision + omentectomy (n=1). Histopathology reported low-grade appendiceal
tumors in 6 cases: simple mucocele or mucinous cystadenoma (n=5), simple mucocele with endometriosis (n=1) and high-grade
AM: mucinous cystadenocarcinoma (n=7).
Results: In all cases of high-grade AMN after 22.43±11.48 the disease progressed to pseudomyxoma peritonei (n=5) or pseudomyxoma
extraperitonei (n=2). All these patients underwent cytoreduction surgery with hypertermic intraperitoneal chemotherapy and
early postoperative intraperitonial chemotherapy (EPIC) with 5-FU (750 mg/m2) for five postoperative days. Two patients died 28 and
4 months after cytoreduction surgery.
Conclusion: AM presents with nonspecific signs and symptoms, and it simulates frequently acute appendicitis, making the preoperative
diagnosis difficult. High-grade appendiceal tumors may progress frequently to pseudomyxoma peritonei/extraperitonei,
thus close follow up of this patients is mandatory and in selected cases – aggressive surgical attitude.

Cuvinte-cheie
apendicitã acuta - mucocel – apendice viermicular – pseudomixom peritoneal,

acute appendicitis - mucocele – vermiform appendix – pseudomyxoma peritonei

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