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    Home > Active Ingredient News > Digestive System Information > What causes the unusual intestinal obstruction that confuses the doctor?

    What causes the unusual intestinal obstruction that confuses the doctor?

    • Last Update: 2021-10-22
    • Source: Internet
    • Author: User
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    It is only for medical professionals to read for reference.
    During the clinical diagnosis process, there is always a lot of fog, and we need to check carefully to confirm the condition
    .

    The old lady admitted to the ward had typical manifestations of intestinal obstruction, including abdominal pain, bloating, vomiting, and reduced defecation and exhaust
    .

    After fasting, fluid rehydration and enema treatment, the old lady’s symptoms improved, but abdominal CT showed that the wall of the ascending colon near the ileocecal region was locally thickened.
    Considering colon cancer, the surrounding lymph nodes were also swollen
    .

    According to the results of enhanced CT of the patient in Figure 1, the old lady is an intestinal obstruction caused by a malignant tumor of the ascending colon
    .

    Is this really true? In order to confirm the diagnosis, we performed a colonoscopy after the intestinal obstruction was relieved, and it was found that there was a mass in the cecum, and the ileocecal valve was almost completely blocked.
    At first glance, it was a malignant tumor, but a few days later, no cancer cells were found.

    .

    I wanted to ask the surgeon to remove the diseased tissue and then send it for examination, but because the biopsy did not find any signs of malignancy, the surgeon was reluctant to risk the operation
    .

    We had to do colonoscopy again for a biopsy.
    This time, in order to ensure the accuracy of the biopsy and effectively assess the scope of the lesion, we directly did an ultrasound colonoscopy
    .

    Figure 2 The results of colonoscopy and ultrasound colonoscopy of the patient.
    The results of ultrasound colonoscopy found that the local intestinal wall was thickened and the echo was reduced, which is considered to be a malignant lesion
    .

    After a deep biopsy, a pathological examination again found a small number of small tubular nested mass cells.
    The results of immunohistochemistry were considered to be goblet cell adenocarcinoma derived from the appendix
    .

    Is it a tumor from the appendix? But why does the patient have no symptoms of appendicitis? In order to verify the above-mentioned examination results, we performed surgical treatment and collected the diseased tissues during the operation for further pathological examination
    .

    Fig.
    3 Pathological results of the patient.
    Postoperative pathological return: Goblet cell adenocarcinoma of the appendix is ​​grade 3, invading the entire thickness of the appendix wall and involving the serosal surface, and the cancer tissue infiltrating the entire thickness of the ileocecal intestinal wall
    .

    It turned out that the old lady got a rare appendix tumor-goblet cell adenocarcinoma of the appendix
    .

    What is the disease of appendix goblet cell adenocarcinoma? Goblet cell adenocarcinoma of the appendix is ​​a unique and rare tumor.
    It has both a neuroendocrine phenotype and a mucus secretion phenotype.
    It is mainly composed of goblet cells, endocrine cells and Paneth cells
    .

    Goblet cell adenocarcinoma of the appendix has an organ-like growth pattern, neuroendocrine cells, lack of cell atypia and mucosal in situ lesions, these characteristics made it once classified as carcinoid
    .

    Later studies found that the main component of the tumor was mucin-producing cells and had the histological characteristics of high-grade adenocarcinoma.
    The metastasis was also similar to the signet ring cell characteristics of adenocarcinoma
    .

    Therefore, in 2019, the World Health Organization (WHO) classified it as an appendix goblet cell adenocarcinoma, which accounts for about 5% of primary appendix tumors
    .

    There is no difference in the incidence of goblet cell adenocarcinoma of the appendix between men and women.
    It can occur in people aged 18-89, but the prevalence age is 50-60 years
    .

    75% of patients present with acute and chronic appendicitis, which is mainly related to the obstruction of the appendix lumen caused by tumor invasion and compression
    .

    Rarely, there are ileocecal tumors, abdominal distension, abdominal mass, and intestinal obstruction.
    Generally, there is no carcinoid syndrome
    .

    Since our patient showed ileocecal tumor and intestinal obstruction, but the tumor did not block the appendix lumen, there was no manifestation of appendicitis
    .

    This is why we mistakenly thought it was the intestinal obstruction caused by the malignant tumor of the ascending colon
    .

    How should appendix goblet cell adenocarcinoma be treated? The prognosis of appendix goblet cell adenocarcinoma depends on the stage and tumor grade, and its grade adopts a three-level grading system
    .

    Most low-grade goblet cell adenocarcinomas of the appendix are stage I-II, and the overall survival time is 84-204 months; 50%-75% of high-grade goblet cell adenocarcinomas are stage III-IV, and the overall survival time is 29-45 Months
    .

    If the lesion does not involve the cecum and the tumor is low-grade, simple appendectomy can be performed
    .

    If the tumor is large, with poor grade, and involves the root of the appendix with infiltration of the cecal wall, radical resection of the right colon is required
    .

    Because the tumor is prone to ovarian metastasis, for female patients, some scholars recommend removing both ovaries
    .

    Goblet cell adenocarcinoma of the appendix has a worse prognosis than other endocrine tumors of the appendix.
    It often has metastasis when discovered.
    The most common way of metastasis is to directly invade the right colon and ileum, and it is also easy to metastasize to the peritoneum and omentum
    .

    Ovary is the most common metastatic site in women.
    Female patients are often misdiagnosed as ovarian tumors due to masses in the adnexal area
    .

    22%–38% of cases had lymph node metastasis at the time of discovery
    .

    Fortunately, our patient is very lucky.
    Although the tumor has invaded the full thickness of the ileocecal intestinal wall, the peritoneum and omentum have not been metastasized.
    Although the preoperative imaging examination suspected lymph node metastasis, the postoperative pathological return The lymph nodes are intact
    .

    The chemotherapy regimen for goblet cell adenocarcinoma of the appendix is ​​similar to that for colon adenocarcinoma.
    5-fluorouracil-based chemotherapy can be used, or intraperitoneal infusion chemotherapy can be used
    .

    The patient's tumor has invaded the entire thickness of the ileocecal intestinal wall.
    Although he had undergone radical resection of the right colon, the patient's prognosis was poor and the general condition was poor.
    The family members gave up the plan of further chemotherapy and are taking Chinese medicine for treatment
    .

    Doctor's summary: Goblet cell adenocarcinoma of the appendix is ​​a unique and rare tumor.
    It has both a neuroendocrine phenotype and a mucus secretion phenotype.
    It is mainly composed of goblet cells, endocrine cells and Paneth cells, accounting for approximately the primary appendix.
    5% of tumors
    .

    There is no difference in the incidence of goblet cell adenocarcinoma of the appendix between men and women, and the prevalence age is 50-60 years
    .

    75% of patients present with acute and chronic appendicitis, which is mainly related to the obstruction of the appendix lumen caused by tumor invasion and compression
    .

    Rarely, there are ileocecal tumors, abdominal distension, abdominal mass, and intestinal obstruction.
    Generally, there is no carcinoid syndrome
    .

    The prognosis of appendix goblet cell adenocarcinoma depends on the stage and tumor grade.
    The characteristics of high-grade tumors are similar to signet ring cell adenocarcinoma, and the prognosis is very poor
    .

    References: [1] Zhang Jixin, Wang Hui, Ba Xiaojun, Li Dong, Wang Yang, Liu Ping.
    Clinicopathological observation of goblet cell adenocarcinoma of appendix.
    Chinese Journal of Pathology, 2021, 50(1): 21-25 .
    [2]Wang Luping.
    The update and progress of the classification of appendix tumors-the fifth edition of digestive system tumors in 2019 WHO classification of appendix tumors.
    Journal of Diagnostic Pathology, 2020, 27(5): 289-294.
    [3] Sinno SAJ ,Jurdi NMH.
    Goblet cell tumors of the appendix:A review.
    Ann Diagn Pathol.
    2019;43:151401.
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