Difference between revisions of "Vermiform appendix"

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Vermiform appendix (view source)

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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==
===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]].
 
===Sign out===
<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.


=Inflammatory pathologies=
=Inflammatory pathologies=
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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):
*[http://www.cdc.gov/ncidod/dvbid/plague/p1.htm Yersinia (CDC)].


==Inflammatory bowel disease==
==Inflammatory bowel disease==
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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==
{{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>
 
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.
 
Image:
<gallery>
Image:Appendiceal_carcinoid_1.JPG | Appendiceal neuroendocrine tumour. (WC)
</gallery>
 
===Microscopic===
Features:
*Nests of cells - with fibrous stroma in between.
**May have a trabecular architecture.
*Stippled chromatin [[AKA]] salt-and-pepper chromatin, coarse chromatin.
*Classically subepithelial/mural.
 
DDx:
*[[Colorectal adenocarcinoma]].
*[[Crypt cell carcinoma]] (goblet cell carcinoid).
*Metastatic adenocarcinoma.
 
====Images====
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.
 
See: ''[[neuroendocrine tumours]]''.


=See also=
=See also=
Michael
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