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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. |
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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}}
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| ===Gross===
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| See ''[[normal vermiform appendix]]''.
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| ===Microscopic===
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| See ''[[normal vermiform appendix]]''.
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| Notes:
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| *Should be ''[[submitted in total]]''.
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| DDx:
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| *[[Acute appendicitis]].
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| *[[Adenovirus appendicitis]].
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| *[[Appendiceal neuroendocrine tumour]].
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| *Non-appendiceal pathology - see DDx of ''[[acute appendicitis]].
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| **Isolated [[periappendicitis]].
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| ===Sign out===
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| <pre>
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| VERMIFORM APPENDIX, APPENDECTOMY:
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| - APPENDIX NEGATIVE FOR ACUTE APPENDICITIS AND NEGATIVE FOR ACUTE PERIAPPENDICITIS.
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| </pre>
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| <pre>
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| VERMIFORM APPENDIX, APPENDECTOMY:
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| - APPENDIX WITH LYMPHOID HYPERPLASIA AND FOCAL MUCOSAL EROSIONS.
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| - NEGATIVE FOR ACUTE APPENDICITIS.
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| - NEGATIVE FOR ACUTE PERIAPPENDICITIS.
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| </pre>
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| ====Micro====
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| The sections show appendiceal wall with focal mucosa erosions and several intraluminal
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| neutrophil clusters. Lymphoid hyperplasia is present. Fecal material is present within
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| the lumen of the appendix.
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| There are no neutrophils within the muscularis propria. There is no serositis. There is
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| no distortion of the crypt architecture. No granulomas are identified. No cryptitis is
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| identified.
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| =Inflammatory pathologies= | | =Inflammatory pathologies= |
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| ==Granulomatous appendicitis== | | ==Granulomatous appendicitis== |
| ===General===
| | {{Main|Granulomatous appendicitis}} |
| Most common cause:
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| *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>
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| DDx:<ref>[http://granuloma.homestead.com/appendicitis.html http://granuloma.homestead.com/appendicitis.html]</ref>
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| *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>
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| **Yersinia = gram negative rod (red on [[Gram stain]]).
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| **"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.
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| *Other micro-organism ([[TB]], fungus).
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| *[[Crohn's disease]].
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| *[[Sarcoidosis]].
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| *Foreign body reaction.
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| *Interval (delayed) appendectomy.
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| **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>
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| ===Microscopic===
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| Features:
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| *[[Granulomas]].
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| *+/-"Safety pin"-like organisms (Yersinia).
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| Image(s):
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| *[http://www.cdc.gov/ncidod/dvbid/plague/p1.htm Yersinia (CDC)].
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|
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| ==Inflammatory bowel disease== | | ==Inflammatory bowel disease== |
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| ==Mucinous tumours of the appendix== | | ==Mucinous tumours of the appendix== |
| {{ Infobox external links | | {{Main|Mucinous tumours of the appendix}} |
| | Name = Mucinous tumours of the appendix | | This grouping includes ''mucinous cystadenoma'' and ''mucinous cystadenocarcinoma''. |
| | EHVSC = 10183
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| | pathprotocols =
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| | wikipedia =
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| | pathoutlines =
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| }} | |
| :''Benign appendiceal [[mucocele]]'' and ''appendiceal mucocele'' redirect here.
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| ===General===
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| *There are many classifications and they are controversial.<ref name=pmid21970481>{{Cite journal | last1 = Panarelli | first1 = NC. | last2 = Yantiss | first2 = RK. | title = Mucinous neoplasms of the appendix and peritoneum. | journal = Arch Pathol Lab Med | volume = 135 | issue = 10 | pages = 1261-8 | month = Oct | year = 2011 | doi = 10.5858/arpa.2011-0034-RA | PMID = 21970481 }}</ref>
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| **The controversy centres on whether to call all mucinous tumours outside of the appendix ''adenocarcinoma'' - regardless of whether they have atypia & show invasion.
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| *''Panarelli and Yantiss'' created a nice summary table - that compare the classifications - see: [http://www.archivesofpathology.org/action/showFullPopup?id=i1543-2165-135-10-1261-t01&doi=10.5858%2Farpa.2011-0034-RA comparison of classifications (archivesofpathology.org)].<ref name=pmid21970481/>
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| *In women - an ovarian primary must be excluded.
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| **Concurrent ''bilateral'' ovarian tumours suggests the tumour originated from the appendix and spread to the ovaries.
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| *[[Onlinepathology]] prefers the classification of Misdraji,<ref name=pmid12883241>{{cite journal |author=Misdraji J, Yantiss RK, Graeme-Cook FM, Balis UJ, Young RH |title=Appendiceal mucinous neoplasms: a clinicopathologic analysis of 107 cases |journal=Am. J. Surg. Pathol. |volume=27 |issue=8 |pages=1089–103 |year=2003 |month=August |pmid=12883241 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0147-5185&volume=27&issue=8&spage=1089}}</ref> as it is the least complicated
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| ====Misdraji classification==== | | ==Goblet cell adenocarcinoma== |
| *Benign - ''low grade mucinous tumour''.
| | {{Main|Goblet cell adenocarcinoma}} |
| *Borderline - ''mucinous tumour of uncertain malignant potential'' or ''borderline mucinous tumour''.
| | *Previously known as ''goblet cell carcinoid''. |
| *Malignant - ''[[mucinous adenocarcinoma]]''.
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| Five year survival (in a series of 107 cases) as per Misdraji classification:<ref name=pmid12883241/>
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| {| class="wikitable sortable"
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| !Tumour
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| !Five year survival
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| |-
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| |LAMN
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| |100%
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| |-
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| |LAMN extra-appendiceal spread
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| |86%
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| |-
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| |MACA
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| |44%
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| |-
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| |}
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| *LAMN = low-grade appendiceal mucinous neoplasm.
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| *LAMN extra-appendiceal = low-grade appendiceal mucinous neoplasm with extra-appendiceal spread.
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| *MACA = mucinous adenocarcinoma of the appendix.
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| | |
| ====World Health Organization classification====
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| WHO classification:
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| *Adenoma with low-grade dysplasia.
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| *Adenoma with high-grade dysplasia.
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| *Low-grade invasive mucinous adenocarcinoma
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| **Confined to the appendiceal wall.
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| **Outside of the appendix.
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| *High-grade invasive mucinous adenocarcinoma.
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| ====Comparison between Misdraji and WHO classification====
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| Adapted from ''Panarelli and Yantiss'':<ref name=pmid21970481>{{Cite journal | last1 = Panarelli | first1 = NC. | last2 = Yantiss | first2 = RK. | title = Mucinous neoplasms of the appendix and peritoneum. | journal = Arch Pathol Lab Med | volume = 135 | issue = 10 | pages = 1261-8 | month = Oct | year = 2011 | doi = 10.5858/arpa.2011-0034-RA | PMID = 21970481 }}</ref>
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| {| class="wikitable sortable"
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| ! Stage
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| ! Cytologic dysplasia
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| ! Misdraji
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| ! World Health Organization
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| |-
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| | Confined to the mucosa
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| | low-grade
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| | low-grade appendiceal mucinous neoplasm (LAMN)
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| | mucinous adenoma, negative for high-grade dysplasia
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| |-
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| | Confined to the mucosa
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| | high-grade
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| | non-invasive mucinous cystadenocarcinoma of the appendix
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| | mucinous adenoma with high-grade dysplasia
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| |-
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| | At least into the submucosa, confined to the appendix
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| | low-grade
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| | low-grade appendiceal mucinous neoplasm (LAMN)
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| | invasive mucinous adenocarcinoma, low-grade
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| |-
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| | At least into the submucosa, confined to the appendix
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| | high-grade
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| | mucinous adenocarcinoma of the appendix (MACA)
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| | invasive mucinous adenocarcinoma, high-grade
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| |-
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| | Extra-appendiceal spread
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| | low-grade
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| | low-grade appendiceal mucinous neoplasm (LAMN)
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| | invasive mucinous adenocarcinoma, low-grade
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| |-
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| | Extra-appendiceal spread
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| | high-grade
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| | mucinous adenocarcinoma of the appendix (MACA)
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| | invasive mucinous adenocarcinoma, high-grade
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| |}
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| ===Microscopic===
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| ====Low-grade appendiceal mucinous neoplasm====
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| *[[AKA]] ''benign mucinous tumour of the appendix''.
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| Microscopic:
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| *Single layer of epithelium with ''tufts''.
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| **Vaguely resemble ''serrations'', i.e. the ''saw-tooth'' pattern in hyperplastic polyps of the colon.
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| *Mucin contained (inside appendix only).
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| *No marked nuclear atypia.
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| Note:
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| *May be deceptively bland appearing from a cytologic perspective.
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| Images:
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| *[http://www.nature.com/modpathol/journal/v17/n12/fig_tab/3800212f1.html LAMN - low mag. (nature.com)].<ref name=pmid15354187/>
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| *[http://www.nature.com/modpathol/journal/v17/n12/fig_tab/3800212f3.html LAMN - high mag. (nature.com)].<ref name=pmid15354187>{{Cite journal | last1 = Misdraji | first1 = J. | last2 = Burgart | first2 = LJ. | last3 = Lauwers | first3 = GY. | title = Defective mismatch repair in the pathogenesis of low-grade appendiceal mucinous neoplasms and adenocarcinomas. | journal = Mod Pathol | volume = 17 | issue = 12 | pages = 1447-54 | month = Dec | year = 2004 | doi = 10.1038/modpathol.3800212 | PMID = 15354187 }}</ref>
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| *[http://pathlabmed.typepad.com/surgical_pathology_and_la/2012/02/digital-case-simple-mucocele-of-the-appendix.html Appendiceal mucocele (pathlabmed.typepad.com)].
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| ====Low-grade appendiceal mucinous neoplasm with extra-appendiceal spread====
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| *[[AKA]] ''mucinous borderline tumour of the appendix''.
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| Microscopic:
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| *Same as LAMN but mucin outside of the appendix. | |
| *Cells in mucin, i.e. cellular mucin.
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| ====Mucinous adenocarcinoma of the appendix====
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| *[[AKA]] ''malignant mucinous tumour of the appendix''.
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| Microscopic:
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| *Marked nuclear pleomorphism.
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| *Invasion into the appendiceal wall.
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| ===Sign out===
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| ====LAMN====
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| <pre>
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| VERMIFORM APPENDIX, APPENDECTOMY:
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| - LOW-GRADE APPENDICEAL MUCINOUS NEOPLASM.
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| - ACUTE APPENDICITIS.
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| - ACUTE PERIAPPENDICITIS.
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| </pre>
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| <pre>
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| VERMIFORM APPENDIX AND CECUM, APPENDECTOMY WITH CECAL CUFF:
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| - LOW-GRADE APPENDICEAL MUCINOUS NEOPLASM (MUCINOUS CYSTADENOMA).
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| - MARGINS NEGATIVE FOR MUCINOUS NEOPLASM.
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| COMMENT:
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| No extra-appendiceal mucin is identified. There is no invasion into the appendiceal wall.
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| </pre>
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| <pre>
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| APPENDIX, APPENDECTOMY:
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| - APPENDICEAL MUCINOUS CYSTADENOMA WITH EXTENSIVE CALCIFICATION.
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| -- NEGATIVE FOR HIGH-GRADE DYSPLASIA.
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| - NEGATIVE FOR MALIGNANCY.
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| </pre>
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| ==Goblet cell carcinoid==
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| {{Main|Crypt cell carcinoma}}
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|
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| ==Neuroendocrine tumour of the appendix== | | ==Neuroendocrine tumour of the appendix== |
| {{Main|Neuroendocrine tumour}}
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| *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>
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| **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>
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| 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.
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| *1.0-2.0 cm - rarely metastasize.
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| ===Gross===
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| *Classically found in the tip of the appendix.
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| Image:
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| <gallery>
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| Image:Appendiceal_carcinoid_1.JPG | Appendiceal neuroendocrine tumour. (WC)
| |
| </gallery>
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| ===Microscopic===
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| Features:
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| *Nests of cells - with fibrous stroma in between.
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| **May have a trabecular architecture.
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| *Stippled chromatin [[AKA]] salt-and-pepper chromatin, coarse chromatin.
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| *Classically subepithelial/mural.
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| DDx:
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| *[[Colorectal adenocarcinoma]].
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| *[[Crypt cell carcinoma]] (goblet cell carcinoid).
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| *Metastatic adenocarcinoma.
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| ====Images====
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| www:
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| *[http://www.humpath.com/spip.php?article10881&id_document=19109#documents_portfolio Appendiceal carcinoid (humpath.com)].
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| *[http://www.brown.edu/Courses/Digital_Path/systemic_path/GI/AppendicealCarcinoid.html Carcinoid of the appendix (brown.edu)].
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| *[http://www.flickr.com/photos/jian-hua_qiao_md/8494061964/in/photostream/ Appendiceal carcinoid (flickr.com/Qiao)].
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| ===IHC===
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| Features:
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| *Chromogranin A -ve/+ve.
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| *Synaptophysin +ve.
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| See: ''[[neuroendocrine tumours]]''.
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|
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|
| =See also= | | =See also= |