Vermiform appendix - Revision history

Michael at 15:11, 4 December 2023

2023-12-04T15:11:21Z

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	This grouping includes ''mucinous cystadenoma'' and ''mucinous cystadenocarcinoma''.		This grouping includes ''mucinous cystadenoma'' and ''mucinous cystadenocarcinoma''.

	==Goblet cell ~~carcinoid~~==		==Goblet cell adenocarcinoma==
	{{Main\|~~Crypt~~ cell ~~carcinoma~~}}		{{Main\|Goblet cell adenocarcinoma}}
			*Previously known as ''goblet cell carcinoid''.

	==Neuroendocrine tumour of the appendix==		==Neuroendocrine tumour of the appendix==

Michael: /* Sign out */

2016-05-05T14:13:15Z

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← Older revision		Revision as of 14:13, 5 May 2016
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	Note:		Note:
	*This is for a normal appendix within a larger operation.		*This is for a normal appendix within a larger operation. The article ''[[negative appendectomy]]'' deals with a normal appearing appendix that was removed for presumed appendicitis.
	*The article ''[[negative appendectomy]]'' deals with a normal appearing appendix that was removed for presumed appendicitis.

	==Negative appendectomy==		==Negative appendectomy==

Michael: /* Normal vermiform appendix */

2016-05-05T14:12:49Z

Normal vermiform appendix

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	VERMIFORM APPENDIX WITHIN NORMAL LIMITS.		VERMIFORM APPENDIX WITHIN NORMAL LIMITS.
	</pre>		</pre>

			Note:
			*This is for a normal appendix within a larger operation.
			*The article ''[[negative appendectomy]]'' deals with a normal appearing appendix that was removed for presumed appendicitis.

	==Negative appendectomy==		==Negative appendectomy==

Michael: /* Negative appendectomy */

2016-05-05T14:10:02Z

Negative appendectomy

← Older revision		Revision as of 14:10, 5 May 2016
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	==Negative appendectomy==		==Negative appendectomy==
	~~===General===~~		{{Main\|Negative appendectomy}}
	*Common.		An appendectomy done for presumed [[acute appendicitis]] that is pathologically within normal limits
	*Use for quality control among general surgeons.{{~~fact~~}}

	~~===Gross===~~
	~~See ''[[normal vermiform appendix]]''.~~

	~~===Microscopic===~~
	~~See ''[[normal vermiform appendix]]''.~~

	~~Notes:~~
	*Should be ''[[submitted in total]]''.

	~~DDx:~~
	*[[Acute appendicitis]].
	*[[Adenovirus appendicitis]].
	*[[Appendiceal neuroendocrine tumour]].
	*Non-appendiceal pathology - see DDx of ''[[acute appendicitis]].
	**Isolated [[periappendicitis]].
	*[[Crypt cell carcinoma]] - [[AKA]] ''goblet cell carcinoid''.

	~~===Sign out===~~
	~~<pre>~~
	~~Vermiform Appendix, Appendectomy:~~
	~~- Appendix~~ within normal limits.
	~~- One benign lymph node.~~
	~~- NEGATIVE for acute appendicitis and NEGATIVE for periappendicitis.~~

	~~Comment:~~
	~~The specimen was submitted in total.~~
	~~</pre>~~

	~~=====Block letters=====~~
	~~<pre>~~
	~~VERMIFORM APPENDIX, APPENDECTOMY:~~
	~~- APPENDIX NEGATIVE FOR ACUTE APPENDICITIS AND NEGATIVE FOR ACUTE PERIAPPENDICITIS.~~
	~~</pre>~~

	~~<pre>~~
	~~VERMIFORM APPENDIX, APPENDECTOMY:~~
	~~- APPENDIX WITH LYMPHOID HYPERPLASIA AND FOCAL MUCOSAL EROSIONS.~~
	~~- NEGATIVE FOR ACUTE APPENDICITIS.~~
	~~- NEGATIVE FOR ACUTE PERIAPPENDICITIS.~~
	~~</pre>~~

	~~====Micro====~~
	~~The sections show appendiceal wall with focal mucosa erosions and several intraluminal~~
	~~neutrophil clusters. Lymphoid hyperplasia is present. Fecal material is present within~~
	~~the lumen of the appendix.~~

	~~There are no neutrophils within the muscularis propria. There is no serositis. There is~~
	~~no distortion of the crypt architecture. No granulomas are identified. No cryptitis is~~
	~~identified.~~

	~~=====Alternate=====~~
	~~The section show appendiceal wall without increased numbers of neutrophils. The~~
	~~appendiceal lumen has cellular debris and inflammatory cells. The mucosa has prominent lymphoid tissue~~
	~~with germinal centre formation.~~

	~~No intraluminal pathologic micro-organisms are seen. There is no serositis. There is no~~
	~~distortion of the crypt architecture. No granulomas are identified. No cryptitis~~
	~~is identified.~~

	=Inflammatory pathologies=		=Inflammatory pathologies=

Michael: /* Alternate */

2015-11-17T19:47:06Z

Alternate

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	=====Alternate=====		=====Alternate=====
	The section show appendiceal wall without increased numbers of neutrophils. The		The section show appendiceal wall without increased numbers of neutrophils. The
	appendiceal lumen has ~~necro-~~inflammatory ~~debris~~. The mucosa has prominent lymphoid tissue		appendiceal lumen has cellular debris and inflammatory cells. The mucosa has prominent lymphoid tissue
	with germinal centre formation.		with germinal centre formation.

Michael: /* Sign out */

2015-11-17T19:45:09Z

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← Older revision		Revision as of 19:45, 17 November 2015
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	===Sign out===		===Sign out===
			<pre>
			Vermiform Appendix, Appendectomy:
			- Appendix within normal limits.
			- One benign lymph node.
			- NEGATIVE for acute appendicitis and NEGATIVE for periappendicitis.

			Comment:
			The specimen was submitted in total.
			</pre>

			=====Block letters=====
	<pre>		<pre>
	VERMIFORM APPENDIX, APPENDECTOMY:		VERMIFORM APPENDIX, APPENDECTOMY:
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	no distortion of the crypt architecture. No granulomas are identified. No cryptitis is		no distortion of the crypt architecture. No granulomas are identified. No cryptitis is
	identified.		identified.

			=====Alternate=====
			The section show appendiceal wall without increased numbers of neutrophils. The
			appendiceal lumen has necro-inflammatory debris. The mucosa has prominent lymphoid tissue
			with germinal centre formation.

			No intraluminal pathologic micro-organisms are seen. There is no serositis. There is no
			distortion of the crypt architecture. No granulomas are identified. No cryptitis
			is identified.

	=Inflammatory pathologies=		=Inflammatory pathologies=

Michael: /* Microscopic */

2015-11-17T19:39:50Z

Microscopic

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	*Non-appendiceal pathology - see DDx of ''[[acute appendicitis]].		*Non-appendiceal pathology - see DDx of ''[[acute appendicitis]].
	**Isolated [[periappendicitis]].		**Isolated [[periappendicitis]].
			*[[Crypt cell carcinoma]] - [[AKA]] ''goblet cell carcinoid''.

	===Sign out===		===Sign out===

Michael: /* Granulomatous appendicitis */

2015-10-23T16:30:53Z

Granulomatous appendicitis

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	==Granulomatous appendicitis==		==Granulomatous appendicitis==
	~~===General===~~		{{Main\|Granulomatous appendicitis}}
	~~Most common cause:~~
	*Yersinia appendicitis.<ref name=pmid11257626>{{~~cite journal~~ \|~~author=Lamps LW, Madhusudhan KT, Greenson JK, ''et al.'' \|title=The role of Yersinia enterocolitica and Yersinia pseudotuberculosis in granulomatous~~ appendicitis~~: a histologic and molecular study \|journal=Am. J. Surg. Pathol. \|volume=25 \|issue=4 \|pages=508–15 \|year=2001 \|month=April \|pmid=11257626 \|doi= \|url=~~}}~~</ref>~~

	~~DDx:<ref>[http://granuloma.homestead.com/appendicitis.html http://granuloma.homestead.com/appendicitis.html]</ref>~~
	*Yersinia appendicitis.<ref name=pmid11257626>{{cite journal \|author=Lamps LW, Madhusudhan KT, Greenson JK, ''et al.'' \|title=The role of Yersinia enterocolitica and Yersinia pseudotuberculosis in granulomatous appendicitis: a histologic and molecular study \|journal=Am. J. Surg. Pathol. \|volume=25 \|issue=4 \|pages=508–15 \|year=2001 \|month=April \|pmid=11257626 \|doi= \|url=}}</ref>
	**Yersinia = gram negative rod (red on [[Gram stain]]).
	**"Safety pin"-like appearance<ref>URL: [http://www.cdc.gov/ncidod/dvbid/plague/p1.htm http://www.cdc.gov/ncidod/dvbid/plague/p1.htm]. Accessed on: 30 June 2011.</ref> - approximately 0.5 micrometers diameter x 2 micrometers length.
	*Other micro-organism ([[TB]], fungus).
	*[[Crohn's disease]].
	*[[Sarcoidosis]].
	*Foreign body reaction.
	*Interval (delayed) appendectomy.
	**Approximately 60% of delayed appendectomies have granulomas.<ref name=pmid12883248>{{Cite journal \| last1 = Guo \| first1 = G. \| last2 = Greenson \| first2 = JK. \| title = Histopathology of interval (delayed) appendectomy specimens: strong association with granulomatous and xanthogranulomatous appendicitis. \| journal = Am J Surg Pathol \| volume = 27 \| issue = 8 \| pages = 1147-51 \| month = Aug \| year = 2003 \| doi = \| PMID = 12883248 }}</ref>

	~~===Microscopic===~~
	~~Features:~~
	*[[Granulomas]].
	*+/-"Safety pin"-like organisms (Yersinia).

	~~Image(s):~~
	~~<gallery>~~
	~~Image:Appendix Appendicitis Acute Granulomatous 2 PA.JPG\|Granulomatous Appendicitis (SKB)~~
	~~Image:Appendix Appendicitis Acute Granulomatous PA.JPG\|Suppurating Granulomatous Appendicitis (SKB)~~
	~~Image:Appendix Appendicitis GranulomatousSuppurating Yersinia-LP PA.JPG\|Suppurating Granulomatous Yersinia Appendicitis (SKB)~~
	~~Image:Appendix Appendicitis GranulomatousSuppurating Yersinia-HP PA.JPG\|Suppurating Granulomatous Yersinia Appendicitis Yersinia(SKB)~~
	~~</gallery>~~
	*[http://www.cdc.gov/ncidod/dvbid/plague/p1.htm Yersinia (CDC)].

	==Inflammatory bowel disease==		==Inflammatory bowel disease==

Michael: /* Neuroendocrine tumour of the appendix */

2015-03-19T07:28:49Z

Neuroendocrine tumour of the appendix

← Older revision		Revision as of 07:28, 19 March 2015
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	==Neuroendocrine tumour of the appendix==		==Neuroendocrine tumour of the appendix==
	~~{{Main\|Neuroendocrine tumour}}~~
	*Previously known as ''appendiceal carcinoid''.		*Previously known as ''appendiceal carcinoid''.
	*[[AKA]] ''appendiceal neuroendocrine tumour'', abbreviated ''appendiceal NET''.		*[[AKA]] ''appendiceal neuroendocrine tumour'', abbreviated ''appendiceal NET''.
	~~===General===~~		{{Main\|Neuroendocrine tumour of the appendix}}
	*Most common tumour of the appendix.<ref name=PCPBoD8_435>{{~~Ref PCPBoD8~~\|~~435}}</ref>~~
	**Not really common though - one is seen in approximately 300 appendectomies.<ref name=pmid23416502>{{Cite journal \| last1 = Mitra \| first1 = B. \| last2 = Pal \| first2 = M. \| last3 = Paul \| first3 = B. \| last4 = Saha \| first4 = TN. \| last5 = Maiti \| first5 = A. \| title = Goblet cell carcinoid of appendix~~: A rare case with literature review. \| journal = Int J Surg Case Rep \| volume = 4 \| issue = 3 \| pages = 334-7 \| month = \| year = 2013 \| doi = 10.1016/j.ijscr.2013.01.007 \| PMID = 23416502 }}</ref>~~
	~~===Presentation===~~
	** Often found incidentally, may be microscopic.
	** May cause obstruction leading to mucocele or acute appendicitis.
	** May precipitate torsion.

	Size matters in ''appendiceal NETs'':<ref name=pmid12569593>{{Cite journal \| last1 = Modlin \| first1 = IM. \| last2 = Lye \| first2 = KD. \| last3 = Kidd \| first3 = M. \| title = A 5-decade analysis of 13,715 carcinoid tumors. \| journal = Cancer \| volume = 97 \| issue = 4 \| pages = 934-59 \| month = Feb \| year = 2003 \| doi = 10.1002/cncr.11105 \| PMID = 12569593 }}~~</ref>~~
	*<1.0 cm - do not metastasize.
	*1.0-2.0 cm - rarely metastasize.

	~~===Gross===~~
	*Classically found in the tip of the appendix.
	*Characteristic yellow cut surface (when fixed)
	*Circumscribed but not encapsulated
	*Firm (due to desmoplasia)
	*Centred in the submucosa
	*Nodules that do not usually cause erosion of the overlying mucosa.


	~~Image:~~
	~~<gallery>~~
	~~Image:Appendiceal_carcinoid_1.JPG \| Appendiceal neuroendocrine tumour. (WC)~~
	~~</gallery>~~

	~~===Microscopic===~~
	~~Features:~~
	*Classically subepithelial/mural.
	*Various growth patterns:
	**Nested (insular)
	**Trabecular
	**Palisading
	**Ribbons, rosettes
	*Fibrous stroma in between cell groups.
	*Cytomorphology
	**Monotonous appearance with scanty mitoses.
	**Round central nuclei
	**Stippled chromatin [[AKA]] salt-and-pepper chromatin, coarse chromatin.
	**Eosinophilic granular cytoplasm

	~~===Special Types===~~
	*Tubular carcinoid
	**Neuroendocrine cells forming tubules (no cell nests)
	**Some tubules can contain mucin
	**Can be confused with adenocarcinoma
	**Features suggesting tubular carcinoid (over adenocarcinoma):
	***Arises from base of crypts, with no disruption of surface epithelium.
	***No associated epithelial precursor (no adenomatous change).
	***Neuroendocrine cytologic features, without prominent atypia
	***IHC (NE markers +ve)

	*Goblet cell carcinoid aka [[Crypt cell carcinoma]]
	*Signet-ring cells forming glandular structures,
	*Possibly also with extra-cellular mucin

	~~DDx:~~
	*[[Colorectal adenocarcinoma]].
	*Adenocarcinoid.
	*[[Crypt cell carcinoma]] (goblet cell carcinoid).
	*Metastatic adenocarcinoma.
	*Normal ganglion cells in the Meissner plexus (submucosa) and Auerbach plexus (located between the inner and outer layers of the muscularis propria).

	~~====Images====~~
	~~<gallery>~~
	~~Image: Appendix Carcinoid Torsion 1X PA.JPG\|Appendiceal carcinoid with torsion of the appendix - 1x (SKB)~~
	~~Image: Appendix Carcinoid Torsion LP PA.JPG\|Appendiceal carcinoid with torsion of the appendix - low power (SKB)~~
	~~Image: Appendix Carcinoid Torsion MP PA.JPG\|Appendiceal carcinoid with torsion of the appendix - medium power (SKB)~~
	~~Image: Appendix Carcinoid LP 14BR***.jpg\|Appendiceal carcinoid - low power (SKB)~~
	~~Image: Appendix Carcinoid HP 14BR***.jpg\|Appendiceal carcinoid - high power (SKB)~~
	~~Image: Appendix Carcinoid Synaptophysin 14BR17120.jpg\|Appendiceal carcinoid - synaptophysin (SKB)~~
	~~Image: Appendix Carcinoid LP CTR.jpg\|Appendiceal carcinoid - low power (SKB)~~
	~~Image: Appendix Carcinoid HP CTR.jpg\|Appendiceal carcinoid - high power (SKB)~~
	~~Image: Appendix Carcinoid LP PA.JPG\|Appendiceal carcinoid - low power (SKB)~~
	~~Image: Appendix Carcinoid Necrosis PA.JPG\|Appendiceal carcinoid with necrosis (SKB)~~
	~~</gallery>~~
	~~www:~~
	*[http://www.humpath.com/spip.php?article10881&id_document=19109#documents_portfolio Appendiceal carcinoid (humpath.com)].
	*[http://www.brown.edu/Courses/Digital_Path/systemic_path/GI/AppendicealCarcinoid.html Carcinoid of the appendix (brown.edu)].
	*[http://www.flickr.com/photos/jian-hua_qiao_md/8494061964/in/photostream/ Appendiceal carcinoid (flickr.com/Qiao)].

	~~===IHC===~~
	~~Features:~~
	*Chromogranin A -ve/+ve.
	*Synaptophysin +ve.
	*Keratin positive, but CK7/CK20 negative
	*S100 positive for appendix

	~~See: ''[[neuroendocrine tumours]]''.~~

	=See also=		=See also=

Sarah: /* Microscopic */

2015-03-19T02:10:08Z

Microscopic

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	<gallery>		<gallery>
	Image:Appendix Appendicitis Acute Granulomatous 2 PA.JPG\|Granulomatous Appendicitis (SKB)		Image:Appendix Appendicitis Acute Granulomatous 2 PA.JPG\|Granulomatous Appendicitis (SKB)
	Image:Appendix Appendicitis Acute Granulomatous PA.JPG\|Granulomatous Appendicitis (SKB)		Image:Appendix Appendicitis Acute Granulomatous PA.JPG\|Suppurating Granulomatous Appendicitis (SKB)
	Image:Appendix Appendicitis GranulomatousSuppurating Yersinia-LP PA.JPG\|Suppurating Granulomatous Yersinia Appendicitis (SKB)		Image:Appendix Appendicitis GranulomatousSuppurating Yersinia-LP PA.JPG\|Suppurating Granulomatous Yersinia Appendicitis (SKB)
	Image:Appendix Appendicitis GranulomatousSuppurating Yersinia-HP PA.JPG\|Suppurating Granulomatous Yersinia Appendicitis Yersinia(SKB)		Image:Appendix Appendicitis GranulomatousSuppurating Yersinia-HP PA.JPG\|Suppurating Granulomatous Yersinia Appendicitis Yersinia(SKB)

← Older revision		Revision as of 02:10, 19 March 2015
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	<gallery>		<gallery>
	Image:Appendix Appendicitis Acute Granulomatous 2 PA.JPG\|Granulomatous Appendicitis (SKB)		Image:Appendix Appendicitis Acute Granulomatous 2 PA.JPG\|Granulomatous Appendicitis (SKB)
	Image:Appendix Appendicitis Acute Granulomatous PA.JPG\|Granulomatous Appendicitis (SKB)		Image:Appendix Appendicitis Acute Granulomatous PA.JPG\|Suppurating Granulomatous Appendicitis (SKB)
	Image:Appendix Appendicitis GranulomatousSuppurating Yersinia-LP PA.JPG\|Suppurating Granulomatous Yersinia Appendicitis (SKB)		Image:Appendix Appendicitis GranulomatousSuppurating Yersinia-LP PA.JPG\|Suppurating Granulomatous Yersinia Appendicitis (SKB)
	Image:Appendix Appendicitis GranulomatousSuppurating Yersinia-HP PA.JPG\|Suppurating Granulomatous Yersinia Appendicitis Yersinia(SKB)		Image:Appendix Appendicitis GranulomatousSuppurating Yersinia-HP PA.JPG\|Suppurating Granulomatous Yersinia Appendicitis Yersinia(SKB)