PMC7490825_01
Abdominal CT showed a huge, 17-cm pelvic tumor with a mixture of cystic and subcapsular parenchymal lesions (arrowhead), which had spooled up the terminal ileum (arrow) (A-C). A cord-like material leading to a tumor from the umbilical region was observed (dotted arrow) (D). Abdominal MRI showed the cystic tumor lumen exhibited a partition-wall structure, and both T1 (E)/T2 (F)-weighted images showed low- and high-intensity signals for the parenchymal lesion and the liquid component, respectively; furthermore, the tumor had a mosaic-like pattern.
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Abdominal computed tomography (CT) showed a huge, 17-cm pelvic tumor with a mixture of cystic and subcapsular parenchymal lesions, which had spooled up the terminal ileum (Fig. 1A-C). Simultaneously, a cord-like material leading to a tumor from the umbilical region was observed (Fig. 1D). T1/T2-weighted images showed low- and high-intensity signals for the parenchymal lesion and the liquid component, respectively; furthermore, the tumor had a mosaic-like pattern (Fig. 1E and F).
Intraoperative findings showed a cord covered with preperitoneal adipose tissue between the huge cystic tumor and the umbilicus (A). Schema of the tumor localization and resection site of the specimen (B).
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Intraoperative findings showed a cord covered with preperitoneal adipose tissue between the huge cystic tumor and the umbilicus (Fig. 2A). Therefore, we resected this huge cystic tumor together with the invading ileum and the ileocecum (Fig. 2B).
Specimen findings (A: ventral side/B: dorsal side). The tumor was 22 x 13.6 x 12.5 cm in size, and the tumor invaded ileum (B: dotted arrow). The cystic lesion was surrounded by a fibrous cystic wall and filled with ocherous porridge-like contents (C). In invaded ileal regions, the tumor seemed to be sub-totally exposed to the mucosal surface over the lumen of the ileum, causing obstruction (D). However, the tumor growth itself appeared not from the ileal mucosa but from the lower part of the ileal mucosa or outside the ileal lumen to induce proliferation and invasion (D: arrowheads).
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The tumor was 22 x 13.6 x 12.5 cm in size (Fig. 3A) and invaded the ileum (Fig. 3B). The cystic lesion was surrounded by a fibrous cystic wall and filled with ocherous porridge-like contents (Fig. 3C). However, the tumor growth itself appeared not from the ileal mucosa but from the lower part of the ileal mucosa or outside the ileal lumen to induce proliferation and invasion, which, ultimately, induced bowel obstruction (Fig. 3D).
On histopathological examination, obstructed ileal lesions (A), cystic wall lesions(B) and porridge-like contents (C) were all diagnosed as moderately differentiated tubular adenocarcinoma. The immunohistochemical analysis with cytokeratin 7(-) (D)/cytokeratin 20(++) (E) confirmed that it was the adenocarcinoma originated from the digestive tract.
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On histopathological examination, obstructed ileal lesions, cystic wall lesions and porridge-like contents were all diagnosed as moderately differentiated tubular adenocarcinoma (Fig. 4A-C), and the immunohistochemical analysis with cytokeratin 7(-)/cytokeratin 20(++) confirmed that it was the adenocarcinoma originated from the digestive tract (Fig. 4D and E).