Inflammatory pseudo-tumour of the colon mimicking acute appendicitis: A case report

Abstract

Introduction: Inflammatory pseudo-tumour (IPT) of the colon is a rare entity with an obscure pathophysiology and largely indeterminate aetiology.

Presentation of case: A young male patient presented with an Alvarado score of 9/10 and was admitted for appendectomy. An irregular hepatic flexure mass was discovered intraoperatively. The patient underwent an oncological right hemicolectomy with lymphadenectomy under the supposition that it was malignant and recovered with no short or long-term repercussions. Haemoxylin and eosin staining of the mass revealed features of a benign IPT.

Discussion: IPTs have clinical and radiological features that may be indistinguishable from those of malignancies, often resulting in extensive oncological resections despite recurrence and malignant transformation being negligibly rare.

Conclusion: Benign pathologies such as IPT that mimic malignancy can sometimes result in extensive investigations or radical resections, the justification of which can only be a point of contention in retrospect. The following report explores our experience with one such patient and is accompanied by a review of the literature.

Keywords: Colonic mass; Colorectal surgery; General surgery; Hepatic flexure tumour; Inflammatory pseudo-tumour.

Fig. 1

The right hemicolectomy specimen A: Specimen in an anatomical position. Black arrow showing hepatic flexure mass measuring 98 × 59 × 34 mm. B: Black arrow indicating an incision into the mass, demonstrating subserosal and cystic quality.

Fig. 2

Photomicrograph of the resected specimen. A: The blue arrow represents the colonic mucosa, and the black arrow, the muscularis propria. The tumour is represented by the black dot and is located in the adventitia [Haematoxylin and eosin (H&E) stain ×20]. B: The tumour has a central cystic cavity represented by the blue dot on A (H&E ×20). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 3

Photomicrograph of the inflammatory pseudo-tumour. A The centre of the tumour has a central cystic cavity (blue dot) containing fibrin, neutrophils and foreign material (food). The cavity is surrounded by granulation tissue as shown by the black arrow (H&E stain ×100). B Higher magnification of the tumour showing a fibroblastic/myofibroblastic proliferation of cells deposited in a collagenous background (blue arrow). There is a prominent admixture of lymphocytes, eosinophils (black arrow) and plasma cells (H&E stain ×400). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)