Difference between revisions of "Appendicitis"
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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''' |
|- | |- | ||
! Acute mucosal inflammation | ! Acute mucosal inflammation | ||
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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]]. |
|- | |- | ||
! Suppurative acute appendicitis | ! Suppurative acute appendicitis | ||
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*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 |
|- | |- | ||
! Gangrenous/necrotizing appendicitis | ! Gangrenous/necrotizing appendicitis | ||
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*'''Necrotic''' areas | *'''Necrotic''' areas | ||
*Extensive mucosal '''ulceration''' | *Extensive mucosal '''ulceration''' | ||
− | | Will perforate if untreated | + | | Will '''perforate''' if untreated |
|- | |- | ||
! Periappendicitis | ! Periappendicitis | ||
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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 |
|- | |- | ||
! Eosinophilic appendicitis | ! Eosinophilic appendicitis | ||
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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. |
|- | |- | ||
! 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> | ||
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*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 13:44, 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
Contents
Comprehensiveness
Comprehensiveness
On this resource, the following formatting is used for comprehensiveness:
- Minimal depth
- (Moderate depth)
- ((Comprehensive))
Gross proccessing
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 | 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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