case_images: PMC11000834_01
case_images: A & B: Coronal and Axial views respectively of an enlarged 11 mm appendix with surrounding inflammatory changes suggestive of appendicitis. C & D Coronal and Axial views respectively of a dilated appendix measuring 19 mm (blue arrows) with a nodular soft tissue density adjacent to appendix (yellow arrows).
case_images: jchim-13-06-029f1.jpg
case_images: PMC11000834_01_jchim-13-06-029f1.jpg
case_images: f1-jchim-13-06-029
case_images: AST normalized. A repeat CT A/P with contrast demonstrated the thrombus in the superior mesenteric vein extending into the main and right portal veins which increased in extent compared to the patient's first hospitalization as well as an enlarged 11 mm appendix with surrounding inflammatory changes interpreted as an appendicitis with a periportal lymph node measuring 1.4 cm (Fig. 1A and B). Five months after his discharge, a repeat CT Chest and A/P without contrast demonstrated a dilated appendix measuring 1.9 cm with slight improvement in the fat stranding and nodular soft tissue adjacent to appendix, raising concern for chronic appendicitis versus an appendiceal carcinoma or neuroendocrine tumor (Fig. 1C and D).
case_images: A: Photomicrograph showing the transition from the flat epithelial mucinous cells of the lesion to the denuded epithelium, which is a common finding in low grade appendiceal mucinous neoplasm (LAMN). The left side of the image shows calcifications while right side demonstrates acute inflammation with accompanying acellular mucin. B: High magnification image demonstrating the low grade morphology of the tumor cells in LAMN. CA: Gross photograph showing a cross section of the appendix (long arrow) and a cross section of the mucinous neoplasm (short arrow), which is approximately 3 cm in greatest dimension.
case_images: jchim-13-06-029f2.jpg
case_images: PMC11000834_01_jchim-13-06-029f2.jpg
case_images: f2-jchim-13-06-029
case_images: The tissue removed during the surgery consisted of portions of the ileum (10.5 cm in length and 1.5-4.0 cm in circumference), cecum and ascending colon (10.1 cm in length and 7.0 cm in average circumference), and appendix (3.8 cm in length and 1.3 cm in average diameter) without any mucin identified in the ileum and colon (Fig. 2C).