case_images: PMC10171976_01
case_images: Hematoxylin and eosin (H&E) stain. Histology demonstrates fibrous tissue with cholesterol clefts and foamy histiocytes (a). Within the fibrous stroma, there are atypical cells within the stroma with atypical cells (b). On higher power (20x), the ducts are lined by moderately atypical cells (c). There are other areas of the normal transitional and columnar epithelium (d).
case_images: CRIPA2023-1282058.001.jpg
case_images: PMC10171976_01_CRIPA2023-1282058.001.jpg
case_images: fig1
case_images: Histologically, the specimen demonstrated fibrous tissue with cholesterol clefts, foamy histocytes, necrosis, and focal calcification (Figure 1(a)). There were atypical glands with a background of desmoplastic stroma (Figure 1(b)). The cells had moderate cytologic atypia (Figure 1(c)) with discrete areas of the normal transitional and columnar epithelium (Figure 1(d)).
case_images: Immunohistochemical stains. The atypical areas stain positive for CDX2 (a) and patchy positive for CK20 (b). The tumor cells are negative for CK7 (c) and synaptophysin (d).
case_images: CRIPA2023-1282058.002.jpg
case_images: PMC10171976_01_CRIPA2023-1282058.002.jpg
case_images: fig2
case_images: Immunohistochemical staining demonstrated patchy staining for caudal-type homeobox 2 (CDX2) (Figure 2(a)) and weak staining for cytokeratin (CK) 20 (Figure 2(b)). CK7 (Figure 2(c)), paired-box gene 8 (PAX-8), synaptophysin (Figure 2(d)), chromogranin, and estrogen receptor (ER) were negative.
case_images: Hematoxylin and eosin (H&E) stain. Histology demonstrates a pyramidal-shaped tumor involving the overlying mucosa (a, b). Higher magnification (40x) demonstrates atypical tumor cells colonizing the overlying mucosa (c). Some areas demonstrate voluminous intracytoplasmic mucin (d).
case_images: CRIPA2023-1282058.003.jpg
case_images: PMC10171976_01_CRIPA2023-1282058.003.jpg
case_images: fig3
case_images: Histological examination demonstrated similar morphology to the initial specimen but more patchy areas with voluminous intracytoplasmic mucin (Figures 3(a) and 3(d)). The bulk of the tumor was in the colon wall in a pyramid shape, with the apex of the tumor appearing to colonize the mucosa (Figure 3(b)). The atypical cells can be seen colonizing the colonic mucosa (Figure 3(c)).
case_images: Immunohistochemical stains. The tumor stains weakly positive for CDX2 (a) and CK7 (b). CK7 also highlights the atypical tumor cells colonizing the overlying mucosa (c). CK20 is negative within the tumor but strongly positive in the surrounding unremarkable colonic mucosa (d).
case_images: CRIPA2023-1282058.004.jpg
case_images: PMC10171976_01_CRIPA2023-1282058.004.jpg
case_images: fig4
case_images: Immunohistochemistry demonstrated a tumor that is positive for CDX2 (weak) (Figure 4(a)) and CK7 (Figures 4(b) and 4(c)) while CK20 (Figure 4(d)) and PAX8 are negative. The surrounding unremarkable colonic tissue is strongly positive for CK20 (Figure 4(d)) and CDX2 (Figure 4(a)).