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):
<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==
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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>
===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=
Michael
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