Review Question - QID 214902

A 61-year-old woman presents to her primary care physician with a 1-month history of increasing abdominal pain and bloating. She says that she started a new diet about 2 months ago and initially thought that her symptoms were related to the diet; however, the symptoms have persisted despite her resuming her typical diet. Her past medical history is significant for type 2 diabetes treated with metformin, and her past surgical history is significant for a laparoscopic cholecystectomy 10 years ago. Physical exam reveals abdominal fullness and right adnexal tenderness. MRI imaging reveals an abnormal appearance of the greater omentum. A biopsy of this tissue is performed, and the results are shown in Figure A. Which of the following processes is most likely responsible for the histological changes seen in this patient's biopsy?