(Disclaimer: This article is for general use only, and the information in the following content has been processed to protect patient privacy)
Abstract: Mucinous adenocarcinoma of the appendix, also known as malignant mucinous cyst, is rare clinically. The patient came to the clinic with persistent right lower abdominal pain for more than 2 weeks, and CT scan of the abdomen showed no obvious normal appendiceal morphology in the appendix area, and a mass shadow was visible in the appendix area. Clinically, the patient’s condition was basically controlled through a combination of surgical resection + chemotherapy, and all indicators were improving.
Basic information】Female, 68 years old
Disease Type】Mucinous adenocarcinoma of the appendix
Hospital】The First Affiliated Hospital of Kunming Medical University
Date of consultation】January 2022
Treatment plan】Surgical treatment (right hemicolectomy) + anti-infection treatment (cefothiamidine for injection, metronidazole tablets) + chemotherapy (oxaliplatin for injection, calcium folinic acid for injection, fluorouracil injection)
[Treatment cycle] 3 weeks of hospitalization, chemotherapy every half month, outpatient follow-up every 1 month
Treatment effect】The disease has been basically controlled, and all indicators are improving
I. Initial consultation
A few months ago, the patient came to the clinic with persistent right lower abdominal pain for more than 2 weeks and found me who was working in the clinic. The patient was 68 years old and had abdominal distension and pain with no obvious cause 2 weeks ago, accompanied by fatigue, no black stool, no fever, no chest pain, chest tightness, shortness of breath and low back pain. The patient had a history of appendicitis in the past. Laboratory tumor markers showed that carcinoembryonic antigen, CA15-3 and CA19-9 were significantly elevated; abdominal ultrasound showed a mixed echogenic mass in the right abdominal cavity with unclear borders, irregular morphology, uneven internal echogenicity, and a small amount of poorly transmissive echogenicity; abdominal CT scan showed that the appendix area was not obvious. The CT scan of the abdomen showed that the appendix did not have a normal morphology, but a mass was visible in the appendix area; laparoscopy showed a pile of appendiceal tissue with a volume of 0.2×0.2×0.5 cm, and the tissue was cut and sent for examination, and the pathology suggested mucinous adenocarcinoma of the appendix. The patient had previous appendicitis and no history of drug allergy, and was admitted to the hospital with a preliminary diagnosis of mucinous adenocarcinoma of the appendix.
II. Treatment process
After admission, the patient continued to have routine blood tests, blood glucose, lipids, liver and kidney function, coagulation function, electrolytes, C-reactive protein, etc. The results were the same as those of the outpatient examination. To further confirm the diagnosis, magnetic resonance examination was performed, which showed a clearly visible mass in the right abdomen, and CT of the appendix area suggested a mass in the appendix area, and enhanced CT showed a heterogeneous mass in the right middle abdomen, with enhancement visible at the edge of the enhanced scan. The ultrasound continued to show a cystic solid mass, but the solid part was mostly coarsely separated, and blood flow signal was visible, and tumor markers were elevated, so the diagnosis of mucinous adenocarcinoma of the appendix was clearly made, and symptomatic treatment was immediately administered. After discussion with me and my family, right hemicolectomy was performed on the 7th day of admission, and postoperative examination showed mucinous adenocarcinoma of the appendix. The patient’s condition was relatively stable, and after 1 week of continuous treatment, the patient’s symptoms were significantly relieved. After comprehensive evaluation, the patient was discharged after 3 weeks of admission, and after half a month of recovery, he was re-admitted to the hospital for the first chemotherapy treatment with oxaliplatin injection, calcium folinic acid for injection and fluorouracil for injection, and then chemotherapy treatment was given once every half month.
III. Treatment effect
After clinical examination and diagnosis, the patient was diagnosed with mucinous adenocarcinoma of the appendix and was admitted to the hospital for treatment. After admission, the patient actively cooperated with the doctor for examination and effective treatment, and underwent right hemicolectomy. He was discharged from the hospital after evaluation. After discharge, he followed the doctor’s instructions and took his medication regularly. Half a month after recovery, he was admitted to the hospital for follow-up, and was given oxaliplatin injection, calcium folinic acid for injection and fluorouracil for injection for the first chemotherapy treatment, and the patient performed well without any obvious abnormal reaction. Each chemotherapy treatment as well as gastrointestinal tract imaging and endoscopy performed during regular follow-ups showed that the patient recovered well, and his condition gradually improved, with all indexes improving.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment. Mucinous adenocarcinoma of the appendix is of low incidence, insidious in origin, and difficult to diagnose preoperatively, relying mainly on careful intraoperative exploration combined with frozen pathology for diagnosis.
Patients should pay more attention to their recovery, pay more attention to rest, follow medical advice, take medication on time, review regularly, and contact the doctor immediately for medical consultation if there is any discomfort to avoid infection. In daily life, pay more attention to rest, maintain sufficient and high quality sleep, avoid strain; arrange the diet reasonably, first fasting water after surgery, give nutritional support, and then mainly liquid food, gradually resume the diet, usually life is mainly light diet, avoid spicy stimulating raw and cold things, less fried food, eat more fruits and vegetables, drink more water; avoid strenuous exercise, after complete recovery after surgery, can be appropriate exercise, relaxation, improve immunity; keep a happy mood, improve immunity. Avoid strenuous exercise. After complete recovery, you can exercise and relax to improve your immunity; keep a happy mood, communicate with your family and relatives, face the disease correctly with a positive and optimistic attitude, and cooperate with the doctor.
V. Personal insight
Appendiceal mucinous tumor originates from appendiceal gland epithelium, which can secrete large amount of mucus. Therefore, it is necessary for patients to understand the disease correctly. Because of its non-specific nature, appendiceal mucinous gland tumor may be misdiagnosed as other diseases in daily life, and because it manifests as abdominal pain and other symptoms, people may not pay attention to it, thus causing the aggravation of the disease, so early detection, early diagnosis and early treatment are needed. Patients who have undergone appendiceal mucinous adenocarcinoma should pay more attention to monitoring their own situation, listen to the doctor’s arrangement, take medication on time, regularly review abdominal ultrasound, endoscopy, CT and other related examinations to check the prognosis of the disease, and avoid infection in ordinary life to prevent the aggravation of the disease and even cause other complications. The patient’s immune system is low after surgery, so he needs to pay more attention to rest, eat a reasonable and healthy diet, and keep a good mood to improve the quality of life to achieve the expected effect of treatment.