Indian Journal of Pathology and Microbiology
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Year : 2021  |  Volume : 64  |  Issue : 4  |  Page : 875-876
Catechism (Quiz 14)

1 Department of Pathology, S. N. Medical College, Agra, Uttar Pradesh, India
2 Department of Pathology, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India

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Date of Submission23-Dec-2020
Date of Acceptance06-Oct-2021
Date of Web Publication20-Oct-2021

How to cite this article:
Gupta A, Rani D, Varshney A. Catechism (Quiz 14). Indian J Pathol Microbiol 2021;64:875-6

How to cite this URL:
Gupta A, Rani D, Varshney A. Catechism (Quiz 14). Indian J Pathol Microbiol [serial online] 2021 [cited 2021 Dec 7];64:875-6. Available from: https://www.ijpmonline.org/text.asp?2021/64/4/875/328544

A 27-year married female presented to a gynecologist with abdominal pain for the last two months. Her periods were regular. Ultrasonography revealed a solid right adnexal mass measuring 9.2 × 7.2 × 5.7 cm. She was operated and the right ovary was removed and sent for histopathology. Photographs of the gross and microscopic appearances of the resected ovary are provided.


  1. What is the diagnosis?
  2. On immunohistochemistry, this particular tumor is likely to show positivity for:-

    1. Inhibin
    2. Prostate-specific acid phosphatase
    3. Estrogen receptor
    4. CDX2

  3. This tumor may involve the ovary in one of two forms with drastic changes in the outcome. Careful examination of the affected (and contralateral) ovary may prove useful in this respect. What are the two forms of involvement that are being alluded to?

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   Answers of Catechism (Quiz 13) Top

  1. Epiploic appendageal infarction.
  2. Torsion of, or vascular occlusion in, the pedicles of the epiploic appendages.
  3. Acute abdominal lower quadrant pain.

   Microscopic Findings Top

On histopathology, the mass was composed of coagulative necrosis of lobulated fat surrounded by layers of concentrically laminated, acellular and thick fibrous cuff with scattered foci of dystrophic calcification [Figure 1]b and [Figure 1]c. A diagnosis of healed epiploic appendageal infarction was made after correlation with gross and microscopic features.

   Discussion Top

Epiploic appendages (appendices epiploicae) are pedunculated fat-filled, serosa-covered structures seen over the entire colon (approximately 50-100 in number); they are more abundant and larger over the transverse and sigmoid segments. Each epiploic appendage is supplied by a small end-artery and drained by a vein, both of which pass through the narrow pedicle. Large sizes and long stalks lead to a tendency for excess mobility, which may make them prone to torsion and subsequent ischemic necrosis referred to as primary epiploic appendagitis.[1] In some patients (incidence of up to 1.3% and mean age of 40 years),[1] this involvement leads to acute-onset lower abdominal pain, simulating acute appendicitis or diverticulitis.[2] In other patients, and in patients with gradual torsion, the infarcted appendices are usually discovered incidentally during laparotomy or autopsy[3] (as noted in this case). There are also chances that these infarcted lesions get detached from the colonic surfaces to become pea-sized peritoneal loose bodies, which might gradually assume larger dimensions to cause symptoms related to intestinal obstruction.[4]

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Conflicts of interest

There are no conflicts of interest.

   References Top

Kefala MA, Tepelenis K, Stefanou CK, Stefanou SK, Papathanakos G, Kitsouli A, et al. Primary epiploic appendagitis mimicking acute appendicitis: A case report and narrative review of the literature. Korean J Gastroenterol 2020;76:88-93.  Back to cited text no. 1
Garg R, Ma D, Fishbain JT. Epiploic appendagitis: The uncommon intestinal imitator. Clin Gastroenterol Hepatol 2018;16:A36.  Back to cited text no. 2
Eberhardt SC, Strickland CD, Epstein KN. Radiology of epiploic appendages: Acute appendagitis, post-infarcted appendages, and imaging natural history. Abdom Radiol 2016;41:1653-65.  Back to cited text no. 3
Teklewold B, Kehaliw A, Teka M, Berhane B. A giant egg-like symptomatic loose body in the peritoneal cavity: A case report. Ethiop J Health Sci 2019;29:779-82.  Back to cited text no. 4

Correspondence Address:
Anupam Varshney
Department of Pathology, Muzaffarnagar Medical College, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijpm.ijpm_1462_20

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