Benign cecal villous adenoma presenting as a bladder mass

Involvement of contiguous organs by a neoplasm is ordinarily evidence of aggressive malignant behavior. A patient presented with a bladder mass found to be arising in the cecum and diagnosed as a benign villous adenoma. Growth down a diseased appendix is proposed to explain the apparent extension of a relatively nonaggressive lesion into an adjacent organ.     

Benign lymphoid hyperplasia manifesting as a cecal mass: Report of a case

Summary We have presented an unusual case of benign lymphoid hyperplasia, which manifested as a cecal deformity in a 15-year-old boy. The clinical manifestation may have been related to partial occlusion of the appendiceal orifice. In future cases of benign lymphoid hyperplasia, colonoscopy may be diagnostic, and if it is used for continuing observation, may avert unnecessary surgical procedures in children and young adults.     

Primary minute invasive de novo colonic adenocarcinoma appearing as submucosal tumor

A 4 mm white-yellow submucosal tumor-like lesion was detected in the sigmoid colon of an asymptomatic 52-yr-old Japanese man. Because the lesion was unexpectedly suspicious for adenocarcinoma by pathological examination of the biopsy specimen, it was treated by endoscopic mucosal resection. The specimen obtained demonstrated well-differentiated adenocarcinoma without any adenomatous element, and was located principally in the submucosal layer with a maximum depth of 1600 mum from the muscularis mucosae. The cancer exposed to the luminal surface was pathologically concluded to be diminutive. Intriguingly, aggregation of lymphocytes was found beneath the mucosal layer, which might have compromised the integrity of the muscularis mucosae. Because of deep submucosal infiltration and the latent aggressive nature of de novo cancer, the patient underwent an additional partial sigmoidcolectomy, which demonstrated no residual cancer and no regional lymph node metastasis. The lesion in this patient exhibited a previously undescribed appearance of de novo colon cancer as submucosal tumor in an early phase of growth.     

Granulomatous disease of the appendix manifesting as a cecal mass: Report of a case

We report the case of a 29-year-old man in whom isolated involvement of the appendix with granulomatous colitis or Crohn's disease manifested as a cecal mass. Appendectomy was performed. At operation the terminal ileum did not appear to be grossly involved. Careful long-term follow-up is essential in these patients to detect recurrent disease.     

Gastrointestinal stromal tumor presenting as a hormonally inactive adrenal mass

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Rarely, tumors with the same histological and immunohistochemical features arise in organs having no connection to the tubular gastrointestinal tract designated as extra-gastrointestinal stromal tumors (EGISTs). In this article, we report the first case of an EGIST presenting as a hormonally inactive adrenal mass. A 68-year-old woman with a 3-month history of right abdominal pain was clinically diagnosed as having a hormonally inactive right adrenal tumor sizing 15 cm in diameter. This mass and the tightly fixed right adrenal gland were resected en bloc.Histologically, the tumor was composed primarily of monomorphic spindle cells. Mitotic figure was 2–3 per 50 high power fields. Immunohistochemical analysis revealed strong positivity for CD117 (c-KIT) and smooth muscle actin (a-SMA), but negativity for beta-catenin, CD34, pan-keratin,S-100, desmin, and H-caldesmon. Genetic analysis showed no mutations in KIT gene exons 9, 11, 13, and 17,and in exon 18 of the platelet-derived growth factor-2 receptor gene (PDGFR). The patient proved to be tumor-free at the 18-month follow-up. This case under study demonstrates that EGIST should be included in the differential diagnosis of hormonally inactive adrenal tumors.CD117 (c-KIT) immunohistochemistry should be applied in the pathological workup of soft tissue adrenal tumors.This case is an additional example suggesting that the prognosis of even a very large EGIST is not definitely grave.