PMC7708860_01
Axial image of contrast enhanced CT abdomen. An oval shaped structure with thickened enhancing mural wall at the sub-hepatic region measuring 3 x 3.4 cm in anterio-posterior and transverse diameters associated with surrounding mesenteric fat stranding and few enlarged lymph nodes.
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It measured 3 x 3.4 cm, and was associated with an increased attenuation of surrounding mesenteric fat in presence of multiple enlarged lymph nodes and air-fluid levels (Fig. 1).
Low power view of longitudinal section of the primary colonic adenocarcinoma, arrow (1) shows the normal colonic mucosa which is in direct continuity with the transformed colonic adenocarcinoma in the center (arrow 2) which infiltrate downwards in the submucosa (Hematoxylin and Eosine stained section X100).
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Ceco-colic junction), with an evidence of direct continuity of the carcinomatous tissue with the adjacent normal looking colonic mucosa invading the submucosa, colonic muscular wall, serosa and the meso-colic fat (Fig. 2, Fig. 3).
High power view of longitudinal section of the distal part of the appendix, with arrow (1) showing normal appendicular surface mucosa in direct continuity above with arrow (2) area of transformed adenocarcinomatous tissue, with the carcinoma involving the whole right side part of the section (2 rectangles) (Hematoxylin and Eosine stained section X400).
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Histopathological examination of the appendix revealed a primary, well-differentiated, infiltrating, colonic type adenocarcinoma that was confined to the distal part (10 mm) of the appendiceal mucosa only, with definite direct continuity of the normal appendicular surface mucosa with the transformed adenocarcinoma (Fig. 4), confirming its primary origin, and excluding an origin from the cecum.
Low power view of longitudinal section of the primary adenocarcinoma of the appendix with upper arrow (1) showing invasion of the appendicular submucosa and lower arrow (2) showing invasion of the appendix full muscular wall (Hematoxylin and Eosine stained section X100).
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The carcinoma invaded and infiltrated the submucosa, the full muscular wall thickness (Fig. 5) and extended very close to, but, not involving the serosa of the distal part of the appendix.
Contrast enhanced CT scan abdomen & pelvis (Coronal view). Bilateral ovarian masses with cystic and solid component, large Right ovarian mass measures 13 x 10 cm.
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Thirteen months later, she presented with bilateral ovarian masses, which were suggestive of ovarian metastasis, for which she was readmitted for bilateral Salpingo-oopherectomy (Fig. 6).