19610147 Visualization

A 46 Age - year Age - old Age woman Sex presented Clinical_event with severe Severity acute Detailed_description pain Sign_symptom in the right Biological_structure iliac Biological_structure fossa Biological_structure and periumbilical Biological_structure region Biological_structure .
Ultrasound Diagnostic_procedure and a computed Diagnostic_procedure tomography Diagnostic_procedure scan Diagnostic_procedure revealed a mucocele Sign_symptom in the vermiform Biological_structure appendix Biological_structure , with a well Detailed_description defined Detailed_description lesion Sign_symptom located at the mid Biological_structure zone Biological_structure of Biological_structure the Biological_structure appendix Biological_structure .
The patient underwent right Therapeutic_procedure hemicolectomy Therapeutic_procedure , and her postoperative clinical course was uneventful.
Gross Diagnostic_procedure examination Diagnostic_procedure of the surgical Biological_structure specimen Biological_structure showed an enlarged Lab_value appendix Biological_structure , which was filled with thick Texture mucinous Biological_structure material Biological_structure .
A distinct Detailed_description lesion Coreference which involved the appendiceal Biological_structure wall Biological_structure , and measured 1.5 Distance cm Distance maximally, was identified in the mid Biological_structure - portion Biological_structure of Biological_structure the Biological_structure appendix Biological_structure .
There was no evidence of perforation Sign_symptom , extravasation Sign_symptom of mucin Biological_structure into the periappendiceal Biological_structure tissue Biological_structure , or pseudomyxoma Disease_disorder peritonei Disease_disorder during surgery.
Histopathological Diagnostic_procedure examination Diagnostic_procedure showed combined GCC Disease_disorder and MCA Disease_disorder of the vermiform Biological_structure appendix Biological_structure (Figure ​1A).
The appendiceal Biological_structure lumen Biological_structure was dilated Sign_symptom and lined by mucin Sign_symptom - containing Sign_symptom columnar Biological_structure epithelial Biological_structure cells Biological_structure (Figure 1B).
There was no significant cytologic Sign_symptom atypia Sign_symptom , and no mitotic Sign_symptom figures Sign_symptom were identified.
Focal Sign_symptom papillary Sign_symptom configurations Sign_symptom of the lining Biological_structure epithelium Biological_structure , and mild Severity epithelial Sign_symptom pseudostratification Sign_symptom were present.
In addition, the appendiceal Biological_structure wall Biological_structure was infiltrated by glandular Sign_symptom structures Sign_symptom of various Area sizes Area which were arranged in nests Shape and tubules Shape .
These glandular Coreference structures Coreference comprised 2 distinct types of cells: (1) small Area to Area intermediate Area sized Area monotonous Detailed_description neuroendocrine Biological_structure cells Biological_structure with a small Detailed_description amount Detailed_description of Detailed_description finely Detailed_description granular Detailed_description eosinophilic Detailed_description cytoplasm Detailed_description , and mild Severity cytonuclear Sign_symptom atypia Sign_symptom (Figure ​(Figure1C);1C); (2) mucin Detailed_description - filled Detailed_description intermediate Area sized Area cells ( goblet Biological_structure cells Biological_structure ), with peripherally Detailed_description located Detailed_description small Area , crescent Shape - like Shape hyperchromatic Sign_symptom nuclei Sign_symptom , and indistinct Detailed_description nucleoli Biological_structure (Figure ​(Figure1D).1D).
Scattered Texture infiltrating Detailed_description single Detailed_description goblet Biological_structure neoplastic Biological_structure cells Biological_structure were focally Sign_symptom present Sign_symptom .
As previously described[1] the tumor Sign_symptom nests Sign_symptom appeared to arise from the basiglandular Biological_structure region Biological_structure of the intestinal Biological_structure crypts Biological_structure in close Detailed_description proximity Detailed_description to Detailed_description the Detailed_description MCA Disease_disorder (Figure ​(Figure1E).1E).
There was no lymphovascular Sign_symptom invasion Sign_symptom , although perineural Sign_symptom and intraneural Sign_symptom invasion Sign_symptom was present.
The tumor Coreference infiltrated the full Biological_structure thickness Biological_structure of the appendiceal Biological_structure wall Biological_structure and extended to the mesoappendix Biological_structure .
Ten Lab_value lymph Biological_structure nodes Biological_structure were histologically Diagnostic_procedure identified Diagnostic_procedure , of which all were negative for malignancy Disease_disorder .
Immunohistochemically Diagnostic_procedure (Table ​1), the tumor Sign_symptom cells Sign_symptom of the GCC Disease_disorder were positive Lab_value for chromogranin Diagnostic_procedure , synaptophysin Diagnostic_procedure , and serotonin Diagnostic_procedure , which are neuroendocrine Detailed_description markers Detailed_description .
Diffuse Lab_value staining Lab_value for cytokeratin Diagnostic_procedure (CK) 20 (Figure ​2), CK19, Diagnostic_procedure and CD99 Diagnostic_procedure was also present.
The Ki67 Diagnostic_procedure proliferating Diagnostic_procedure index Diagnostic_procedure revealed nuclear Sign_symptom staining Sign_symptom in approximately 15% Lab_value of the tumor Sign_symptom cells Sign_symptom .
There was no staining for CK7. Diagnostic_procedure