Seal Hwangbo, et al. Fig. 2. Coronal reformatted CT image reveals thickened mucosa, submucosa and muscle layer and serosa layer in the distal ileum. Two polypoid masses are seen, repre- senting well enhanced thickened mucosa. Innumerable small nodular lesions are scattered in mesentery. long segmental dilatation of the distal ileal loop. The dilated small bowel contained a thickened w all representing smoothly thickened mucosa, markedly thickened submucosa, muscle layers, and serosa. Two large polypoid masses were noted in the distal ileum. These masses were mainly composed of thickened mucosa with lobular contour, which were markedly enhanced (Fig. 2). Innumerable small nodular lesions were scattered along the serosal surface of the small intestine and in the mesentery. The appendix was also diffusely thickened, especially in the sub- mucosa, or muscle layer, with low attenuation. Because ileal malignancy was suspected, a segmental resection of the small intestine and colon was performed. Pathologic findings Gross findings The specimens consisted of a small intestinal segment measuring 58 cm, a continuous colonic segment measuring 36 cm in length, and an appendix measuring 9 × 9 × 6 cm in size. Over 100 small conglomerated nodules on the serosal surface were situated along the mesenteric border of the ileum and colon. The opened specimen revealed two polypoid masses in the ileal segment (Fig. 3). The larger mass measured 23 cm distant from the ileocecal valve and 10 × 9 × 6 cm in size, and the smaller mass was 46 cm distant from the ileocecal valve and 8 × 7 × 5 cm in size. The surrounding small intestinal mucosa showed Yonsei Med J Vol. 48, No. 6, 2007 Fig. 3. Two ill-defined polypoid masses with diffuse edematous mucosal lesions in the ileum. Fig. 4. Cross section of the intestinal wall revealed edematous submucosa and thick fibrotic muscle layer in the involved segment, which is contrasted with a continu- ous thin normal segment. diffuse, irregularly elevated edematous lesions with pin point ulcerations. A cut section of bowel wall showed edematous submucosa and a thick fibrotic muscle layer (Fig. 4). The appendix showed flat mucosa with diffuse thickening of the muscle layer. The colonic wall did not show any polypoid mass lesions or transmural thickening. Microscopic findings Histologic evaluation of the two polypoid masses revealed well-to-moderately differentiated adenocarcinoma and surrounding tubulo-villous adenoma with neurofibromatosis background (Fig. 5A). In the larger mass, the carcinoma ex- tended into the serosa and regional lymph nodes.