Assuntos
Músculo Grácil , Fístula Retal , Procedimentos Cirúrgicos Robóticos , Fístula da Bexiga Urinária , Fístula Urinária , Masculino , Humanos , Músculo Grácil/cirurgia , Fístula Retal/etiologia , Fístula Retal/cirurgia , Retalhos Cirúrgicos , Prostatectomia/efeitos adversos , Fístula da Bexiga Urinária/cirurgia , Fístula Urinária/cirurgiaAssuntos
COVID-19 , Gastroenterologia , Humanos , Pandemias , SARS-CoV-2 , Instituições de Assistência AmbulatorialRESUMO
Appendiceal endometriosis is a rare entity and, when accompanied by intestinal metaplasia, represents a challenging differential diagnosis with low-grade appendiceal mucinous neoplasm (LAMN). We present the case of a 47 years-old woman, with multiple surgical interventions for endometriosis, with persistent symptoms despite chronic hormonal treatment, with imaging showing stage IV endometriosis. Hence, en bloc low rectum resection with total hysterectomy and bilateral adnexectomy was performed, followed by appendectomy. Unexpectedly, despite the gross normal macroscopic appearance of the appendix, microscopy showed multiple endometriosis foci, consisting of endometrial glands embedded in varying amounts of endometrial stroma. As some of these glands were bordered by mucinous-type epithelium containing intestinal cells, Goblet cells, Paneth cells in addition to the presence of mucus-filled microcysts, immunohistochemistry (IHC) was performed in order to differentiate between intestinal-metaplasia and LAMN. IHC showed positivity of the endometrial epithelium for KRT7, estrogen receptor (ER) and progesterone receptor (PR). Both the appendiceal mucosa and the intestinal-type metaplastic epithelium of the glandular structures were positive for KRT20. Additionally, the endometrial stroma enclosing endometrial glands, as well as the stroma surrounding mucinous-type metaplastic epithelium, were positive for CD10, ER and PR. This patient's case draws attention to the rare occurrence of appendiceal endometriosis and the uncommon intestinal metaplasia, which can easily mimic LAMN, emphasizing the paramount importance of the differential diagnosis with this type of neoplasia.
Assuntos
Adenocarcinoma Mucinoso , Neoplasias do Apêndice , Apêndice , Endometriose , Neoplasias Intestinais , Feminino , Humanos , Pessoa de Meia-Idade , Endometriose/diagnóstico , Endometriose/cirurgia , Patologistas , Apêndice/cirurgia , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/cirurgia , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/cirurgia , Metaplasia/diagnósticoRESUMO
Due to a lack of a standardized surgical approach in splenic flexure cancer, we consider useful to present a how to do it material on laparoscopic high left colectomy with complete mesocolic excision and central vascular ligation for this type of tumours.
