Difference between revisions of "Appendicitis"
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===Types=== | ===Types=== | ||
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|+ Classification of acute appendicitis based on gross pathology and light microscopy characteristics<ref name="Carr2000">Unless otherwise specified in rows, reference is:<br>- {{cite journal|last1=Carr|first1=Norman J.|title=The pathology of acute appendicitis|journal=Annals of Diagnostic Pathology|volume=4|issue=1|year=2000|pages=46–58|issn=10929134|doi=10.1016/S1092-9134(00)90011-X}}</ref> | |+ Classification of acute appendicitis based on gross pathology and light microscopy characteristics<ref name="Carr2000">Unless otherwise specified in rows, reference is:<br>- {{cite journal|last1=Carr|first1=Norman J.|title=The pathology of acute appendicitis|journal=Annals of Diagnostic Pathology|volume=4|issue=1|year=2000|pages=46–58|issn=10929134|doi=10.1016/S1092-9134(00)90011-X}}</ref> | ||
|- | |- | ||
− | ! Pattern !! Gross pathology !! Light microscopy !! Clinical significance | + | ! Pattern !! Gross pathology !! Light microscopy !! Image !! Clinical significance |
|- | |- | ||
! Acute intraluminal inflammation | ! Acute intraluminal inflammation | ||
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*Only '''neutrophils in lumen''' | *Only '''neutrophils in lumen''' | ||
*No ulceration or transmural inflammation | *No ulceration or transmural inflammation | ||
+ | | | ||
| Probably '''none''' | | Probably '''none''' | ||
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*'''Neutrophils within mucosa''', and possibly in submucosa | *'''Neutrophils within mucosa''', and possibly in submucosa | ||
*Mucosal '''ulceration''' | *Mucosal '''ulceration''' | ||
+ | | | ||
| May be '''secondary''' to [[enteritis]]. | | May be '''secondary''' to [[enteritis]]. | ||
|- | |- | ||
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*Commonly intramural '''abscesses''' | *Commonly intramural '''abscesses''' | ||
*Possibly vascular '''thrombosis''' | *Possibly vascular '''thrombosis''' | ||
+ | | [[File:Acute suppurative appendicitis with perforation.jpg|190px]] | ||
| Can be presumed to be primary '''cause''' of symptoms | | Can be presumed to be primary '''cause''' of symptoms | ||
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*'''Necrotic''' areas | *'''Necrotic''' areas | ||
*Extensive mucosal '''ulceration''' | *Extensive mucosal '''ulceration''' | ||
+ | | | ||
| Will '''perforate''' if untreated | | Will '''perforate''' if untreated | ||
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| | | | ||
*'''Serosal and subserosal inflammation''', no further than outer muscularis propria | *'''Serosal and subserosal inflammation''', no further than outer muscularis propria | ||
+ | | | ||
| If isolated, probably '''secondary''' to other disease | | If isolated, probably '''secondary''' to other disease | ||
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*>10 '''eosinophils'''/mm<sup>2</sup> in muscularis propria. | *>10 '''eosinophils'''/mm<sup>2</sup> in muscularis propria. | ||
*No changes conforming to other types of appendicitis | *No changes conforming to other types of appendicitis | ||
+ | | | ||
| Possibly '''parasitic''', or eosinophilic enteritis. | | Possibly '''parasitic''', or eosinophilic enteritis. | ||
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*Predominantly '''mononuclear''' infiltrate rather than neutrophilic. | *Predominantly '''mononuclear''' infiltrate rather than neutrophilic. | ||
+ | | [[File:Histopathology of chronic appendicitis - high magnification.jpg|190px]] | ||
| Should preferably correlate with '''long-term or recurrent''' symptoms. | | Should preferably correlate with '''long-term or recurrent''' symptoms. | ||
|} | |} |
Revision as of 14:01, 9 September 2020
Author:
Mikael Häggström [note 1]
Appendicitis may histopathologically be defined as neutrophilic infiltrates of the wall of the appendix in the correct clinical context.
See also: General notes on fixation
Contents
Comprehensiveness
Comprehensiveness
On this resource, the following formatting is used for comprehensiveness:
- Minimal depth
- (Moderate depth)
- ((Comprehensive))
Gross proccessing
Standard sections if the appendix appears inflamed and there are no signs of malignancy. Further information: Appendix
Microscopic evaluation
- Evaluate depth of the inflammation.
- Look for any perforation of the wall.
- Look for cancerous cells (which may have caused the appendicitis). Further information: Appendix
- (Attempt to specify the type of appendicitis as either of the following:)
Types
Pattern | Gross pathology | Light microscopy | Image | Clinical significance |
---|---|---|---|---|
Acute intraluminal inflammation | None visible |
|
Probably none | |
Acute mucosal inflammation | None visible |
|
May be secondary to enteritis. | |
Suppurative acute appendicitis | May be inapparent.
|
|
Can be presumed to be primary cause of symptoms | |
Gangrenous/necrotizing appendicitis |
|
|
Will perforate if untreated | |
Periappendicitis | May be inapparent.
|
|
If isolated, probably secondary to other disease | |
Eosinophilic appendicitis | None visible |
|
Possibly parasitic, or eosinophilic enteritis. | |
Chronic appendicitis[2] |
|
|
Should preferably correlate with long-term or recurrent symptoms. |
Microscopy report
Should include, if detected:
- Acute or chronic appendicitis
- Depth of inflammation
- Any abscess and\or perforation
- Necrosis and\or ulceration, at least if transmural
(Classification into one or several types as per table above.)
- Example
Acute appendicitis and periappendicitis with transmural necrosis
Notes
Main pageReferences
Image sources
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