13岁女性急性单纯性阑尾炎伴阑尾黏膜局灶低级别上皮内瘤变1例报告

A Case Report of Acute Simple Appendicitis with Focal Low-Grade Intraepithelial Neoplasia of the Appendiceal Mucosa in a 13-Year-Old Female

摘要: 探讨儿童急性阑尾炎伴阑尾黏膜低级别上皮内瘤变的临床特点、病理特征、诊断及治疗策略。方法：回顾性分析我院收治的1例13岁彝族女性急性单纯性阑尾炎伴阑尾黏膜局灶低级别上皮内瘤变患者的临床资料，结合相关文献进行讨论。结果：患者因“反复腹痛1年，加重伴右下腹疼痛2天”入院，术前影像学提示阑尾尾端囊性包块、盆腔右侧黏液性病变待排。入院第5天行腹腔镜探查 + 阑尾切除术，术中见阑尾充血水肿、阑尾腔扩张，尖端呈囊泡样改变，与回肠末端粘连。术中冰冻病理提示良性病变，考虑阑尾黏液囊肿伴炎症。术后石蜡病理确诊为急性单纯性阑尾炎，阑尾腔扩张，局灶黏膜腺上皮低级别上皮内瘤变，病变严格局限于黏膜层，未突破基底膜，阑尾切缘未见异型上皮；回肠壁送检组织为黏液外渗伴急慢性炎症，未见肿瘤性上皮成分。患者术后恢复良好，随访期内无复发。结论：儿童阑尾黏膜低级别上皮内瘤变极为罕见，多继发于阑尾炎症及管腔黏液潴留，临床表现与单纯急性阑尾炎无显著差异，术前难以确诊。腹腔镜手术既是明确诊断也是有效的治疗手段，术后常规石蜡病理检查是确诊金标准，切缘阴性者预后良好，需长期随访监测。

Abstract: Objective: To explore the clinical characteristics, pathological features, diagnosis, and treatment strategies of acute appendicitis in children with low-grade intraepithelial neoplasia of the appendiceal mucosa. Methods: A retrospective analysis was conducted on the clinical data of a 13-year-old Yi female patient with acute uncomplicated appendicitis and focal low-grade intraepithelial neoplasia of the appendiceal mucosa admitted to our hospital, and the case was discussed in conjunction with relevant literature. The patient was admitted to the hospital due to “recurrent abdominal pain for 1 year, worsening with right lower quadrant pain for 2 days.” Preoperative imaging suggested a cystic mass at the distal end of the appendix and a mucinous lesion in the right pelvic cavity. On the 5^th day of admission, laparoscopic exploration and appendectomy were performed. Intraoperatively, the appendix was found to be congested and edematous, with a dilated appendiceal lumen and a cystic appearance at the tip, adhered to the terminal ileum. Intraoperative frozen section pathology indicated a benign lesion, considered to be an appendiceal mucocele with inflammation. Postoperative paraffin pathology confirmed acute simple appendicitis, with a dilated appendiceal lumen and focal low-grade intraepithelial neoplasia of the mucosal glandular epithelium. The lesion was strictly confined to the mucosal layer and did not break through the basement membrane. No atypical epithelium was seen at the appendiceal resection margin. The ileal wall tissue sample showed mucus extravasation with acute and chronic inflammation, and no neoplastic epithelial components were found. The patient recovered well postoperatively and had no recurrence during the follow-up period. Conclusion: Low-grade intraepithelial neoplasia of the appendix mucosa is extremely rare in children, often secondary to appendicitis and mucus retention in the lumen. Its clinical presentation is not significantly different from simple acute appendicitis, making preoperative diagnosis difficult. Laparoscopic surgery is both a definitive diagnostic and effective treatment. Routine postoperative paraffin pathology is the gold standard for diagnosis. Patients with negative surgical margins have a good prognosis and require long-term follow-up monitoring.