PMC3896797_01
Re-examination by enhanced computed tomography (CT) scan. The CT scan shows right hydronephrosis (a), a tumorous lesion in the mesentery (b), and persistent encapsulated abscesses on the mesenteric side (c) and on the outside (d) of the ileocecal region.
1477-7819-12-4-1.jpg
PMC3896797_01_1477-7819-12-4-1.jpg
F1
Enhanced CT was performed again and showed a persistent abscess, a tumorous lesion in the mesentery and right hydronephrosis (Figure 1).
Intraoperative findings. Encapsulated abscesses can be seen on the mesenteric side (a) and outside of the ileocecal region (b). When we raised the ileocecal region, a tumor was found to be fixed to the right ureter (c). A ureteral stent was inserted into the right ureter; the tumor was then separated and removed from the ureter (d).
1477-7819-12-4-2.jpg
PMC3896797_01_1477-7819-12-4-2.jpg
F2
At laparotomy, there were no ascites but encapsulated abscesses were present on the mesenteric side and outside of the ileocecal region (Figure 2a,b). When we raised the ileocecal region, a tumor was found to be fixed to the right ureter and there was leakage of white, solid tumor content (Figure 2c). A ureteral stent was then inserted into the right ureter, and the tumor was separated and removed from the ureter with scissors (Figure 2d).
Macroscopic findings of the tumor and ileocecal lesion. No changes involving the mucosal surface of the cecum or the terminal ileum were detected.
1477-7819-12-4-3.jpg
PMC3896797_01_1477-7819-12-4-3.jpg
F3
The pathological diagnosis was poorly differentiated carcinoma, but there were no changes involving the mucosal surface of the cecum or the terminal ileum (Figure 3).
Histological and immunohistochemical findings of the tumor. Hematoxylin-eosin (HE) staining reveals poorly differentiated carcinoma (a). Alcian blue (AB) staining showed moderate production of mucin accompanied by a partial ductal structure (b). Immunohistochemistry was partially positive for CK34betaE12 (about 20% of tumor) (c), positive for AE1/AE3 (d), negative for CDX2 (e), and negative for TTF-1 (f).
1477-7819-12-4-4.jpg
PMC3896797_01_1477-7819-12-4-4.jpg
F4
Immunohistochemistry showed the tumor to be positive for AE1/AE3 (pancytokeratin), cytokeratin(CK)7, CK34betaE12 (about 20% of tumor) and Wilms tumor gene 1 (WT-1), with nonspecific reactions for CK5/6, p63, carcinoembryonic antigen (CEA), estrogen receptor (ER) and vimentin, while CK20, thyroid transcription factor 1 (TTF-1), caudal type homeobox 2 (CDX2), gross cystic disease fluid protein-15 (GCDFP-15), calretinin, D2-40 and CD10 were negative (Figure 4).