Appendicitis: Difference between revisions

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===Types===
===Types===
[[File:Acute suppurative appendicitis with perforation.jpg|thumb|Acute suppurative appendicitis with transmural inflammation, with associated perforation (at right).]]
{|class=wikitable
{|class=wikitable
|+ 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


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

Classification of acute appendicitis based on gross pathology and light microscopy characteristics[1]
Pattern Gross pathology Light microscopy Image 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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