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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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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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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<dc:creator>Ghidirim, G.P.</dc:creator>
<dc:creator>Mişin, I.V.</dc:creator>
<dc:creator>Rojnoveanu, G.A.</dc:creator>
<dc:creator>Vozian, M.</dc:creator>
<dc:creator>Guţu, E.</dc:creator>
<dc:creator>Mişina, A.E.</dc:creator>
<dc:creator>Danci, A.V.</dc:creator>
<dc:date>2018-07-09</dc:date>
<dc:description xml:lang='ro'><p>Scop: Descrierea cazurilor de neoplasme mucinoase ale apendicelui (NMA) diagnosticate drept apendicit&atilde; acut&atilde;.<br />Material &aelig;i metode: Analiza pacien&aring;ilor diagnostica&aring;i preoperator cu apendicit&atilde; acut&atilde; &aelig;i intra- &aelig;i postoperator cu NMA cu poten&aring;ial<br />malign redus &aelig;i sporit, trata&aring;i pe parcurs a 18 ani. &Icirc;n studiu au fost inclu&aelig;i 13 pacien&aring;i (6F, 7B; v&acirc;rsta medie 55.69&plusmn;5.1 ani) cu NMA.<br />Procedeele chirurgicale de prim&atilde; etap&atilde; au fost: apendicectomie (n=11), drenarea colec&aring;iei periapendiculare (n=1) &aelig;i hemicolonectomie<br />dreapt&atilde;+excizia implantelor+rezectie de oment. Examenul histopatologic a relevat NMA cu poten&aring;ial malign redus &icirc;n 6 cazuri:<br />mucocel simplu sau chistadenom mucinos (n=5), mucocel cu endometrioz&atilde; (n=1) &aelig;i MA cu poten&aring;ial malign sporit: chistadenocarcinom<br />mucinos (n=7).<br />Rezultate: &Icirc;n toate cazurile de NMA cu poten&aring;ial malign sporit pacien&aring;ii au dezvoltat pseudomixom peritoneal (n=5) sau extraperitoneal<br />(n=2) peste 22.43&plusmn;11.48 luni. Ace&aelig;ti pacien&aring;i au beneficiat de interven&aring;ie citoreductiv&atilde; cu chimioterapie intraperitoneal&atilde;<br />hipertermic&atilde; &aelig;i 5 zile de chimioterapie postoperatorie intraperitoneal&atilde; cu 5-FU (750 mg/m2). Au decedat 2 pacien&aring;i peste 28 &aelig;i 4 luni<br />dup&atilde; interven&aring;iile citoreductive.<br />Concluzie: Mucocelul apendicular prezint&atilde; simtomatologie nespecific&atilde; &aelig;i simuleaz&atilde; frecvent apendicita acut&atilde;, iar diagnosticul<br />preoperator cert este dificil. Mucocelul apendicular cu poten&aring;ial malign sporit posed&atilde; poten&aring;ial de progresare spre pseudomixom<br />peritoneal/extraperitoneal. Din acest motiv se impune monitorizarea &icirc;n dinamic&atilde; a acestor pacien&aring;i &aelig;i &icirc;n cazuri selectate &ndash; atitudine<br />terapeutic&atilde; mai agresiv&atilde;.</p></dc:description>
<dc:description xml:lang='en'><p>Purpose: To describe the cases of appendiceal mucinous neoplasms (AMN) treated diagnosed as acute appendicitis.<br />Material and Methods: Review of the patients diagnosed preoperatively with acute appendicitis and intra- and postoperatively with<br />low-grade and high-grade appendiceal tumors during the last 18 years. Thirteen patients (6F, 7M; mean age 55.69&plusmn;5.1 years) with<br />AMN were included in study. The first stage procedures included: appendectomy (n=11), external drainage of periappendiceal<br />abscess (n=1) and right hemicolectomy + implants excision + omentectomy (n=1). Histopathology reported low-grade appendiceal<br />tumors in 6 cases: simple mucocele or mucinous cystadenoma (n=5), simple mucocele with endometriosis (n=1) and high-grade<br />AM: mucinous cystadenocarcinoma (n=7).<br />Results: In all cases of high-grade AMN after 22.43&plusmn;11.48 the disease progressed to pseudomyxoma peritonei (n=5) or pseudomyxoma<br />extraperitonei (n=2). All these patients underwent cytoreduction surgery with hypertermic intraperitoneal chemotherapy and<br />early postoperative intraperitonial chemotherapy (EPIC) with 5-FU (750 mg/m2) for five postoperative days. Two patients died 28 and<br />4 months after cytoreduction surgery.<br />Conclusion: AM presents with nonspecific signs and symptoms, and it simulates frequently acute appendicitis, making the preoperative<br />diagnosis difficult. High-grade appendiceal tumors may progress frequently to pseudomyxoma peritonei/extraperitonei,<br />thus close follow up of this patients is mandatory and in selected cases &ndash; aggressive surgical attitude.</p></dc:description>
<dc:source>Chirurgia (București, Romania) 113 (S1) 217-218</dc:source>
<dc:subject>apendicitã acuta - mucocel – apendice viermicular – pseudomixom peritoneal</dc:subject>
<dc:subject>acute appendicitis - mucocele – vermiform appendix – pseudomyxoma peritonei</dc:subject>
<dc:title>Tumori mucinoase ale apendicelui diagnosticate drept apendicită acută</dc:title>
<dc:type>info:eu-repo/semantics/article</dc:type>
</oai_dc:dc>