case_images: PMC3896797_01
case_images: Re-examination by enhanced computed tomography (CT) scan. The CT scan shows right hydronephrosis (a), a tumorous lesion in the mesentery (b), and persistent encapsulated abscesses on the mesenteric side (c) and on the outside (d) of the ileocecal region.
case_images: 1477-7819-12-4-1.jpg
case_images: PMC3896797_01_1477-7819-12-4-1.jpg
case_images: F1
case_images: Enhanced CT was performed again and showed a persistent abscess, a tumorous lesion in the mesentery and right hydronephrosis (Figure 1).
case_images: Intraoperative findings. Encapsulated abscesses can be seen on the mesenteric side (a) and outside of the ileocecal region (b). When we raised the ileocecal region, a tumor was found to be fixed to the right ureter (c). A ureteral stent was inserted into the right ureter; the tumor was then separated and removed from the ureter (d).
case_images: 1477-7819-12-4-2.jpg
case_images: PMC3896797_01_1477-7819-12-4-2.jpg
case_images: F2
case_images: At laparotomy, there were no ascites but encapsulated abscesses were present on the mesenteric side and outside of the ileocecal region (Figure 2a,b). When we raised the ileocecal region, a tumor was found to be fixed to the right ureter and there was leakage of white, solid tumor content (Figure 2c). A ureteral stent was then inserted into the right ureter, and the tumor was separated and removed from the ureter with scissors (Figure 2d).
case_images: Macroscopic findings of the tumor and ileocecal lesion. No changes involving the mucosal surface of the cecum or the terminal ileum were detected.
case_images: 1477-7819-12-4-3.jpg
case_images: PMC3896797_01_1477-7819-12-4-3.jpg
case_images: F3
case_images: The pathological diagnosis was poorly differentiated carcinoma, but there were no changes involving the mucosal surface of the cecum or the terminal ileum (Figure 3).
case_images: Histological and immunohistochemical findings of the tumor. Hematoxylin-eosin (HE) staining reveals poorly differentiated carcinoma (a). Alcian blue (AB) staining showed moderate production of mucin accompanied by a partial ductal structure (b). Immunohistochemistry was partially positive for CK34betaE12 (about 20% of tumor) (c), positive for AE1/AE3 (d), negative for CDX2 (e), and negative for TTF-1 (f).
case_images: 1477-7819-12-4-4.jpg
case_images: PMC3896797_01_1477-7819-12-4-4.jpg
case_images: F4
case_images: Immunohistochemistry showed the tumor to be positive for AE1/AE3 (pancytokeratin), cytokeratin(CK)7, CK34betaE12 (about 20% of tumor) and Wilms tumor gene 1 (WT-1), with nonspecific reactions for CK5/6, p63, carcinoembryonic antigen (CEA), estrogen receptor (ER) and vimentin, while CK20, thyroid transcription factor 1 (TTF-1), caudal type homeobox 2 (CDX2), gross cystic disease fluid protein-15 (GCDFP-15), calretinin, D2-40 and CD10 were negative (Figure 4).