Appendicitis: Difference between revisions

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→Types: +Chronic
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[[File:Acute suppurative appendicitis with perforation.jpg|thumb|Acute suppurative appendicitis with transmural inflammation, with associated perforation (at right).]]
[[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">{{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 !! Clinical significance
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*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.
|}
|}


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Revision as of 08:50, 1 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.
  • (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
  • Congested surface vessels
  • Fibropurulent serosal exudate in late cases
  • Dilated 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.

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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