Indian Journal of Pathology and Microbiology

NEW HORIZON
Year
: 2021  |  Volume : 64  |  Issue : 4  |  Page : 875--876

Catechism (Quiz 14)


Atul Gupta1, Deepa Rani1, Anupam Varshney2,  
1 Department of Pathology, S. N. Medical College, Agra, Uttar Pradesh, India
2 Department of Pathology, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India

Correspondence Address:
Anupam Varshney
Department of Pathology, Muzaffarnagar Medical College, Uttar Pradesh
India




How to cite this article:
Gupta A, Rani D, Varshney A. Catechism (Quiz 14).Indian J Pathol Microbiol 2021;64:875-876


How to cite this URL:
Gupta A, Rani D, Varshney A. Catechism (Quiz 14). Indian J Pathol Microbiol [serial online] 2021 [cited 2022 Jan 27 ];64:875-876
Available from: https://www.ijpmonline.org/text.asp?2021/64/4/875/328544


Full Text



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.

Questions

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

InhibinProstate-specific acid phosphataseEstrogen receptorCDX2

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?{Figure 1}

 Answers of Catechism (Quiz 13)



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

 Microscopic Findings



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



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]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

[INLINE:1]

References

1Kefala 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.
2Garg R, Ma D, Fishbain JT. Epiploic appendagitis: The uncommon intestinal imitator. Clin Gastroenterol Hepatol 2018;16:A36.
3Eberhardt SC, Strickland CD, Epstein KN. Radiology of epiploic appendages: Acute appendagitis, post-infarcted appendages, and imaging natural history. Abdom Radiol 2016;41:1653-65.
4Teklewold 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.