: , * * = A bs tra c t= A cas e of colonic adhes ion caus ed by appendiceal orig in ps eudomy x oma peritonei Sang Ill Lee, M.D., Kwon Choi

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1 : , * * = A bs tra c t= A cas e of colonic adhes ion caus ed by appendiceal orig in ps eudomy x oma peritonei Sang Ill Lee, M.D., Kwon Choi, M.D., Sang Hoon Kim, M.D., Seung Sae Lee, M.D. and Myung Sook Kim, M.D.* Departments of Internal M edicine and Pathology*, K angbuk Samsung H ospital, Sungkyunkwan University School of M edicine, Seoul, Korea Mucocele of the appendix is an uncommon disorder, usually found incidentally during ultrasonography or radiographic studies. It occurs predominantly in the sixth or seventh decades,and has a distinct female predominance. Pseudomyxoma peritonei is a rare condition resulting from a ruptured mucin- producing lesion of the appendix or ovary. It is not easily diagnosed clinically before operation and only histopathologic finding provides the correct final diagnosis. Treatment should consist of evacuation of the mucinous ascites and removal of the mucocele. Reoperations for correction of intestinal obstruction may be needed. The role of chemotherapy is uncertain, and external radiation is probably of no value. We experienced a case of colonic adhesion caused by pseudomyxoma peritonei that originated from the vermiform appendix. This patient was 75 year old female who had suffered from lower abdominal pain associated with constipation and tenesmus for 5 days. We performed ileocecal resection and ileocecal anastomosis. We report this case with brief review of the literature.(korean J Med 59:64-68, 2000) Key Words : Pseudomyxoma peritonei; Mucocele; Appendix (mucocele) Rokitansky1-3), 1884 Werth4).,, : : :, 108, ( ) lsi@medigate.net

: air- fluid level (Figure 1), S 3.2x4.2x3.9cm (Figure 2). Figure 1.

2 Sang Ill Lee, et al : A case of colonic adhesion caused by appendiceal origin pseudomyxoma peritonei,,,,... 75,, 1. :, 75 : 5,, : 1 2.4cm 5,,. : 2,,,,. :,. : 140/80 mmhg, 36.5oC, 80 /, 15 /,,.,,,,.,,... : 11.5 g/dl, 34%, 4,300/mm3 ( 55%, 37%, 6%, 2%), 230,000/mm3.,, CEA 1.27 ng/ml, CA U/ml. : air- fluid level (Figure 1), S 3.2x4.2x3.9cm (Figure 2). Figure 1. T he simple abdomen finding shows diffuse stool retained bowel loops and air- fluid level, intestinal obstruction sign. Figure 2. On ultrasonography of lower abdomen, round echogenic solid mass is noted in posterior portion to rectosigmoid colon, cm sized

대한내과학회지 : 제 59 권 제 1 호 통권 제 479 호 2000 Fig ure 3.

Pelvic CT : T here is dis tal colonic obstruction at the level of sigmoid by cys t in right low er

화 단층 촬영상 S상 결장 부위의 두꺼워진 벽을 갖는 낭 포성 병변 및 장유착 소견과 근위부 대장의 내강의 팽창 됨이 관찰되었고 림프절 크기 증가 소견은 없었다 (Figure

수술 소견상 맹장 주위로 투명한 점액 및 낭포 벽으로 여겨지는 막들이 붙어 있었고(Figure 5), 맹장과 S상 결장이 심하게 유착되어 있어서 충수돌기 점액류 파열로 인한

이후 항암화학요법과 방사선치료 는 시행하지 않았고 일단 퇴원하여 현재 외래 추적 관찰 Fig ure 5.

3 대한내과학회지 : 제 59 권 제 1 호 통권 제 479 호 2000 Fig ure 3. Abdominal CT : T here are cys tic lesion such as mucocele in the Right low er quadrant. Fig ure 4. Pelvic CT : T here is dis tal colonic obstruction at the level of sigmoid by cys t in right low er quadrant. 화 단층 촬영상 S상 결장 부위의 두꺼워진 벽을 갖는 낭 포성 병변 및 장유착 소견과 근위부 대장의 내강의 팽창 됨이 관찰되었고 림프절 크기 증가 소견은 없었다 (Figure 3, 4). 치료 및 경과 : 내원 6일경 환자는 혈압이 90/60 mmhg, 맥박수 분당 90회 소견보여 응급 개복술을 시행 하였다. 수술 소견상 맹장 주위로 투명한 점액 및 낭포 벽으로 여겨지는 막들이 붙어 있었고(Figure 5), 맹장과 S상 결장이 심하게 유착되어 있어서 충수돌기 점액류 파열로 인한 복막위점액종 및 이차적 장유착증으로 진 단되었으며, 낭포와 점액 제거술, 회맹장 절제술 및 유착 박리술을 시행하였다. 이후 항암화학요법과 방사선치료 는 시행하지 않았고 일단 퇴원하여 현재 외래 추적 관찰 Fig ure 5. Gross specimen from cecal area show ing grayish w hite cystic wall admixed with mucinous material. 중에 있으며 아직까지 특별한 이상 소견 없으며 정상 Fig ure 6. T he cystic wall cons is ts of thick fibrocollagenous w all and chronic inflammatory cells (A.H&E, 40).A few cuboidal cells are found within the mucinous material(b.h&e, 400). Figure 6. A Figure 6. B

4 4 : 1. :. PAS D- PAS (Figure 6A & 6B). (mucocele). 5), 6), 1842 Rokitansky1-3), 1884 Werth4) Frankel3) Corder 7) 0.3%.,, Cheng1), 1953 Woolner8) Higa 9),,, (focal or diffuse mucosal hyperplasia), (mucinous cystadenoma), (mucinous cystadenocarcinoma) 3. Novak Virchow 10) (theory of peritoneal implantation) Shaw4) (theory of serosal metaplasia),,.,,,.. Woodruff McDonald 11) 8:1, , Robert 12) 84% ,,,,... S,. X-,,. low attenuation,

5 Korean Journal of Medicine : Vol. 59, No. 1, 2000,. fluorouracil melphalan. Limber13) thio- tepa hyaluronidase. Hesketh14), Fernandez Daly15) 5..,,, Gerald 13) %..,. (Mucocele) RE F E R E N C E S 1) Dachman AH, Lichtenstein JE, Friedman AC. M ucocele of the appendix and pseudom yxoma peritonei. Am J Roentgenol 144: , ) Limber GK, King RE, Silverberg SG. Pseudomyxom a peritonei: A report of ten cases. A nn Surg 178: , ) Parsons J, Gray GF, T horbjarnarson B. Pseudomyxoma peritonei. Arch Surg 101: , ) Werth R. Peritoneal pseudomyxoma origining from the verm iform appendix. B r M ed J 1:687, ),, :722, ),,.. 24:984, ) Corder AP, Masters A, Heald RJ. Sigm oid invasion as a late complication of mucinous cystadenoma of the appendix: Report of a case. Dis Colon Rectum 33: , ) Woolner LB. Carcinom a of the appendix: com ments on pathology. M ayo Clin Proc 28:17, ) Burt CA. Carcinoma of the cecum complicated by appendicitis or pararectal abscess. Surg Gynecol Obstet 88:501, ) Novak. Novak's gynecologic and obstetric pathology. 7th, Philadelphia and London, WB Saunders Co, ) Woodruff R, McDonald JR. B enign and malignant cystic tumors of the appendix. Surg Gynecol Obstet 71: , ) Long RT, Spratt JS Jr, Dowling E. Pseudomyxoma peritonei: new concepts in managem ent with a report of seventeen patients. A m J Surg 117: , ) Limber GK, King RE, Silverberg SG. Pseudomyxom a peritonei. Ann Surg 178: , ) Hesketh KT. T he managem ent of prim ary adenocarcinoma of the vermiform appendix. Gut 4:158, ) Fernandez RN, Daly JM. pseudomyxoma peritonei. Arch Surg 115: ,

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(49-54)Kjhps004.hwp Biliary Cystadenoma and Cystadenocarcinoma of the Liver Jae Hoon Lee, M.D., Dong Ho Choi, M.D. 1, Kyeong Geun Lee, M.D., Hwon Kyum Park M.D. and Kwang Soo Lee, M.D. Department of Surgery, College of Medicine,