Japanese

Title	虫垂原発粘液産生腫瘍の切除11症例に関する検討
Subtitle	原著論文
Authors	辻本琴音1), 高岡宗徳1), 吉田和弘1), 物部泰昌2), 浦上淳1), 赤木晃久1), 浦野貴至1), 中村有希1), 松本築1), 石田尚正1), 松原正樹1), 林次郎1), 羽井佐実1), 山辻知樹1)
Authors (kana)
Organization	1)川崎医科大学総合外科学, 2)病理学
Journal	川崎医学会誌
Volume	46
Number
Page	73-79
Year/Month	2020 /
Article	原著
Publisher	川崎医学会
Abstract	「抄録」虫垂原発粘液産生腫瘍はWHO分類に基づき低異型度虫垂粘液性腫瘍(Low-grade appendiceal mucinous neoplasm, 以下LAMN)と粘液癌に分類される. 当科にて2010年4月〜2018年11月までに外科的切除された11症例を集積検討した. 11症例の内訳は年齢が27〜88歳(中央値61歳)で男女比は男7人, 女4人であった. 主訴は腹痛が6人で無症状が5人であった. 病理診断での腫瘍最大径は3〜12cm(平均5.9cm)であった. 術前よりLAMNと疑われた症例は7例で, 虫垂腺癌の術前診断に至った症例は1例であった. 虫垂腫瘍との術前診断に至らなかった3症例のうち, 虫垂炎の術前診断で虫垂切除術施行後に病理診断で判明したものが2例, 十二指腸潰瘍穿孔で緊急手術を行った際に合併切除した虫垂組織より偶然発見されたものが1例であった. 術式は虫垂切除のみが3例, 回盲部切除が5例, 右半結腸切除が3例であった. 予定手術は6例で緊急手術が5例であった. 最終病理診断(大腸癌取り扱い規約第9版に準拠)はLAMNが7例で虫垂腺癌が2例, 粘液嚢胞が2例であった. 術後入院期間は2〜47日(中央値12日)で, 虫垂腫瘍切除に関連する術後合併症はなかった. LAMNは比較的稀な疾患であるが, 腫瘍破裂により粘液が漏出することで腹膜偽粘液腫をきたす可能性がある. そのため, 再発を引き起こさないためには(1)画像検査などでの術前診断(術中診断を含む), (2)術中に粘液漏出させない術式選択, (3)術後病理診断で判明した場合の追加治療の適否, についてその都度慎重に判断する必要がある. LAMNは低悪性度腫瘍にも関わらず再発の危険性があるため, 画像検査で疑った場合は再発防止を念頭においた術前評価と治療方針の策定が必要であり, 切除後の厳重フォローも重要である.
Practice	医学総合
Keywords	虫垂原発粘液産生腫瘍, 低異型度虫垂粘液性腫瘍, LAMN, 虫垂粘液癌, Appendiceal mucinous neoplasm, Low-grade appendiceal mucinous neoplasm, Appendiceal mutinous adenocarcinoma, Corresponding author

English

Title	Appendiceal mucinous neoplasm : a review of eleven surgical cases in our institution
Subtitle	Regular Article
Authors	Kotone TSUJIMOTO1), Munenori TAKAOKA1), Kazuhiro YOSHIDA1), Yasumasa MONOBE2), Atsushi URAKAMI1), Akihisa AKAGI1), Takashi URANO1), Yuki NAKAMURA1), Kizuki MATSUMOTO1), Naomasa ISHIDA1), Masaki MATSUBARA1), Jiro HAYASHI1), Minoru HAISA1), Tomoki YAMATSUJI1)
Authors (kana)
Organization	1)Department of General Surgery, 2)Department of Pathology, Kawasaki Medical School
Journal	KAWASAKI MEDICAL JOURNAL (Japanese)
Volume	46
Number
Page	73-79
Year/Month	2020 /
Article	Original article
Publisher	Kawasaki Medical Society
Abstract	[ABSTRACT] Appendiceal mucinous neoplasm (AMN) is composed of mucinous adenocarcinoma and low-grade appendiceal mucinous neoplasm (LAMN) according to the fifth edition World Health Organization classification. Although AMN is relatively rare in clinical practice, we had eleven surgical cases of AMN from April 2010 to November 2018 and retrospectively review them in this report. The eleven cases consisted of seven men and four women, ages 27 - 88 years old (average: 65.5 y.o.). Six patients had abdominal pain upon their initial visit. Preoperative examinations made a presumptive diagnosis of LAMN in 7 cases and cancer of the appendix in 2 cases. In the other two cases, one was diagnosed after surgery for acute appendicitis, and the other was coincidently found in the appendiceal tissue that was resected during an emergent laparotomy for a perforated duodenal ulcer. Emergency operations were performed for 5 cases, whereas laparoscopic surgery was done in 4 of the cases. The following operative procedures were performed; 5 ileocecal resections, 3 right hemicolectomies, and 3 simple appendectomies. Pathological examinations concluded that 7 cases were LAMN, 2 were appendiceal adenocarcinoma, and the remaining 2 were hyperplastic mucocele. The length of hospital stay after surgery varied from 2 to 47 days (median: 12 days), with no apparent complications related to surgery in any cases. The most critical features of AMN are the potential to recur as pseudomyxoma peritonei, when the tumor is ruptured during surgery, or in case of tumor cells remaining at the resection stump. Since LAMN is specifically recognized to be low-grade malignant, several steps should be taken to minimize recurrence in addition to the standard postoperative follow-up on regular basis. These steps include assessing each preoperative state of disease adequately, selecting the most suitable procedure to reduce the risk of mucus leakage, and cautiously reviewing the necessity of additional resection based upon pathological determinations.
Practice	General medicine
Keywords	Appendiceal mucinous neoplasm, Low-grade appendiceal mucinous neoplasm, LAMN, Appendiceal mutinous adenocarcinoma, Corresponding author

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