PMC5244891_01
Focal erythematous patch at the appendiceal orifice seen on colonoscopy 1 year prior to presentation.
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F1
Remarkable findings on that colonoscopy included two 3-4 mm sessile polyps in the ascending and sigmoid colon, diverticulosis, and a focal patch of erythematous mucosa at the appendiceal orifice (Figure 1).
Endoscopic view of appendiceal lumen showing ulcerated mucosa.
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F2
Diagnostic colonoscopy was notable for severely ulcerated nonbleeding mucosa within an enlarged appendiceal orifice (Figure 2).
Computed tomography of the abdomen demonstrating a midline appendiceal mass extending superiorly and communicating with the proximal bowel.
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F3
It appeared to lie inferiorly to the duodenum and superiorly to the colon (Figure 3).
Cytopathology and histopathology of the peritoneal implant showing clusters of epithelial cells of low-grade mucinous neoplasm in a thick mucinous background. (A) Papanicolaou stain, 400x. (B) Diff-quick stain, 400x. (C) Hematoxylin and eosin stain, 100x. (D) Hematoxylin and eosin stain, 400x.
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F4
The histopathology and cytopathology findings were consistent with a low-grade mucinous neoplasm originating from the appendix with pseudomyxoma peritonei syndrome (Figure 4).
Small bowel follow-through demonstrating a fistulous tract extending from the third part of the duodenum to the cecum.
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F5
A small-bowel follow-through demonstrated a fistulous communication from the third portion of the duodenum to the cecum (Figure 5).