Liao Xiaoyan, Rex Douglas K, Zhang Dongwei
Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA.
Division of Gastroenterology/Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
Ann Diagn Pathol. 2025 Apr;75:152428. doi: 10.1016/j.anndiagpath.2024.152428. Epub 2024 Dec 14.
Isolated ischemic necrosis of the cecum (INC) is an uncommon benign condition that occurs most often in elderly patients. The clinical presentation and radiographic findings often mimic acute appendicitis or malignancy. This study aimed to investigate the clinicopathologic features of mass-forming INC. Eleven INC patients who presented with cecal masses were identified by searching the electronic medical record system in two large academic centers. The clinical and pathological features, including symptoms, imaging, endoscopic and surgical findings, histomorphology, and follow-up, were retrospectively analyzed. The study cohort included 4 males and 7 females, with a median age 72 (range 43-87) years. Common clinical presentations included right lower quadrant abdominal pain, nausea and vomiting, and bloody diarrhea. Nine patients had hypertension and cardiovascular diseases, including coronary artery disease, congestive heart failure, atrial fibrillation, and heart valve disease. All patients had a mass in the cecum by endoscopy and/or imaging studies, clinically suspicious for malignancy. The median mass size was 5 (range 3.1-6) cm. Six patients received non-surgical treatment after the biopsy specimen proved a benign histologic pattern of ischemic necrosis. The remaining 5 patients underwent right hemicolectomy. Pathologic examination of the biopsy or resection specimens showed similar histologic changes such as mucosal denudation, ulceration, necrosis, crypt withering and loss, and lamina propria hyalinization, findings consistent with ischemic necrosis. No malignancy was identified in any case. After a median follow-up of 78 (range 3-121) months, 10 patients were still alive. Only 1 patient died and this was from other causes and 96 months later. Mass-forming INC is a rare and unique variant of ischemic colitis that occurs in elderly patients with a low flow state. It is a benign condition with a favorable prognosis. INC should be considered in patients with long-standing hypertension or cardiovascular disease who present with right lower quadrant abdominal pain and cecal mass. Biopsy of the mass with pathologic examination helps make a diagnosis, assess the disease severity, and rule out malignancy. Awareness of this rare entity is important to avoid unnecessary resections in these patients.
孤立性盲肠缺血性坏死（INC）是一种罕见的良性疾病，最常发生于老年患者。其临床表现和影像学表现常类似急性阑尾炎或恶性肿瘤。本研究旨在探讨肿块型INC的临床病理特征。通过检索两个大型学术中心的电子病历系统，确定了11例表现为盲肠肿块的INC患者。对其临床和病理特征，包括症状、影像学、内镜及手术所见、组织形态学和随访情况进行了回顾性分析。研究队列包括4例男性和7例女性，中位年龄72岁（范围43 - 87岁）。常见临床表现包括右下腹腹痛、恶心呕吐和血性腹泻。9例患者患有高血压和心血管疾病，包括冠状动脉疾病、充血性心力衰竭、心房颤动和心脏瓣膜病。所有患者经内镜检查和/或影像学检查均发现盲肠有肿块，临床上怀疑为恶性肿瘤。肿块中位大小为5cm（范围3.1 - 6cm）。6例患者在活检标本证实为缺血性坏死的良性组织学模式后接受了非手术治疗。其余5例患者接受了右半结肠切除术。活检或切除标本的病理检查显示出类似的组织学变化，如黏膜剥脱、溃疡、坏死、隐窝萎缩和消失以及固有层玻璃样变，这些结果与缺血性坏死一致。所有病例均未发现恶性肿瘤。中位随访78个月（范围3 - 121个月）后，10例患者仍存活。仅1例患者死亡，且是96个月后因其他原因死亡。肿块型INC是缺血性结肠炎的一种罕见且独特的变异型，发生于低血流状态的老年患者。它是一种预后良好的良性疾病。对于患有长期高血压或心血管疾病且出现右下腹腹痛和盲肠肿块的患者，应考虑INC。对肿块进行活检并进行病理检查有助于做出诊断、评估疾病严重程度并排除恶性肿瘤。认识这种罕见疾病对于避免对这些患者进行不必要的切除很重要。
