低级别阑尾黏液性肿瘤误诊为卵巢肿瘤一例

doi:10.12280/gjfckx.20250983

摘要/Abstract

摘要：

低级别阑尾黏液性肿瘤（low-grade appendiceal mucinous neoplasm，LAMN）是一种罕见且具有异质性的消化道肿瘤。当LAMN分泌黏蛋白播散至腹腔形成腹膜假黏液瘤（pseudomyxoma peritonei，PMP）并累及卵巢时，其临床表现及辅助检查与卵巢黏液性肿瘤伴有盆腹腔转移高度相似，易导致术前误诊。LAMN伴有PMP，术后复发风险高，规范化的治疗可改善预后。鉴于LAMN与卵巢黏液性肿瘤治疗方案不同，因此早期识别肿瘤来源是治疗的关键。报告1例以卵巢肿瘤为首发表现的LAMN合并PMP患者。患者因腹胀、腹痛就诊，术前影像学检查提示卵巢肿瘤，术中病理诊断卵巢黏液性交界性肿瘤，术后病理证实为LAMN累及卵巢。患者拒绝行腹腔热灌注化疗，术后随访1年，未见复发和转移。本病例旨在为临床处理卵巢肿瘤与LAMN鉴别诊断困难病例提供参考，以避免误诊误治。

关键词: 阑尾黏液性肿瘤, 卵巢肿瘤, 腹膜假黏液瘤, 误诊, 肿瘤细胞减灭术, 腹腔热灌注化疗

Abstract:

Low-grade appendiceal mucinous neoplasm (LAMN) is a rare and heterogeneous gastrointestinal tumor. When LAMN secretes mucin that spreads into the peritoneal cavity, forming pseudomyxoma peritonei (PMP) and involving the ovarian, its clinical manifestations and auxiliary examinations are highly similar to those of ovarian mucinous tumors with pelvic and abdominal metastasis, which can easily lead to preoperative misdiagnosis. LAMN complicated by PMP has a high risk of postoperative recurrence, and standardized treatment can improve the prognosis. Given that the treatment regimens for LAMN and ovarian mucinous tumors are different, early identification of the tumor origin is the key to treatment. We report a case of a patient with LAMN complicated by PMP initially presenting as an ovarian tumor. The patient presented with abdominal distension and abdominal pain. Preoperative imaging studies suggested an ovarian tumor. Intraoperative pathological diagnosis indicated a borderline mucinous ovarian tumor, while postoperative pathology confirmed LAMN involving the ovaries. The patient refused hyperthermic intraperitoneal chemotherapy. After one year postoperative surveillance, no recurrence or metastasis was observed. This case aims to provide a reference for the clinical management of cases with difficult differential diagnosis between ovarian tumors and LAMN, so as to avoid misdiagnosis and inappropriate treatment.

Key words: Appendiceal mucinous neoplasms, Ovarian neoplasms, Pseudomyxoma peritonei, Misdiagnosis, Cytoreduction surgical procedures, Hyperthermic intraperitoneal chemotherapy

李雪建, 吴博琼, 温锦营, 彭剑丰, 陈誉. 低级别阑尾黏液性肿瘤误诊为卵巢肿瘤一例[J]. 国际妇产科学杂志, 2026, 53(1): 33-37.

LI Xue-jian, WU Bo-qiong, WEN Jin-ying, PENG Jian-feng, CHEN Yu. Low-Grade Appendiceal Mucinous Neoplasm Misdiagnosed as Ovarian Tumor: A Case Report[J]. Journal of International Obstetrics and Gynecology, 2026, 53(1): 33-37.

图/表 5

图1 妇科彩色多普勒超声图注：子宫前方一囊性包块，椭圆形，边界清，内见多条分隔光带，见点状血流信号。

图2 腹盆腔MRI图注：左侧箭头所示为T2加权成像显示阑尾区见一条形囊状占位，边界清，高信号，大小约24 mm×80 mm，近端见一管状影，囊壁强化；右侧箭头所示为腹盆腔囊性占位，边界清，壁薄，内见多发分隔，未见壁结节及软组织肿块；腹盆腔见少量液体信号。

图3 术中探查图注：右侧卵巢肿瘤充满胶冻样内容物。

图4 阑尾巨检图注：阑尾增粗，可见胶冻样黏液。

图5 术后病理及免疫组织化学图注：A （LAMN）肿瘤细胞为单层及假复层，柱状，顶端有黏液滴，细胞核拉长，有极性，轻度异型，固有层及黏膜肌萎缩（HE×400，标尺=50 μm）；B （卵巢肿瘤）肿瘤上皮呈绒毛状、锯齿状，肿瘤细胞为单层、柱状，局部立方或扁平，边界呈“推挤式”生长（HE×200，标尺=100 μm）；C CK20（+）（免疫组织化学染色×200，标尺=100 μm）；D CK7（-）（免疫组织化学染色×200，标尺=100 μm）。

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