Abstract
We report an example of dysplastic intestinal-type metaplasia involving endometriosis of the appendix in a 45 year old woman. One other example of this phenomenon has been reported. As it occurs within the muscular wall of the appendix, confusion with low grade appendiceal mucinous neoplasm (LAMN) may occur. Evidence supporting the metaplastic nature of the intestinal epithelium is offered. As the initial pathological diagnosis was of invasive cancer with perforation of the appendix treatment consisted of peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC).Virtual slidesThe virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1068246472111756.
Highlights
Endometriosis of the appendix may be an incidental finding or the cause of appendicitis, intussusception or perforation [1]
The latter has been described in two cases of appendiceal endometriosis to date, one associated with focal dysplasia [3,4]
We describe a case of endometriosis of the appendix with dysplastic intestinal-type epithelium presenting as a mucocele with acute appendicitis and perforation
Summary
Endometriosis of the appendix may be an incidental finding or the cause of appendicitis, intussusception or perforation [1]. Various types of metaplasia may involve the epithelial component of endometriosis [2] including intestinal-type. The latter has been described in two cases of appendiceal endometriosis to date, one associated with focal dysplasia [3,4]. We describe a case of endometriosis of the appendix with dysplastic intestinal-type epithelium presenting as a mucocele with acute appendicitis and perforation. Following a pathologic diagnosis of “invasive low-grade carcinoma of the appendix colonizing appendicial endometriosis”, the patient was referred to our hospital for consideration of second look laparotomy and HIPEC. There was no macroscopic evidence of neoplasia, but mucin was seen localized to the right peritoneal surface. The patient’s clinical course has been uneventful after eighteen months
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