It Look Benign at First

in STEMGeeks4 months ago

This from a 40 year old male with an cecal tumor.

photo_2022-01-09_15-16-14.jpg

It’s hard to put the right words when describing the specimen grossly. It’s one of those experiences where you just know just by looking at it. On the surface level, I could rationalize the amount of necrosis present on the specimen and located resembled something like a ruptured appendicitis that was left untreated long. It can also resemble tuberculosis of the cecum. They are hard to tell apart grossly.

photo_2022-01-09_15-16-15.jpg

Upon cutting it up, it “felt like” a ruptured gangrenous appendicitis by look and feel but there was another layer of complexity that didn’t felt right. The amount of spread to nearby tissues and the texture was slightly coarse and firm. Suspecting malignancy just makes me more conscious about adding more sections than originally intended just in case I miss out.

photo_2022-01-09_15-16-15 (2).jpg

It’s ideal to processed the specimen as soon as possible because that’s when most of the receptors for immunohistochemical stains and structural morphology get well preserved for viewing. This was my last specimen for 2021.

photo_2022-01-09_15-00-11.jpg

photo_2022-01-09_15-00-11 (2).jpg

I’m entertaining a Non-Hodgkin’s Lymphoma based from this image retrieved from the appendiceal walls and surrounding cecum. Probably a MALT type, consider they are common on the area and are made up of small to intermediate sized lymphocytic cells. My life would have been easier if I just saw a foreign body reaction giant cells or another type called Langhans’ multinucleated giant cells which lean on gangrenous appendicitis versus tuberculosis involving the colon.

But nope, I just had to get these histomorphologic views and this complicates the case just by a little. I’ll wait for the final sign out for this one and if proven MALT, it’s my first encountered so far. I’m recommending immunohistochemical stains CD3 and CD20 and LCA to differentiate this from Hodgkins Lymphoma.

Immunohistochemical stains when positive for staining their intended targets can confirm or eliminate potential differentials.

If you made it this far reading, thank you for your time.

Posted with STEMGeeks

Sort:  

Scary stuff they also have cut stuff out of me no clue how it looked!

What did they removed?

Yay! The weekly dose of gross!

I read that cecal tumors develop at the tip of the colon. Is this true? What would cause it to develop there? Are there any cures for this?

I don't know about what you meant by tip, but if the reference point was a large intestine it's either cecum or anal canal on both entrance and exits. The cecum is also linked to the appendix where the tip is usually where carcinoma arises, maybe that's what you meant?

For the cause, usually hereditary, sporadic mutation, chronic inflammation, metastasis, and acquired mutations over the years. A lot of cancers are caused by multiple factors and only few cancers have a specific causation to pinpoint.

For cures, if it's benign, resection usually fixes it but when it's malignant, there's no true cure because relapse can happen and it's risk is always present for a lifetime compared to benign tumors. Asking whether the case is benign vs malignant is always one of the first questions we try to answer when looking at the slide.

The cecum is also linked to the appendix where the tip is usually where carcinoma arises, maybe that's what you meant?

Yes, that's what I meant. Thank you.

Mucinous carcinomas, I think. These often get found out as an incidental finding.