PMC3420562_01
(a) Cross-section of appendix with disrupted mucosal surface and small lymphoid aggregates (hematoxylin and eosin, 2x objectives); (b) serosal surface of appendix with fibrinopurulent adhesions and dilated vessels (hematoxylin and eosin, 10x objective); (c) Inflamed mucosal surface of appendix (hematoxylin and eosin, 20x objective); (d) dense, thickened appendiceal and a lymphoid aggregate (also depicted in (e) and (f)) (hematoxylin and eosin, 2x objective); (e) CD20 immunostain, 50x oil objective; (f) cyclin D1 immunostain, 50x oil objective. All images were captured with an Olympus DP70 camera attached to an Olympus BX45 with a 1x U adapter.
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fig1
While some portions of the appendiceal lumen had normal histologic findings, the most inflamed portions had a disrupted mucosal surface (Figure 1(a)). Scattered on the mucosal surface were small aggregates composed predominantly of small lymphocytes and few plasma cells, along with focal neutrophil-rich areas consistent with suppurative inflammation (Figures 1(a) and 1(c)). The appendiceal wall was thickened and fibrous (Figures 1(a) and 1(d)), and the inflamed serosa contained dilated vessels with a surface coated by fibrinopurulent debris (Figure 1(b)). Overall, the submucosal lymphoid aggregates appeared small (Figure 1(a)). As the patient had a history of mantle cell lymphoma, we performed immunohistochemical studies on the lymphoid aggregates (Figure 1(d)). The neoplastic B cells expressed nuclear cyclin D1 gene product (Figure 1(f)), but lacked expression of BCL-6 (not shown). The morphologic and immunophenotypic findings confirm that the patient's appendiceal specimen was involved by mantle cell lymphoma.