Journal of Pathology and Translational Medicine

Case Study

Appendiceal actinomycosis mimicking appendiceal tumor, appendicitis or inflammatory bowel disease: You-Na Sung, Jihun Kim; J Pathol Transl Med. 2021;55(5):349-354. Published online June 26, 2020; DOI: https://doi.org/10.4132/jptm.2020.05.17

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Appendiceal actinomycosis is very rare and its diagnosis is often difficult even in surgically resected specimens. Here we report two cases of appendiceal actinomycosis confirmed by pathologic examination of surgically resected specimens. Characteristic histologic features included transmural chronic inflammation with Crohn-like lymphoid aggregates and polypoid mucosal protrusion into cecal lumen through fibrous expansion of the submucosa. Chronic active inflammation involved the mucosa of the appendix and cecum around the appendiceal orifice. Crohn’s disease with predominant cecal involvement and inflammatory pseudotumor were considered as differential diagnoses. Careful examination revealed a few actinomycotic colonies in the mucosa, confirming the diagnosis. A high index of suspicion with awareness of the characteristic histologic features might prompt careful inspection for the actinomycotic colonies, leading to the appropriate diagnosis of this rare disease.

Citations

Citations to this article as recorded by

Appendicular actinomycosis: The first reported case of an uncommon finding of a common ailment from Nepal
Sujan Bohara, Manoj Khadka, Pawan Singh Bhat, Prajwal Syangtang, Badal Karki, Bhagawan Shrestha, Shoshan Arja Acharya, Khusbhu Khetan, Jyoti Rayamajhi, Sushil Bahadur Rawal
Clinical Case Reports.2023;[Epub] CrossRef
Abdominopelvic actinomycosis: An unexpected diagnosis in an elderly female with a destructive-appearing soft tissue mass
Elise Hyser, Drashti Antala, Harvey Friedman, Jonathan Stake
IDCases.2022; 28: e01479. CrossRef

Case Reports

Primary Extrapulmonary Small Cell Carcinoma of the Appendix: A Case Report.: Jong Hyeok Park, Ki Jae Park, Young Hoon Roh, Mee Sook Roh; Korean J Pathol. 2010;44(1):101-105.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.1.101

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Abstract PDF: Primary extrapulmonary small cell carcinoma (EPSCC) of the appendix is an extremely rare entity, and there has been only one previous report on this in the English medical literature. We report here on the first Korean case of EPSCC of the appendix in a 55-year-old woman. The patient had no history of an identified pulmonary tumor, and she presented with constipation and lower abdominal pain. The patient underwent right hemicolectomy with regional lymph node dissection and bilateral salphigo-oophorectomy. The histology of the entire appendiceal tumor revealed pure EPSCC with diffuse immunoreactivity for pancytokeratin, cytokeratin 7, cytokeratin 20, CD56, thyroid transcription factor 1, c-kit and carcinoembryonic antigen, and there was focal weak immunoreactivity for chromogranin A and synaptophysin. After the second cycle of chemotherapy, the condition of the patient gradually deteriorated due to cancer peritonei and the patient died 7 months later. EPSCC of the appendix is a distinctive clinicopathological entity that displays highly aggressive behavior and an unfavorable outcome.

Non-Hodgkin's Malignant Lymphoma Arising in the Appendix: A case report.: Yun Sin Kim, Mi Sook Lee, Kwang Seok Lee Lee, Sung Chul Lim, Ho Jong Jeon; Korean J Pathol. 1995;29(4):524-526.

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Abstract PDF: Primary malignant lymphoma of the appendix is an unconnnon neoplasm although the gastrointestinal tract is the most common extranodal site of malignant lymphoma. We report a case of primary malignant lymphoma of the appendix in a 54-year-old male, who presented with pain in the right lower abdomen. An appendectomy was performed. The appendix measured 9.5 cm in length and 5.5 cm in diameter. Cut sections showed a solitary circumferential mass in the appendiceal lumen. Light microscopic features were compatible with malignant lymphoma of diffuse large cell type(Working Formulation) and the immunophenotype was B cell type.

Goblet Cell Carcinoid of the Appendix: A case report.: Joo Heon Kim, Ho Lee, So Young Oh, Myoung Jae Kang, Ho Yeul Choi, Dong Geun Lee; Korean J Pathol. 1996;30(9):839-842.

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Abstract PDF: Carcinoid tumors of the appendix are common incidental findings, but appendiceal tumors with histologic features of both carcinoids and adenocarcinomas are rare, and their biologic behavior and histogenesis are still unclear. We report a case of goblet cell carcinoid of the appendix in a 54-year-old male, who exhibited pain in the right lower abdomen. Microscopically, the tumor contained smooth-bordered, widely separated nests composed of tumor cells with abundant mucin. The principal tumor cell type had a close resemblance to the normal goblet cell. Histochemically, the tumor cells revealed positive reaction for PAS and alcian blue stain. Immunohistochemically, the tumor showed strong reactivity for carcinoembryonic antigen, chromogranin and, neuron specific enolase but none for cytokeratin and epithelial membrane antigen.

Appendiceal Polyp: A report of two cases.: Ki Hwa Yang, Jung Min Lee, Mi Sook Lee, Sang Ho Park, Young Gun Yoon, Choong Gu Kang; Korean J Pathol. 1996;30(11):1045-1049.

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Abstract PDF: Varying types of polyps could occur in the vermiform appendix. However, it is very unusual. Collins found 57 cases (0.08%) of benign mucosal polyps in the 71,000 cases of appendectomy specimens. There has been no reported case of appendiceal polyp in the literature in Korea. The authors experienced two cases of polyp in the vermiform appendix. The first case was a 51 year-old male patient who received a left hemicolectomy due to colonic polyposis. The second case was a 71 year-old male patient who was treated by appendectomy under the clinical diagnosis of acute appendicitis. The microscopic type of both cases were hyperplastic polyp.

Original Article

Mucinous Tumors of the Appendix Associated with Mucinous Tumors of the Ovary and Pseudomyxoma Peritonei: A Clinicopathologic Analysis of 5 Cases Supporting an Appendiceal Origin.: Eung Seok Lee, Han Kyeom Kim, In Sun Kim; Korean J Pathol. 1998;32(2):131-137.

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Abstract PDF: Pseudomyxoma peritonei often have synchronous appendiceal and ovarian mucinous tumors. There has been considerable debate as to whether the ovarian tumors are secondary to the appendiceal tumor or they are independent primary ovarian tumors. It is important to reveal the primary site for treatment and prognosis of a patient. Five cases of synchronous mucinous tumors of the ovary and appendix were studied. Four cases had pseudomyxoma peritonei and pseudomyxoma ovarii. The ovarian tumors were bilateral in two cases, right in two, and left in one. The ovarian tumors were four mucinous cystadenoma of borderine malignancy and one mucinous cystadenocarcinoma, and the appendiceal tumors consisted of four mucinous tumors of borderline malignancy and one mucinous adenocarcinoma. The histology of the ovarian and appendiceal tumors was similar. Rupture of the tumor was seen in all appendiceal tumors and two ovarian tumors. It has been reported that cytokeratin 7 is a useful marker for distinguishing primary ovarian neoplasms from metastases of intestinal origin. All ovarian and appendiceal tumors showed positive reaction for broad-spectrum cytokeratin, but negative for cytokeratin 7. Based on the clinicopathologic and immunohistochemical features, it should be considered that the appendiceal tumors are primary and ovarian tumors are secondary in the synchronous presentation of the ovarian and appendiceal mucinous tumors.

Case Report

Combined Mucinous Tumor and Carcinoid of Appendix Associated with Mucinous Tumor of Ovary and Pseudomyxoma Peritonei: A case report .: Hye Jeong Choi, Mi Jin Kim; Korean J Pathol. 1999;33(11):1094-1096.

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Abstract PDF: We report a case of mucinous cystadenoma of uncertain malignant potential and carcinoid of appendix associated with bilateral mucinous cystadenoma of ovary and pseudomyxoma peritonei. The patient was a 46-year-old female. She suffered from dyspnea and lower abdominal palpable masses for several months. Ultrasonogram showed multilocular huge ovarian cysts. Appendectomy, transabdominal hysterectomy, bilateral salphingo-oophorectomy and biopsy of omentum were performed. The bilateral ovaries measured 16 11 cm and 7X5 cm in size, respectively. The both ovaries showed multilocular cysts filled with thick mucus material. The ovarian cysts were covered by a single layer of columnar epithelium with focal proliferation. Mucus materials dissected through the ovarian stroma (pseudomyxoma ovarii). The tip of appendix was dilated and covered by mucus material. The cut surface showed a cyst and a yellowish solid mass proximal to the cyst. Microscopically, the appendiceal cyst was lined by stratified columnar epithelium with moderate cytologic atypia. Mucus material dissected through the wall. In the proximal portion of the appendix, a classic carcinoid with focal tubular form was present in submucosa and muscle layer. The omentum was covered by thick mucus material. Microscopically, the omentum showed mucinous epithelium and mucus material (pseudomyxoma peritonei).

Original Article

Pathologic Analysis of 2159 Cases of Appendix.: Chan Sik Park, Mee Soo Chang, In Ae Park, Yong Il Kim, Gheeyoung Choe; Korean J Pathol. 2000;34(1):39-49.

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Abstract PDF: We reviewed 2159 consecutive cases of surgically resected appendices. The appendectomy specimen consisted of 91 cases of acute focal appendicitis (5.4%), 926 cases of acute suppurative appendicitis (55.1%), 228 cases of acute gangrenous appendicitis (13.6%), 63 cases of periappendicitis (3.8%), 13 cases of pure fibrous obliteration of the lumen (FOL; 0.8%), 18 cases of other diseases (7 mucoceles, 2 mucinous cystic neoplasms, 4 carcinoids, 2 metastatic carcinomas, 2 tuberculous appendicitides, and 1 eosinophilic appendicitis; 1%), and 342 cases with no diagnostic abnormality (20.3%). Patients having acute appendicitis ranged from 3 to 84 years of age, and patients in their 10's and 20's occupied over half of 2159 cases. Diagnostic accuracy of the acute appendicitis was 79.7%. Incidence of the acute appendicitis was suspected to be 7.2/100,000/year. Twenty eight cases of acute appendicitis were associated with diverticula. In the former acute primary diverticulitis led to acute appendicitis in 14 of 28 cases. Among 478 incidental appendectomy cases, there were 3 acute focal appendicitides, 1 acute suppurative appendicitis, 1 eosinophilic appendicitis, 32 periappendicitides, 1 mucocele, 40 pure FOLs, 1 deciduosis, 1 endometriosis, and 1 diverticulosis without inflammation. There were 69 cases of FOL (32 complete forms and 37 incomplete forms), among which 13 cases were associated with acute appendicitis. FOL was more frequent in female patients as well as patients over 40 years of age. Incomplete FOL was considered to progress to complete form with age. The incidence of appendiceal diverticula was higher, whereas the incidences of carcinoid tumor and FOL were lower compared with that in the western report. In 14 of 28 cases the appendiceal diverticulum was the site in which acute appendicitis began.

Case Reports

Myxoglobulosis of the Appendix: A Case Report.: Jong Yup Bae, Jong Woo Kim; Korean J Pathol. 2001;35(3):256-258.

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Abstract PDF: Myxoglobulosis of the appendix is a rare and peculiar form of appendiceal mucocele. It is characterized by pearl or fish egg-like mucin globules in the lumen. We report a case of myxoglobulosis of the appendix in a 31-year-old man. Myxoglobules are composed of eosinophilic necrotic cell debris and mucin in the central nidus and lamellar structures alternating with necrotic cell debris and mucin in the peripheral zone. A stirring effect produced by vigorous appendiceal peristalsis may contribute to its lamellar growth.

Diffuse Ganglioneuromatosis of Appendix associated with Von Recklinghausen;s Disease.: Young Su Kim, Sang Chul Nam, Man Hoon Han, Jeong Shik Kim, Ji Yun Jeong, Han Ik Bae; Korean J Pathol. 2007;41(5):334-336.

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Abstract PDF: Gastrointestinal ganglioneuromatosis is a rare neoplastic condition that can occur in association with von Recklinghausen's disease with multiple endocrine neoplasia type II B. The main locations are the ileum, colon, and appendix. We report a case of diffuse ganglioneuromatosis of the appendix associated with a mesenteric and ileocecal plexiform neurofibroma in von Recklinghausen's disease.

Obstructive Mucocele of the Appendix Secondary to Endometriosis: A Case Report.: Chang Hun Lee, Dong Hoon Shin, Jun Woo Lee; Korean J Pathol. 2004;38(6):419-422.

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Abstract PDF: Appendiceal mucoceles are usually associated with hyperplastic or neoplastic mucosal proliferation and obstructive lesions such as postinflammatory scarring, fecalith, carcinoid tumor, and endometriosis. Among these, an association with endometriosis is known to be very exceptional. We herein report on a rare case of obstructive mucocele of the appendix that was secondary to endometriosis in a 42-year-old patient with pelvic endometriosis. A computed tomography scan demonstrated a periappendiceal abscess-like lesion with a left adnexal mass that was suggestive of endometriosis. On gross examination, the periappendiceal lesion consisted of a mucin-filled cavity (the so-called mucocele) that was 1.8 cm in diameter, and it protruded into the cecal lumen. Microscopically, the lining epithelium of the cavity was almost totally denuded. A small amount of mucus spilled over outside the mucocele, but pseudomyxoma peritonei was not present. The wall of the mucocele showed the characteristic multiple foci of endometriosis involving predominantly the muscularis propria and the serosa of the appendix and adjacent cecal walls.

Primary Appendiceal Papillary Adenocarcinoma of Colonic Type: Report of a case.: Yun Kyung Kang, Ghee Young Choe, Yong Il Kim, Kuk Jin Choe; Korean J Pathol. 1992;26(3):306-309.

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Abstract PDF: We report a case of colonic type-papillary adenocarcinoma of appendiceal origin in a 73-year-old male patient. The patient presented with right lower quadrant mass and was operated for a preoperative diagnosis of inflammatory small bowel mass. The mid one-third of the appendix showed a 3.5x3.3 cm sized, broad-based, intraluminal papillary mass. Microscopically, it was a well differentiated papillary adenocarcinoma and revealed a strong immunoreactivity to carcinoembryonic antigen. Tumor desmoplasia and acute inflammatory change were prominent.

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