case_images: PMC11374415_01
case_images: Abdominal CT scan with contrast shows a huge mass in the transverse colon.
case_images: CRIM2024-5741625.001.jpg
case_images: PMC11374415_01_CRIM2024-5741625.001.jpg
case_images: fig1
case_images: Despite treatment with immunosuppressant drugs, there was no improvement after 6 months, and with worsening of symptoms, more investigations by computed tomography (CT) revealed a large complex new malignant-looking abdominal mass encasing the transverse colon, stomach, tail of pancreas, and left kidney (Figure 1).
case_images: The gross morphology of the case shows extensive visceral involvement (a) in the operation room and (b) after formalin fixation at the pathology department.
case_images: CRIM2024-5741625.002.jpg
case_images: PMC11374415_01_CRIM2024-5741625.002.jpg
case_images: fig2
case_images: According to the clinical and radiologic data and also based on the previous histologic diagnosis of ulcerative colitis, she underwent exploratory laparotomy in our center with a preoperation diagnosis of advanced colon malignancy, which showed extensive involvement of the visceral organs (Figure 2(a)). The largest mass was 17 x 15 x 10 cm found in the submucosa of the colon and pancreas with attachment to the stomach (Figure 2(b)).
case_images: The microscopic view of the specimen. (a) Ulceration with normal overlying colon mucosa (hematoxylin and eosin x100). (b) Necrosis with the Splendore-Hoeppli phenomenon (arrow) (hematoxylin and eosin x400). (c) Splendore-Hoeppli phenomenon (arrow) (Periodic Acid-Schiff (PAS) x400). (d) Splendore-Hoeppli phenomenon (arrow) (Grocott's Methenamine Silver (GMS) stain x400).
case_images: CRIM2024-5741625.003.jpg
case_images: PMC11374415_01_CRIM2024-5741625.003.jpg
case_images: fig3
case_images: Splendore-Hoeppli phenomenon (radiating intensely eosinophilic material) surrounding the fungal hyphae. Special stains for fungal elements, such as Periodic Acid-Schiff (PAS) and Grocott's Methenamine Silver (GMS), were also used to confirm the diagnosis (Figure 3).
case_images: Review of the previous biopsy showed a tiny focus of the Splendore-Hoeppli phenomenon (arrows) (hematoxylin and eosin x40).
case_images: CRIM2024-5741625.004.jpg
case_images: PMC11374415_01_CRIM2024-5741625.004.jpg
case_images: fig4