Appendicitis: Difference between revisions

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Line 30: Line 30:
! 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
Line 36: Line 36:
! 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
*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
| Can be presumed to be primary cause of symptoms
|-
|-
Line 58: Line 58:
*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
|-
|-
Line 67: Line 67:
*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
| If isolated, probably secondary to other disease
| If isolated, probably secondary to other disease
|-
|-
Line 73: Line 73:
| 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.
Line 81: Line 81:
*Fibrosis
*Fibrosis
|  
|  
*Predominantly mononuclear infiltrate rather than neutrophilic.
*Predominantly '''mononuclear''' infiltrate rather than neutrophilic.
| Should preferably correlate with long-term or recurrent symptoms.
| Should preferably correlate with long-term or recurrent symptoms.
|}
|}

Revision as of 13:42, 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


Comprehensiveness

Comprehensiveness

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

Gross proccessing

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. Further information: Appendix

Microscopic evaluation

Suppurative acute appendicitis, with ulceration seen at left in lumen.
  • 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

Acute suppurative appendicitis with transmural inflammation, with associated perforation (at right).
Classification of acute appendicitis based on gross pathology and light microscopy characteristics[1]
Pattern Gross pathology Light microscopy Clinical significance
Acute intraluminal inflammation None visible
  • Only neutrophils in lumen
  • No ulceration or transmural inflammation
 Probably none
Acute mucosal inflammation None visible
  • Neutrophils within mucosa, and possibly in submucosa
  • Mucosal ulceration
 May be secondary to enteritis.
Suppurative acute appendicitis May be inapparent.
  • Dull mucosa
  • Congestion of surface vessels
  • Fibropurulent serosal exudate in late cases
  • Dilation of the appendix
  • Neutrophils in mucosa, submucosa and muscularis propria, potentially transmural.
  • Extensive inflammation
  • Commonly intramural abscesses
  • Possibly vascular thrombosis
 Can be presumed to be primary cause of symptoms
Gangrenous/necrotizing appendicitis
  • Friable wall
  • Purple, green or black color
  • Transmural inflammation
  • Necrotic areas
  • Extensive mucosal ulceration
 Will perforate if untreated
Periappendicitis May be inapparent.
  • Serosa may be congested, dull and exudative
  • Serosal and subserosal inflammation, no further than outer muscularis propria
 If isolated, probably secondary to other disease
Eosinophilic appendicitis None visible
  • >10 eosinophils/mm2 in muscularis propria.
  • No changes conforming to other types of appendicitis
 Possibly parasitic, or eosinophilic enteritis.
Chronic appendicitis[2]
  • Fibrosis
  • Predominantly mononuclear infiltrate rather than neutrophilic.
 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

  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ Unless otherwise specified in rows, reference is:
    - Carr, Norman J. (2000). "The pathology of acute appendicitis ". Annals of Diagnostic Pathology 4 (1): 46–58. doi:10.1016/S1092-9134(00)90011-X. ISSN 10929134. 
  2. ↑ Sierakowski, Kyra; Pattichis, Andrew; Russell, Patrick; Wattchow, David (2016). "Unusual presentation of a familiar pathology: chronic appendicitis ". BMJ Case Reports: bcr2015212485. doi:10.1136/bcr-2015-212485. ISSN 1757-790X. 

Image sources
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