Appendix
Author:
Mikael Häggström [note 1]
Contents
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
- Wall defects
- Exterior coatings. Note if it contains "stones" or fruit kernels.
- Any tumor. If found:
- Measure the greatest dimension of the tumor
- Look for foci of carcinoma or lymph nodes in the mesoappendiceal fat, which may be lymphatic or perineural invasion
- Submit:[1]
- 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
Gross report
Example:
((Labeled - appendix. The specimen is received in formalin and consists of a resected)) appendix measuring __ cm in length and __ cm in maximum diameter. The serosa is tan-red {{and
The attached mesoappendix measures __ cm and appears {{
On cut sections, the lumen {{is dilated and contains {{
No perforation is identified. ((Representative sections are submitted for microscopic examination in __ cassette(s).)) Microscopic evaluationAlways look for inflammation and malignancy. Inflammation
Neutrophilic infiltrates of the wall of the appendix in the correct clinical context confers a diagnosis of appendicitis. Malignancy
Report
Example, using image at right:
Notes
Main pageReferences
Image sources
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