Difference between revisions of "Appendicitis"
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{{Fixation - general notes}} | {{Fixation - general notes}} | ||
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{{Comprehensiveness}} | {{Comprehensiveness}} | ||
− | ==Gross | + | ==Gross processing== |
[[File:Acute Appendicitis.jpg|thumb|Acute suppurative appendicitis: The organ is enlarged and sausage-like (botuliform). This longitudinal section shows red inflamed mucosa with an irregular luminal surface. It was removed early in the disease, with no late complications like transmural necrosis, perforation, and abscess formation.]] | [[File:Acute Appendicitis.jpg|thumb|Acute suppurative appendicitis: The organ is enlarged and sausage-like (botuliform). This longitudinal section shows red inflamed mucosa with an irregular luminal surface. It was removed early in the disease, with no late complications like transmural necrosis, perforation, and abscess formation.]] | ||
Standard sections if the appendix appears inflamed and there are no signs of malignancy. | Standard sections if the appendix appears inflamed and there are no signs of malignancy. | ||
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==Microscopic evaluation== | ==Microscopic evaluation== | ||
− | |||
*Evaluate '''depth''' of the inflammation. | *Evaluate '''depth''' of the inflammation. | ||
*Look for any '''perforation''' of the wall. | *Look for any '''perforation''' of the wall. | ||
+ | *Look for '''cancerous cells''' (which may have caused the appendicitis). {{further|Appendix|linebreak=no}} | ||
*{{Moderate-begin}}Attempt to specify the type of appendicitis as either of the following:{{Moderate-end}} | *{{Moderate-begin}}Attempt to specify the type of appendicitis as either of the following:{{Moderate-end}} | ||
===Types=== | ===Types=== | ||
− | |||
{|class=wikitable | {|class=wikitable | ||
− | |+ Classification of acute appendicitis based on | + | |+ 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 | ||
| None visible || | | None visible || | ||
− | *Only neutrophils in lumen | + | *Only '''neutrophils in lumen''' |
*No ulceration or transmural inflammation | *No ulceration or transmural inflammation | ||
− | | Probably none | + | | |
+ | | Probably '''none''' | ||
|- | |- | ||
! Acute mucosal inflammation | ! Acute mucosal inflammation | ||
| None visible || | | None visible || | ||
− | *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]]. | ||
|- | |- | ||
! Suppurative acute appendicitis | ! Suppurative acute appendicitis | ||
| May be inapparent. | | May be inapparent. | ||
− | *Dull mucosa | + | *'''Dull''' mucosa |
− | * | + | *'''Congestion''' of surface vessels |
− | *Fibropurulent serosal exudate in late cases | + | *Fibropurulent serosal '''exudate''' in late cases |
− | * | + | *'''Dilation''' of the appendix |
| | | | ||
− | *Neutrophils in mucosa, submucosa and muscularis propria, potentially transmural. | + | *Neutrophils in mucosa, submucosa and muscularis propria, potentially '''transmural'''. |
− | *Extensive inflammation | + | *'''Extensive inflammation''' |
− | *Commonly intramural abscesses | + | *Commonly intramural '''abscesses''' |
− | *Possibly vascular thrombosis | + | *Possibly vascular '''thrombosis''' |
− | | Can be presumed to be primary cause of symptoms | + | | [[File:Acute suppurative appendicitis with perforation.jpg|190px]] |
+ | | Can be presumed to be primary '''cause''' of symptoms | ||
|- | |- | ||
! Gangrenous/necrotizing appendicitis | ! Gangrenous/necrotizing appendicitis | ||
| | | | ||
− | *Friable wall | + | *'''Friable''' wall |
*Purple, green or black color | *Purple, green or black color | ||
| | | | ||
− | *Transmural inflammation | + | *'''Transmural''' inflammation |
− | *Necrotic areas | + | *'''Necrotic''' areas |
− | *Extensive mucosal ulceration | + | *Extensive mucosal '''ulceration''' |
− | | Will perforate if untreated | + | | |
+ | | Will '''perforate''' if untreated | ||
|- | |- | ||
! Periappendicitis | ! Periappendicitis | ||
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*Serosa may be congested, dull and exudative | *Serosa may be congested, dull and exudative | ||
| | | | ||
− | *Serosal and subserosal inflammation, no further than outer muscularis propria | + | *'''Serosal and subserosal inflammation''', no further than outer muscularis propria to be called isolated. |
− | | If isolated, probably secondary to other disease | + | | [[File:Histopathology of periappendicitis.jpg|190px]] |
+ | | If isolated, probably '''secondary''' to other disease | ||
|- | |- | ||
! Eosinophilic appendicitis | ! Eosinophilic appendicitis | ||
| None visible | | None visible | ||
| | | | ||
− | *>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. | ||
|- | |- | ||
− | ! Chronic appendicitis<ref name="SierakowskiPattichis2016">{{cite journal|last1=Sierakowski|first1=Kyra|last2=Pattichis|first2=Andrew|last3=Russell|first3=Patrick|last4=Wattchow|first4=David|title=Unusual presentation of a familiar pathology: chronic appendicitis|journal=BMJ Case Reports|year=2016|pages=bcr2015212485|issn=1757-790X|doi=10.1136/bcr-2015-212485}}</ref> | + | ! [[Chronic appendicitis]]<ref name="SierakowskiPattichis2016">{{cite journal|last1=Sierakowski|first1=Kyra|last2=Pattichis|first2=Andrew|last3=Russell|first3=Patrick|last4=Wattchow|first4=David|title=Unusual presentation of a familiar pathology: chronic appendicitis|journal=BMJ Case Reports|year=2016|pages=bcr2015212485|issn=1757-790X|doi=10.1136/bcr-2015-212485}}</ref> |
| | | | ||
*Fibrosis | *Fibrosis | ||
| | | | ||
− | *Predominantly mononuclear infiltrate rather than neutrophilic. | + | *Predominantly '''mononuclear''' infiltrate rather than neutrophilic. |
− | | Should preferably correlate with long-term or recurrent symptoms. | + | | [[File:Histopathology of chronic appendicitis - high magnification.jpg|190px]] |
+ | | 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 | ||
+ | {{Moderate-begin}}Classification into one or several types as per table above.{{Moderate-end}} | ||
+ | |||
+ | ;Example: | ||
+ | {|class=wikitable | ||
+ | | Acute appendicitis and periappendicitis with transmural necrosis | ||
{{Bottom}} | {{Bottom}} |
Revision as of 13:05, 6 October 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
On this resource, the following formatting is used for comprehensiveness:
- Minimal depth
- (Moderate depth)
- ((Comprehensive))
Gross processing
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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