LIPOMATOSE EM APÊNDICE CECAL: RELATO DE CASO

Cecal appendix lipomatosis is a rare pathological entity characterized by diffuse infiltration of mature adipose tissue within the appendicular wall, typically without a capsule and often diagnosed incidentally during histopathological examination. We report the case of a 27-year-old male, previously healthy, presenting with localized right iliac fossa pain and clinical suspicion of acute appendicitis. The patient underwent urgent laparoscopic appendectomy with satisfactory postoperative recovery. Macroscopic evaluation revealed diffuse wall thickening and evident fat accumulation; microscopically, mature adipose infiltration without atypia was observed, associated with fibrinoleukocytic serositis confined to the serosa, excluding well-differentiated liposarcoma and characterizing periapendicitis. Preoperative diagnosis of appendicular lipomatosis is challenging, as symptoms mimic acute appendicitis and imaging studies may not distinguish it from common inflammatory processes. Although isolated cases have been identified using computed tomography or magnetic resonance imaging, most diagnoses are confirmed histologically. The clinical importance lies in including this condition in the differential diagnosis of atypical appendicular syndromes, thereby avoiding inappropriate management and enabling investigation of secondary causes of serosal inflammation. This case reinforces the value of routine histopathological evaluation of all appendectomy specimens, even when macroscopically normal, since such analysis may reveal uncommon conditions impacting clinical management. Surgeons and pathologists should remain aware of the possibility of appendicular lipomatosis, given its rarity and the importance of clinico-pathological correlation for accurate diagnosis and appropriate treatment.