Appendiceal perforation secondary to endometriosis with intestinal metaplasia: A case report
Affiliations: Department of Pathology, Longgang District People's Hospital of Shenzhen, The Second Affiliated Hospital of The Chinese University of Hong Kong, Shenzhen 518172, P.R. China, Department of Pathology, Jinan University School of Medicine, Guangzhou, Guangdong 510632, P.R. China
- Published online on: April 19, 2023 https://doi.org/10.3892/etm.2023.11961
- Article Number: 262
Copyright: © Wang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
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Appendiceal endometriosis with intestinal metaplasia is particularly challenging to diagnose preoperatively based on clinical features. Microscopically, it can mimic malignant transformation into mucinous neoplasms of the appendix. The present study reports a case of a 47‑year‑old woman who presented with abdominal pain that was not related to her menstruation. The preoperative diagnosis and laparoscopic evaluation were chronic appendicitis. No mucinous or haemorrhagic secretions were present within the abdominal cavity. Pathological evaluation revealed conventional endometriosis with intestinal‑type metaplasia of the epithelium. An inverse pattern of cytokeratin (CK)7, paired‑box 8, estrogen receptor, CK20, caudal type homeobox transcription factor 2 and mucin 2 immunoreactivity between intestinal‑type and endometrial‑type endothelium was observed. Infiltration and replacement of the appendiceal wall by marked levels of acellular mucin, a lack of stromal components and a DNA mismatch repair protein profile were vital in diagnosing appendiceal endometriosis without appendiceal mucinous neoplasms (AMNs). The lesion of appendiceal endometriosis are usually superficial and small in previously reported cases but was deeply invasive in our case. A careful histopathological examination is necessary for diagnosing and distinguishing the histologic imitators of AMN.