DOI: 10.1148/rg.233025134
Primary Neoplasms of the Appendix: Radiologic Spectrum of Disease with Pathologic Correlation1
Perry J. Pickhardt, LCDR, MC, USNR,
Angela D. Levy, LTC, MC, USA,
Charles A. Rohrmann, Jr, MD and
Amir I. Kende, Maj, MC, USAF
1 From the Department of Radiology, National Naval Medical Center, 8901 Wisconsin Ave, Bethesda, MD 20889-5600 (P.J.P.); the Department of Radiology and Nuclear Medicine, Uniformed Services University of the Health Sciences, Bethesda, Md (P.J.P., A.D.L.); the Departments of Radiologic Pathology (A.D.L., C.A.R.) and Gastrointestinal Pathology (A.I.K.), Armed Forces Institute of Pathology, Washington, DC; and the Department of Radiology, University of Washington, Seattle (C.A.R.). Recipient of a Certificate of Merit award for an education exhibit at the 2001 RSNA scientific assembly. Received August 1, 2002; revision requested September 9 and received September 17; accepted September 18. Address correspondence to P.J.P. (e-mail: pjpik@hotmail.com).
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Figure 1a. Asymptomatic appendiceal mucocele from mucinous adenoma in a 77-year-old man. (a) Abdominal radiograph collimated to the right lower quadrant shows coarse curvilinear calcification (arrows) overlying the right iliac wing. An associated rounded mass (arrowheads) is suggested. (b) Axial contrast material-enhanced computed tomographic (CT) scan shows a cystic lesion with mural calcification (M) in the expected region of the appendix. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin [H-E] stain) shows a collapsed lumen (*) lined by undulating and flattened dysplastic epithelium (arrowheads), as well as fibrosis of the wall.
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Figure 1b. Asymptomatic appendiceal mucocele from mucinous adenoma in a 77-year-old man. (a) Abdominal radiograph collimated to the right lower quadrant shows coarse curvilinear calcification (arrows) overlying the right iliac wing. An associated rounded mass (arrowheads) is suggested. (b) Axial contrast material-enhanced computed tomographic (CT) scan shows a cystic lesion with mural calcification (M) in the expected region of the appendix. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin [H-E] stain) shows a collapsed lumen (*) lined by undulating and flattened dysplastic epithelium (arrowheads), as well as fibrosis of the wall.
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Figure 1c. Asymptomatic appendiceal mucocele from mucinous adenoma in a 77-year-old man. (a) Abdominal radiograph collimated to the right lower quadrant shows coarse curvilinear calcification (arrows) overlying the right iliac wing. An associated rounded mass (arrowheads) is suggested. (b) Axial contrast material-enhanced computed tomographic (CT) scan shows a cystic lesion with mural calcification (M) in the expected region of the appendix. (c) Photomicrograph (original magnification, x100; hematoxylin-eosin [H-E] stain) shows a collapsed lumen (*) lined by undulating and flattened dysplastic epithelium (arrowheads), as well as fibrosis of the wall.
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Figure 2a. Asymptomatic appendiceal mucocele from mucinous adenoma in a 62-year-old man. (a) Photograph obtained during colonoscopy shows a smooth mass (M) protruding into the cecum. (b) Radiograph from a solid-column contrast enema examination shows a smooth, broad-based filling defect (arrowhead). (c) Axial contrast-enhanced CT scan demonstrates the cecal filling defect (arrowhead). (d) Axial contrast-enhanced CT scan shows the full extent of the mucocele (arrow).
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Figure 2b. Asymptomatic appendiceal mucocele from mucinous adenoma in a 62-year-old man. (a) Photograph obtained during colonoscopy shows a smooth mass (M) protruding into the cecum. (b) Radiograph from a solid-column contrast enema examination shows a smooth, broad-based filling defect (arrowhead). (c) Axial contrast-enhanced CT scan demonstrates the cecal filling defect (arrowhead). (d) Axial contrast-enhanced CT scan shows the full extent of the mucocele (arrow).
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Figure 2c. Asymptomatic appendiceal mucocele from mucinous adenoma in a 62-year-old man. (a) Photograph obtained during colonoscopy shows a smooth mass (M) protruding into the cecum. (b) Radiograph from a solid-column contrast enema examination shows a smooth, broad-based filling defect (arrowhead). (c) Axial contrast-enhanced CT scan demonstrates the cecal filling defect (arrowhead). (d) Axial contrast-enhanced CT scan shows the full extent of the mucocele (arrow).
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Figure 2d. Asymptomatic appendiceal mucocele from mucinous adenoma in a 62-year-old man. (a) Photograph obtained during colonoscopy shows a smooth mass (M) protruding into the cecum. (b) Radiograph from a solid-column contrast enema examination shows a smooth, broad-based filling defect (arrowhead). (c) Axial contrast-enhanced CT scan demonstrates the cecal filling defect (arrowhead). (d) Axial contrast-enhanced CT scan shows the full extent of the mucocele (arrow).
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Figure 3. Asymptomatic appendiceal mucocele from mucinous adenoma in a 53-year-old man. Spot radiograph from an air-contrast barium enema examination shows a smooth filling defect (M) that appears to be submucosal. The acute angles formed with the adjacent cecal wall may represent early intussusception.
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Figure 4a. Appendiceal mucocele from mucinous adenoma in a 57-year-old man with a palpable abdominal mass in the right lower quadrant. (a) Transabdominal US image shows a cystic lesion with a "chicken drumstick" appearance. (b) Photograph of the surgically resected specimen shows the dilated appendix extending inferiorly from the base of the cecum.
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Figure 4b. Appendiceal mucocele from mucinous adenoma in a 57-year-old man with a palpable abdominal mass in the right lower quadrant. (a) Transabdominal US image shows a cystic lesion with a "chicken drumstick" appearance. (b) Photograph of the surgically resected specimen shows the dilated appendix extending inferiorly from the base of the cecum.
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Figure 5a. Mucocele from mucinous adenoma in a 47-year-old man with nonspecific abdominal pain. (a) Axial CT scan shows an elongated cystic mass (M) in the expected region of the appendix. (b, c) Sagittal T2-weighted (b) and contrast-enhanced fat-suppressed T1-weighted (c) MR images show the same elongated cystic mass (M). (d) Photograph of the gross specimen shows fusiform dilatation of the appendix.
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Figure 5b. Mucocele from mucinous adenoma in a 47-year-old man with nonspecific abdominal pain. (a) Axial CT scan shows an elongated cystic mass (M) in the expected region of the appendix. (b, c) Sagittal T2-weighted (b) and contrast-enhanced fat-suppressed T1-weighted (c) MR images show the same elongated cystic mass (M). (d) Photograph of the gross specimen shows fusiform dilatation of the appendix.
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Figure 5c. Mucocele from mucinous adenoma in a 47-year-old man with nonspecific abdominal pain. (a) Axial CT scan shows an elongated cystic mass (M) in the expected region of the appendix. (b, c) Sagittal T2-weighted (b) and contrast-enhanced fat-suppressed T1-weighted (c) MR images show the same elongated cystic mass (M). (d) Photograph of the gross specimen shows fusiform dilatation of the appendix.
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Figure 5d. Mucocele from mucinous adenoma in a 47-year-old man with nonspecific abdominal pain. (a) Axial CT scan shows an elongated cystic mass (M) in the expected region of the appendix. (b, c) Sagittal T2-weighted (b) and contrast-enhanced fat-suppressed T1-weighted (c) MR images show the same elongated cystic mass (M). (d) Photograph of the gross specimen shows fusiform dilatation of the appendix.
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Figure 6a. Mucinous adenocarcinoma of the appendix in a 68-year-old woman with acute right lower quadrant pain. (a) Axial unenhanced CT scan shows a complex heterogeneous mass in the right lower quadrant (arrowhead). (b) US image shows a thick-walled cystic lesion with a complex internal architecture (arrowhead). (c) Photograph of the cut gross specimen shows internal polypoid tumor nodules that correspond to the complex mass identified at cross-sectional imaging. Scale is in centimeters. (d) Photomicrograph (original magnification, x100; H-E stain) shows lightly basophilic mucin pools (*) lined by columnar glandular epithelium (arrow) and extending below the surface epithelium (arrowheads).
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Figure 6b. Mucinous adenocarcinoma of the appendix in a 68-year-old woman with acute right lower quadrant pain. (a) Axial unenhanced CT scan shows a complex heterogeneous mass in the right lower quadrant (arrowhead). (b) US image shows a thick-walled cystic lesion with a complex internal architecture (arrowhead). (c) Photograph of the cut gross specimen shows internal polypoid tumor nodules that correspond to the complex mass identified at cross-sectional imaging. Scale is in centimeters. (d) Photomicrograph (original magnification, x100; H-E stain) shows lightly basophilic mucin pools (*) lined by columnar glandular epithelium (arrow) and extending below the surface epithelium (arrowheads).
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Figure 6c. Mucinous adenocarcinoma of the appendix in a 68-year-old woman with acute right lower quadrant pain. (a) Axial unenhanced CT scan shows a complex heterogeneous mass in the right lower quadrant (arrowhead). (b) US image shows a thick-walled cystic lesion with a complex internal architecture (arrowhead). (c) Photograph of the cut gross specimen shows internal polypoid tumor nodules that correspond to the complex mass identified at cross-sectional imaging. Scale is in centimeters. (d) Photomicrograph (original magnification, x100; H-E stain) shows lightly basophilic mucin pools (*) lined by columnar glandular epithelium (arrow) and extending below the surface epithelium (arrowheads).
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Figure 6d. Mucinous adenocarcinoma of the appendix in a 68-year-old woman with acute right lower quadrant pain. (a) Axial unenhanced CT scan shows a complex heterogeneous mass in the right lower quadrant (arrowhead). (b) US image shows a thick-walled cystic lesion with a complex internal architecture (arrowhead). (c) Photograph of the cut gross specimen shows internal polypoid tumor nodules that correspond to the complex mass identified at cross-sectional imaging. Scale is in centimeters. (d) Photomicrograph (original magnification, x100; H-E stain) shows lightly basophilic mucin pools (*) lined by columnar glandular epithelium (arrow) and extending below the surface epithelium (arrowheads).
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Figure 7. Infected mucocele from a mucinous appendiceal neoplasm manifesting as acute appendicitis in a 61-year-old man with acute right lower quadrant pain and leukocytosis. Axial contrast-enhanced CT scan shows a complex, thick-walled cystic mass (arrowhead). There is an extensive soft-tissue component, infiltration of the adjacent fat, and a tiny gas bubble (arrow). Histologic analysis showed these findings to represent a benign mucinous adenoma.
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Figure 8. Infected mucocele from a mucinous appendiceal neoplasm manifesting as acute appendicitis in a 34-year-old woman with acute right lower quadrant pain. Axial contrast-enhanced CT scan shows a thick-walled cystic mass (arrows) adjacent to the cecum. There are gas bubbles surrounding the luminal fluid. Although similar in appearance to the lesion in Figure 7, the underlying neoplasm in this case was malignant (mucinous adenocarcinoma).
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Figure 9a. Myxoglobulosis in an asymptomatic mucocele from mucinous adenoma in a 51-year-old man. The neoplasm was found initially at contrast enema examination. (a) Axial contrast-enhanced CT scan shows a mucocele with rim calcification (arrowheads) and multiple small, rounded intraluminal hyperattenuating areas. (b) Photograph of the sectioned gross specimen shows multiple intraluminal pearly spherules (arrowheads), one of which has been extruded (arrow).
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Figure 9b. Myxoglobulosis in an asymptomatic mucocele from mucinous adenoma in a 51-year-old man. The neoplasm was found initially at contrast enema examination. (a) Axial contrast-enhanced CT scan shows a mucocele with rim calcification (arrowheads) and multiple small, rounded intraluminal hyperattenuating areas. (b) Photograph of the sectioned gross specimen shows multiple intraluminal pearly spherules (arrowheads), one of which has been extruded (arrow).
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Figure 10a. Appendiceal mucocele from mucinous adenoma manifesting as intussusception in a 39-year-old woman. (a) Abdominal radiograph shows a rounded mass (arrow) that projects into the lumen of the transverse colon, a finding that suggests intussusception. There is faint rim calcification along the leading edge of the mass. (b) Image from a contrast enema examination helps confirm the intussusception, which has been partially reduced (cf a). A rounded lead mass (M) is also present. (c) Axial contrast-enhanced CT scan shows the cystic lead mass (M) and mesenteric fat and vessels (arrow) of the intussusceptum.
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Figure 10b. Appendiceal mucocele from mucinous adenoma manifesting as intussusception in a 39-year-old woman. (a) Abdominal radiograph shows a rounded mass (arrow) that projects into the lumen of the transverse colon, a finding that suggests intussusception. There is faint rim calcification along the leading edge of the mass. (b) Image from a contrast enema examination helps confirm the intussusception, which has been partially reduced (cf a). A rounded lead mass (M) is also present. (c) Axial contrast-enhanced CT scan shows the cystic lead mass (M) and mesenteric fat and vessels (arrow) of the intussusceptum.
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Figure 10c. Appendiceal mucocele from mucinous adenoma manifesting as intussusception in a 39-year-old woman. (a) Abdominal radiograph shows a rounded mass (arrow) that projects into the lumen of the transverse colon, a finding that suggests intussusception. There is faint rim calcification along the leading edge of the mass. (b) Image from a contrast enema examination helps confirm the intussusception, which has been partially reduced (cf a). A rounded lead mass (M) is also present. (c) Axial contrast-enhanced CT scan shows the cystic lead mass (M) and mesenteric fat and vessels (arrow) of the intussusceptum.
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Figure 11. Partial ureteral obstruction from a benign mucocele (mucinous adenoma) in a 74-year-old man with a history of transitional cell carcinoma of the bladder. Abdominal radiograph obtained after retrograde injection of contrast material into the right upper collecting system shows narrowing and partial obstruction of the ureter at the level of an adjacent rounded soft-tissue mass with faint rim calcification (arrowheads).
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Figure 12. Pseudomyxoma peritonei from mucinous adenocarcinoma of the appendix manifesting as increasing abdominal girth in a 49-year-old man. Axial contrast-enhanced CT scan shows mass effect on and distortion of the bowel caused by diffuse intraperitoneal locules of varying attenuation. Omental caking is also present.
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Figure 13. Pseudomyxoma peritonei from mucinous adenocarcinoma of the appendix manifesting as increasing abdominal girth in a 49-year-old woman. Axial contrast-enhanced CT scan shows scalloping of the liver and spleen by intraperitoneal mucin. There are multiple areas of septal calcification (arrowheads).
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Figure 14. Pseudomyxoma peritonei in a 51-year-old man. Axial contrast-enhanced CT scan shows intraperitoneal mucin and a thick-walled appendiceal mucocele with mural calcification (arrowhead), findings that represent a primary mucinous adenocarcinoma of the appendix.
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Figure 15a. Colonic-type (nonmucinous) adenocarcinoma of the appendix manifesting as acute appendicitis in an 88-year-old man with acute right lower quadrant pain and leukocytosis. (a) Axial contrast-enhanced CT scan shows a soft-tissue mass with no mucocele formation (arrowhead). The mass is seen to replace the appendix. Note the soft-tissue mound at the appendiceal orifice. (b) Photomicrograph (original magnification, x100; H-E stain) shows infiltrating neoplastic glands (arrow) with luminal necrosis (*).
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Figure 15b. Colonic-type (nonmucinous) adenocarcinoma of the appendix manifesting as acute appendicitis in an 88-year-old man with acute right lower quadrant pain and leukocytosis. (a) Axial contrast-enhanced CT scan shows a soft-tissue mass with no mucocele formation (arrowhead). The mass is seen to replace the appendix. Note the soft-tissue mound at the appendiceal orifice. (b) Photomicrograph (original magnification, x100; H-E stain) shows infiltrating neoplastic glands (arrow) with luminal necrosis (*).
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Figure 16a. Colonic-type (nonmucinous) adenocarcinoma of the appendix manifesting as acute appendicitis in a 33-year-old man with acute abdominal pain and leukocytosis. (a) Axial unenhanced CT scan shows a focal soft-tissue mass (arrow) that involves the tip of a long, retrocecal appendix. Note the soft-tissue infiltration of the surrounding fat. (b) On an axial unenhanced CT scan, the proximal portion of the appendix (arrow) appears normal.
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Figure 16b. Colonic-type (nonmucinous) adenocarcinoma of the appendix manifesting as acute appendicitis in a 33-year-old man with acute abdominal pain and leukocytosis. (a) Axial unenhanced CT scan shows a focal soft-tissue mass (arrow) that involves the tip of a long, retrocecal appendix. Note the soft-tissue infiltration of the surrounding fat. (b) On an axial unenhanced CT scan, the proximal portion of the appendix (arrow) appears normal.
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Figure 17a. Colonic-type adenocarcinoma of the appendix in a 38-year-old man with hematuria from bladder invasion. (a) Axial contrast-enhanced CT scan shows a thickened appendix (A) with an expansile soft-tissue mass (arrowheads) that extends from the distal aspect of the appendix and continues inferiorly. (b) Axial contrast-enhanced CT scan shows direct invasion of the urinary bladder by the mass (arrow).
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Figure 17b. Colonic-type adenocarcinoma of the appendix in a 38-year-old man with hematuria from bladder invasion. (a) Axial contrast-enhanced CT scan shows a thickened appendix (A) with an expansile soft-tissue mass (arrowheads) that extends from the distal aspect of the appendix and continues inferiorly. (b) Axial contrast-enhanced CT scan shows direct invasion of the urinary bladder by the mass (arrow).
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Figure 18a. Appendiceal carcinoid tumor manifesting as obstructive appendicitis in a 6-year-old boy. (a) Longitudinal US image of the right lower quadrant shows a dilated, noncompressible appendix (arrowheads) with striated wall thickening and intraluminal gas echoes. No obvious mass was appreciated at the base of the appendix. (b) Photograph of the gross specimen sectioned at the appendiceal base shows a rounded, subcentimeter carcinoid tumor (arrowheads), which produced the luminal obstruction. (c) Photomicrograph (original magnification, x400; H-E stain) shows cords and glands of endocrine cells with small nucleoli and stippled chromatin (arrows).
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Figure 18b. Appendiceal carcinoid tumor manifesting as obstructive appendicitis in a 6-year-old boy. (a) Longitudinal US image of the right lower quadrant shows a dilated, noncompressible appendix (arrowheads) with striated wall thickening and intraluminal gas echoes. No obvious mass was appreciated at the base of the appendix. (b) Photograph of the gross specimen sectioned at the appendiceal base shows a rounded, subcentimeter carcinoid tumor (arrowheads), which produced the luminal obstruction. (c) Photomicrograph (original magnification, x400; H-E stain) shows cords and glands of endocrine cells with small nucleoli and stippled chromatin (arrows).
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Figure 18c. Appendiceal carcinoid tumor manifesting as obstructive appendicitis in a 6-year-old boy. (a) Longitudinal US image of the right lower quadrant shows a dilated, noncompressible appendix (arrowheads) with striated wall thickening and intraluminal gas echoes. No obvious mass was appreciated at the base of the appendix. (b) Photograph of the gross specimen sectioned at the appendiceal base shows a rounded, subcentimeter carcinoid tumor (arrowheads), which produced the luminal obstruction. (c) Photomicrograph (original magnification, x400; H-E stain) shows cords and glands of endocrine cells with small nucleoli and stippled chromatin (arrows).
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Figure 19a. Metastatic appendiceal carcinoid tumor with an infiltrative growth pattern in a 26-year-old woman. (a) Axial contrast-enhanced CT scan shows a poorly defined soft-tissue mass with a focus of eccentric calcification located near the root of the mesentery (arrowhead). (b) Axial contrast-enhanced CT scan obtained inferior to a shows diffuse wall thickening of the appendix (arrowhead) from the infiltrating primary appendiceal carcinoid tumor.
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Figure 19b. Metastatic appendiceal carcinoid tumor with an infiltrative growth pattern in a 26-year-old woman. (a) Axial contrast-enhanced CT scan shows a poorly defined soft-tissue mass with a focus of eccentric calcification located near the root of the mesentery (arrowhead). (b) Axial contrast-enhanced CT scan obtained inferior to a shows diffuse wall thickening of the appendix (arrowhead) from the infiltrating primary appendiceal carcinoid tumor.
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Figure 20a. Subtle infiltrative goblet cell carcinoid tumor of the appendix manifesting as acute appendicitis in a 39-year-old man. (a) Axial contrast-enhanced CT scan shows mild diffuse wall thickening of the appendix (arrowhead) with apparent intraluminal fluid or debris. (b) Photograph of the sectioned gross specimen shows that the "intraluminal" material seen at CT actually represents mural thickening from an infiltrative tumor that obliterates the lumen (arrow). (c) Photomicrograph (original magnification, x400; H-E stain) shows nests of goblet cells (arrow) separated by stroma.
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Figure 20b. Subtle infiltrative goblet cell carcinoid tumor of the appendix manifesting as acute appendicitis in a 39-year-old man. (a) Axial contrast-enhanced CT scan shows mild diffuse wall thickening of the appendix (arrowhead) with apparent intraluminal fluid or debris. (b) Photograph of the sectioned gross specimen shows that the "intraluminal" material seen at CT actually represents mural thickening from an infiltrative tumor that obliterates the lumen (arrow). (c) Photomicrograph (original magnification, x400; H-E stain) shows nests of goblet cells (arrow) separated by stroma.
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Figure 20c. Subtle infiltrative goblet cell carcinoid tumor of the appendix manifesting as acute appendicitis in a 39-year-old man. (a) Axial contrast-enhanced CT scan shows mild diffuse wall thickening of the appendix (arrowhead) with apparent intraluminal fluid or debris. (b) Photograph of the sectioned gross specimen shows that the "intraluminal" material seen at CT actually represents mural thickening from an infiltrative tumor that obliterates the lumen (arrow). (c) Photomicrograph (original magnification, x400; H-E stain) shows nests of goblet cells (arrow) separated by stroma.
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Figure 21a. Metastatic goblet cell carcinoid tumor of the appendix in a 38-year-old woman. (a) Axial contrast-enhanced CT scan shows a large, enhancing pelvic mass (M) that encases the ovaries, making determination of appendiceal origin difficult. (b) Axial contrast-enhanced CT scan obtained cephalad to a demonstrates intraperitoneal spread (arrowheads).
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Figure 21b. Metastatic goblet cell carcinoid tumor of the appendix in a 38-year-old woman. (a) Axial contrast-enhanced CT scan shows a large, enhancing pelvic mass (M) that encases the ovaries, making determination of appendiceal origin difficult. (b) Axial contrast-enhanced CT scan obtained cephalad to a demonstrates intraperitoneal spread (arrowheads).
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Figure 22a. Non-Hodgkin lymphoma of the appendix in a 66-year-old man with lower gastrointestinal bleeding. (a) Image from a barium enema examination shows a broad cecal filling defect with partial opacification of the appendiceal lumen (arrowhead). (b) US image obtained over the right lower quadrant shows prominent hypoechoic vermiform enlargement of the appendix (A). The diffuse hypoechoic appearance mimics that of a cystic mucocele. (c) Photomicrograph (original magnification, x400; H-E stain) shows monotonous lymphocytic infiltration.
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Figure 22b. Non-Hodgkin lymphoma of the appendix in a 66-year-old man with lower gastrointestinal bleeding. (a) Image from a barium enema examination shows a broad cecal filling defect with partial opacification of the appendiceal lumen (arrowhead). (b) US image obtained over the right lower quadrant shows prominent hypoechoic vermiform enlargement of the appendix (A). The diffuse hypoechoic appearance mimics that of a cystic mucocele. (c) Photomicrograph (original magnification, x400; H-E stain) shows monotonous lymphocytic infiltration.
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Figure 22c. Non-Hodgkin lymphoma of the appendix in a 66-year-old man with lower gastrointestinal bleeding. (a) Image from a barium enema examination shows a broad cecal filling defect with partial opacification of the appendiceal lumen (arrowhead). (b) US image obtained over the right lower quadrant shows prominent hypoechoic vermiform enlargement of the appendix (A). The diffuse hypoechoic appearance mimics that of a cystic mucocele. (c) Photomicrograph (original magnification, x400; H-E stain) shows monotonous lymphocytic infiltration.
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Figure 23a. Non-Hodgkin lymphoma of the appendix in a 48-year-old woman with acute appendicitis. (a) Axial unenhanced CT scan shows a focal soft-tissue mass in the expected region of the appendix (arrowheads) with stranding of the adjacent fat. (b) Photograph of the cut surface of the gross specimen shows circumferential wall thickening with obliteration of the lumen (arrow). Periappendiceal inflammation and direct lymphomatous extension were seen at histologic analysis.
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Figure 23b. Non-Hodgkin lymphoma of the appendix in a 48-year-old woman with acute appendicitis. (a) Axial unenhanced CT scan shows a focal soft-tissue mass in the expected region of the appendix (arrowheads) with stranding of the adjacent fat. (b) Photograph of the cut surface of the gross specimen shows circumferential wall thickening with obliteration of the lumen (arrow). Periappendiceal inflammation and direct lymphomatous extension were seen at histologic analysis.
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Copyright © 2003 by the Radiological Society of North America.
