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Difference between revisions of "Vermiform appendix"
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The appendix is a vestigial structure that is thought to have arisen from a larger cecum. Larger cecae are often seen in herbivores and thought to facilitate better digestion of plant matter.<ref>{{cite book |author=Dawkins, R. |title=The Greatest Show on Earth: The Evidence for Evolution |publisher=Free Press |location= |year=2009 |pages=115 |edition=1st |isbn=978-1416594789 |oclc= |doi= |accessdate=}}</ref> | The appendix is a vestigial structure that is thought to have arisen from a larger cecum. Larger cecae are often seen in herbivores and thought to facilitate better digestion of plant matter.<ref>{{cite book |author=Dawkins, R. |title=The Greatest Show on Earth: The Evidence for Evolution |publisher=Free Press |location= |year=2009 |pages=115 |edition=1st |isbn=978-1416594789 |oclc= |doi= |accessdate=}}</ref> | ||
=Appendicitis= | |||
==Acute appendicitis== | ==Acute appendicitis== | ||
===General=== | ===General=== | ||
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*May be perforated (best determined on gross). | *May be perforated (best determined on gross). | ||
*+/-Fibrinous exudate. | *+/-Fibrinous exudate. | ||
===Microscopic=== | ===Microscopic=== | ||
Features: | Features: | ||
* Neutrophils in the muscularis propria | * Neutrophils in the muscularis propria - '''key feature'''. | ||
* +/- Vascular thrombosis (and [[necrosis]]) - known as ''gangrenous appendicitis''.<ref>URL: [http://emedicine.medscape.com/article/363818-overview http://emedicine.medscape.com/article/363818-overview]. Accessed on: 21 June 2010.</ref> | * +/- Vascular thrombosis (and [[necrosis]]) - known as ''gangrenous appendicitis''.<ref>URL: [http://emedicine.medscape.com/article/363818-overview http://emedicine.medscape.com/article/363818-overview]. Accessed on: 21 June 2010.</ref> | ||
* +/- Findings suggestive of etiology - usu. absent: | |||
** +/- Fecalith. | |||
** +/- Viral inclusions (extremely rare) | |||
*** See ''[[adenovirus appendicitis]]''. | |||
===DDx=== | ====DDx==== | ||
*Mucinous tumour. | *Mucinous tumour. | ||
*Neuroendocrine tumour. | *Neuroendocrine tumour. | ||
*Granulomatous appendicitis. | *Granulomatous appendicitis. | ||
*Crohn's disease of the appendix. | *Crohn's disease of the appendix. | ||
==Adenovirus appendicitis== | |||
===General=== | |||
*Rare type of appendicitis in children. | |||
*Presents as run-of-the-mill acute appendicitis. | |||
===Microscopic=== | |||
Features:<ref name=pmid17990936>{{cite journal |author=Grynspan D, Rabah R |title=Adenoviral appendicitis presenting clinically as acute appendicitis |journal=Pediatr. Dev. Pathol. |volume=11 |issue=2 |pages=138–41 |year=2008 |pmid=17990936 |doi=10.2350/07-06-0299.1 |url=}}</ref> | |||
*Lymphoid hyperplasia - key feature. | |||
*+/-Adenovirus inclusions; "smudge cells". | |||
Notes: | |||
*The classic finding of appendicitis (neutrophils infiltrating into the muscularis propria) may be absent.<ref name=pmid17990936/> | |||
Image: | |||
*[http://wiki.medpedia.com/Image:Ab14.jpg?filetimestamp=20091014175858 Smudge cell (medpedia.com)]. | |||
===IHC=== | |||
*Adenovirus +ve = '''diagnostic'''. | |||
==Granulomatous appendicitis== | ==Granulomatous appendicitis== | ||
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*Granulomas. | *Granulomas. | ||
=Tumours of the appendix= | |||
==Adenocarcinoma== | ==Adenocarcinoma== | ||
*Like ''colorectal adenocarcinoma'' - see ''[[colorectal tumours]]''. | *Like ''colorectal adenocarcinoma'' - see ''[[colorectal tumours]]''. | ||
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*Nice review of stains in Pahlavan and Kanthan.<ref name=pmid15967038>{{cite journal |author=Pahlavan PS, Kanthan R |title=Goblet cell carcinoid of the appendix |journal=World J Surg Oncol |volume=3 |issue= |pages=36 |year=2005 |month=June |pmid=15967038 |pmc=1182398 |doi=10.1186/1477-7819-3-36 |url=http://wjso.com/content/3/1/36}}</ref> | *Nice review of stains in Pahlavan and Kanthan.<ref name=pmid15967038>{{cite journal |author=Pahlavan PS, Kanthan R |title=Goblet cell carcinoid of the appendix |journal=World J Surg Oncol |volume=3 |issue= |pages=36 |year=2005 |month=June |pmid=15967038 |pmc=1182398 |doi=10.1186/1477-7819-3-36 |url=http://wjso.com/content/3/1/36}}</ref> | ||
=See also= | |||
*[[Colon]]. | *[[Colon]]. | ||
*[[Gastrointestinal pathology]]. | *[[Gastrointestinal pathology]]. | ||
=References= | |||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Gastrointestinal pathology]] | [[Category:Gastrointestinal pathology]] | ||