Difference between revisions of "Appendix"

From patholines.org
Jump to navigation Jump to search
Line 19: Line 19:
 
:*Look for any yellow firm areas at the tip, which may be '''carcinoids'''. Carcinoids may hide behind obstructions in the tip. If found grossly, submit entire appendix, and ink the surgical margin and submit separately enface.
 
:*Look for any yellow firm areas at the tip, which may be '''carcinoids'''. Carcinoids may hide behind obstructions in the tip. If found grossly, submit entire appendix, and ink the surgical margin and submit separately enface.
 
:*In case of '''mucocele''', submit the entire appendix
 
:*In case of '''mucocele''', submit the entire appendix
<gallery>
+
[[File:Gross pathology of mucocele of the appendix.jpg|thumb|Gross pathology of '''mucocele''' of the appendix.]]
File:Gross pathology of mucocele of the appendix.jpg|Gross pathology of mucocele of the appendix
 
File:Pie chart of histological types of mucocele of the appendix.jpg|Pie chart of histological types of mucocele of the appendix, with relative incidences
 
</gallery>
 
 
:*'''Wall defects'''
 
:*'''Wall defects'''
 
:*Exterior '''coatings'''. Note if it contains "stones" or fruit kernels.  
 
:*Exterior '''coatings'''. Note if it contains "stones" or fruit kernels.  

Revision as of 11:53, 7 August 2020

Author: Mikael Häggström [note 1]

Fixation

Generally 10% neutral buffered formalin.

  See also: General notes on fixation


Comprehensiveness

Comprehensiveness

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

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

Gross processing

  • Measure the length of the appendix.[1]
  • ((Note its shape.[1] ))
  • Inspect the serosa (color, congestion, adhesions, hemorrhage, exudate etc)
  • ((Describe and measure the mesoappendix.))
  • Cut off about 1.5 cm from the tip and split it in half long the lumen. Divide the remainder into about 3-5 mm thick transverse slices.[1]
  • ((Note the wall thickness[1]))
  • Look mainly for:[1]
  • Luminal pus or obstruction, including stones.
  • Look for any yellow firm areas at the tip, which may be carcinoids. Carcinoids may hide behind obstructions in the tip. If found grossly, submit entire appendix, and ink the surgical margin and submit separately enface.
  • In case of mucocele, submit the entire appendix
Gross pathology of mucocele of the appendix.
  • Wall defects
  • Exterior coatings. Note if it contains "stones" or fruit kernels.
  • At least one half of the tip
  • At least one slice from visually inflamed areas.
  • ((A transverse slice closest to the base, that is, the surgical cut.))
  • ((At least one transverse slice from an intermediate part.))

Particular findings indicating additional sampling include:[1]

  • Wall discoloration
  • External green-gray-yellow coating
  • Suspected wall defects

  See also: General notes on gross processing


Microscopic evaluation

Always look for inflammation and malignancy.

Inflammation

Appendix neoplasms by incidence and prognosis.
Main article: Appendicitis

Neutrophilic infiltrates of the wall of the appendix in the correct clinical context confers a diagnosis of appendicitis.

Malignancy

  • Look for cancerous cells (also for specimens with clinical appendicitis).

Report

  • Description of objective findings.
  • Presence or absence of malignancy.

Example, using image at top:

Mucosa with ulceration. ((No atypia in residual mucosa.)) Inflammatory cells in the stroma and all muscle layers, as well as on the serosal surface and adherent adipose tissue. No evidence of malignancy. ((Optionally: No perforation))

  See also: General notes on reporting


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. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Monica Dahlgren, Janne Malina, Anna Måsbäck, Otto Ljungberg (1997-02-13). Lilla utskärningen.
  2. Elkbuli, Adel; Sanchez, Carol; McKenney, Mark; Boneva, Dessy (2019). "Incidental neuro-endocrine tumor of the appendix: Case report and literature review ". Annals of Medicine and Surgery 43: 44–47. doi:10.1016/j.amsu.2019.05.015. ISSN 20490801. 
  3. Hajjar, Roy; Dubé, Pierre; Mitchell, Andrew; Sidéris, Lucas (2019). "Combined Mucinous and Neuroendocrine Tumours of the Appendix Managed with Surgical Cytoreduction and Oxaliplatin-based Hyperthermic Intraperitoneal Chemotherapy ". Cureus. doi:10.7759/cureus.3894. ISSN 2168-8184. 

Image sources