PMC7229422_01
US abdomen showed both ovaries are normal in volume, and echogenicity bilateral multiple follicles are seen. The right ovary shows cyst measuring about 3 x 2.87 cm.
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The patient underwent serial US in the referral hospital which revealed a cystic lesion in the right ovary measuring 3 x 2 cm increased up to 6 x 2.8 cm (Fig. 1).
MRI of the abdomen showed: Sizable cyst-like measuring 7 x 4 x 3 cm in the right iliac fossa region, very close to the cecum and away from the right ovary and adnexa.
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Due to her persistent pain and increase in the size of the ovarian cyst in the US, the patient underwent MRI which revealed a sizable cyst measuring 7 x 4 x 3 cm in the RIF region, away from the right ovary and adnexa with no fat stranding, or mesenteric lymph nodes enlargement (Fig. 2).
Mucinous neoplasm growing in the appendix (intraoperatively).
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Gross examination revealed a dilated appendix with smooth shiny serosa and thin wall, and it is filled with thick mucus material (Fig. 3).
A: Hematoxylin and eosin staining (40x) revealed the lumen of appendix lined by unremarkable colonic mucosa with underlying lymphatic aggregates. There is a cystic dilatation space filled with acellular mucin. This cystic space starts replacing appendiceal mucosa epithelial lining, lamina propria, and settle in the muscularis propria without invasion. B: Haemotoxylin and eosin staining (100x) revealed no mucosa or lamina propria. There is epithelial denudation in the lack of acellular mucin. The neoplasm is rest on fibrotic stroma filled with lymphatic aggregates. C: Haemotoxylin and eosin staining (100x) revealed a lumen of mucocele contains acellular mucin and mucinous surface epithelium. D: Hematoxylin and eosin staining (400x) revealed an appendiceal mucosa is replaced by tall, columnar, non-ciliated cells, basal nuclei, and abundant intracellular mucin.
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The patient was diagnosed as a well-differentiated low-grade AM neoplasm with stage 0 (pTis, pN0, M0) based on the 8th edition of the AJCC Staging System (Fig. 4A, B, C, and D).