図６の１〜図１６の１２は虫垂であり，図５〜図８と図１３〜図１７で広範囲のphlegmonを示し（▲），図１１〜図１３の回腸末端(TI)は壁肥厚を呈しているので感染した粘液嚢腫である．虫垂切除を行ったところ，病理検査で壁肥厚した部分（↑）から虫垂粘液嚢胞腺癌（Mucinous cystadenocarcinoma of appendix）が検出され，後日回盲部切除を追加した．

文献考察：虫垂径が1.5cm以上，嚢胞状腫大，虫垂内軟部組織像は虫垂腫瘍による二次性虫垂炎を示唆する．
Radiology. 2002 Sep;224(3):775-81.
Primary neoplasms of the appendix manifesting as acute appendicitis: CT findings with pathologic comparison.
Pickhardt PJ, Levy AD, Rohrmann CA Jr, Kende AI.
PURPOSE: To evaluate the computed tomographic (CT) findings in patients with acute appendicitis related to an underlying appendiceal neoplasm. MATERIALS AND METHODS: Clinical and pathologic data obtained over a 10-year period in 65 patients with primary appendiceal neoplasms were reviewed. Preoperative CT studies in patients who presented clinically with symptoms of acute appendicitis were analyzed retrospectively and in consensus by three radiologists. The appendix was evaluated on CT scans for morphology, location, presence of calcification, maximal diameter, and wall thickness. RESULTS: Twenty-six (40%) of the 65 patients with appendiceal neoplasms had presented with symptoms of acute appendicitis. Preoperative CT studies available in 22 patients showed increased appendiceal diameter, wall thickening, and periappendiceal fat stranding in 22 (100%), 22 (100%), and 21 (95%) patients, respectively. The appendiceal diameter was greater than 15 mm (mean diameter, 2.9 cm) in 19 patients (86%). Morphologic changes of concern for neoplasm were present in 19 patients (86%) and included cystic dilatation in nine patients and presence of a soft-tissue mass without dilatation in 10 patients. An appendiceal diameter greater than 15 mm and/or a morphologic abnormality were present in 21 of 22 cases (95%). CONCLUSION: CT findings strongly suggest the presence of underlying neoplasm in the majority of patients with secondary appendicitis.PMID: 12202713（full text）