Appendicitis: Difference between revisions

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Appendicitis may histopathologically be defined as neutrophilic infiltrates of the wall of the appendix in the correct clinical context.
Appendicitis may histopathologically be defined as neutrophilic infiltrates of the wall of the appendix in the correct clinical context.
{{Fixation - general notes}}
<noinclude>{{Comprehensiveness}}</noinclude>


{{Fixation}}
==Gross processing==
==Comprehensiveness==
Standard sections if the appendix appears inflamed and there are no signs of malignancy. Describe abnormal signs including:
{{Comprehensiveness}}
<gallery mode=packed>
 
File:Gross pathology of congested appendicitis.jpg|thumb|Appendicitis with '''congestion'''
==Gross proccessing==
File:Gross pathology of appendicitis with a patchy purulent exudate, annotated.jpg|Serosa with a '''patchy purulent exudate'''.
[[File:Acute Appendicitis.jpg|thumb|Acute 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:Gross pathology of appendicitis containing a blood-tinged purulent exudate.jpg|Appendicitis, with the lumen containing a '''blood-tinged purulent exudate'''.
Standard sections if the appendix appears inflamed and there are no signs of malignancy.
File:Acute Appendicitis.jpg|Longitudinal section showing a '''red inflamed mucosa''' with an '''irregular luminal surface''' (in a case of acute suppurative appendicitis).
</gallery>
{{Further|Appendix}}
{{Further|Appendix}}


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*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 '''thrombosis''', indicating gangrenous appendicitis.<ref name=Medscape>{{cite web|url=https://emedicine.medscape.com/article/773895-workup#c20
*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}}


==Types==
===Types===
{|class=wikitable
{|class=wikitable
|+ Classification of acute appendicitis based on [[gross pathology]] and [[light microscopy]] characteristics<ref name="Carr2000">{{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  
| None visible ||
| None visible ||
*Only neutrophils in lumen
*Only '''neutrophils in lumen'''
*No ulceration or transmural inflammation  
*No ulceration or transmural inflammation  
| Probably none
| [[File:Histopathology of acute intraluminal inflammation of the appendix.jpg|190px]]
| Probably '''none'''
|-
|-
! Acuta 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
*Congested surface vessels
*'''Congestion''' of surface vessels
*Fibropurulent serosal exudate in late cases
*Fibropurulent serosal '''exudate''' in late cases
*Dilated appendix
*'''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, obliterating normal histological structures
*Necrotic areas
*'''Necrotic''' areas
*Extensive mucosal ulceration
*Extensive mucosal '''ulceration'''
| Will perforate if untreated
| [[File:Histopathology of necrotizing appendicitis, high magnification.jpg|190px]]
| 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.
| 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>
|
*Fibrosis
|
*Predominantly '''mononuclear''' infiltrate rather than neutrophilic.
|
| Should preferably correlate with '''long-term or recurrent''' symptoms.
|}
 
===Further workup===
{{Moderate-begin}}In acute suppurative appendicitis, still look for any periappendicitis. Also look by the lumen for parasites.{{Moderate-end}}
 
===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
| {{Moderate-begin}}Appendix, resection (or appendectomy):{{Moderate-end}}<br>Acute {{Moderate-begin}}suppurative{{Moderate-end}} appendicitis {{Moderate-begin}}and periappendicitis{{Moderate-end}} with transmural necrosis and perforation.
|}
 
{|class=wikitable
| Example AI prompt:<br>neuts across wall to meso and serosa, no perf. make report (copy-paste gross description)
|}
|}
{{Bottom}}
<noinclude>{{Bottom}}</noinclude>
Retrieved from "https://patholines.org/Appendicitis"