PMC8597804_01
Abdominal ultrasound. Distended ileocecal appendix (13mm in diameter), with hypoechoic lumen, parietal thickening, and diffuse hyperreflectivity of the surrounding fat (A and B).
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Analytically, she had increased inflammatory parameters, and ultrasound revealed uncomplicated acute appendicitis (Figure 1).
Photomicrographs of the ileocecal appendix. Area of invasive adenocarcinoma, with desmoplastic stroma and focal presence of extracellular mucus (inferior right corner) - H&E stain 10x (A). Appendicular wall, with neoplastic glandular structures in the subserosa (superior left corner) with a lake of mucus accompanied by rare neoplastic cell clusters (inferior left corner) - H&E stain lower magnification (B). Cross-section of the appendicular surgical top - H&E stain (C). Detail of the mucosa of the appendicular surgical top, where low-grade dysplasia lesions are observed - H&E stain 20x (D).
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Pathological examination revealed well-differentiated invasive mucinous adenocarcinoma of the appendicular middle third, 2 cm in length, with subserosa invasion, without appendicular wall rupture, with overlapping evidence of acute appendicitis and appendicular mucosa of the proximal top with low-grade dysplasia lesions (Figure 2).
Inguinal ultrasound. Suspicious right inguinal adenomegaly measuring 20 x 11 mm (A) and the adenomegaly during the tru-cut biopsy (B).
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The ultrasound depicted two suspicious lymph nodes (Figure 3).
Photomicrographs of the lymph node biopsy. Fragment of a lymph node partially involved by adenocarcinoma metastasis, with growth areas in the form of small glands accompanied by stromal desmoplasia and others represented by extracellular mucus lakes accompanied by rare neoplastic glands - H&E stain lower magnification (A). Small neoplastic glands within a pool of extracellular mucus - H&E stain 10x (B). Area of lymph node tissue with multifocal metastatic involvement, due to adenocarcinoma, represented by multiple small neoplastic glands accompanied by mild desmoplastic stromal reaction - H&E stain 20x (C). Isolated neoplastic cells and several small neoplastic glands were highlighted by immunohistochemical staining for cytokeratin 20 (D) and CDX 2 (E) - 20x magnification.
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The tru-cut biopsy revealed adenocarcinoma, with areas of extracellular mucin and an immunophenotypic profile compatible with primary colorectal neoplasia (Figure 4).