SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
A mucocele of the appendix secondary to obstruction by endometriosis is reported and the relevant literature reviewed. The theories of the pathogenesis of appendiceal mucocele are reviewed and discussed. To our knowledge, no similar, well documented case has been reported.
A case of pseudomyxoma peritonei associated with mucocele of the appendix is reported. To date there is no general agreement as to whether this entity (pseudomyxoma) should be categorized as a malignant lesion. The presence of intracellular canaliculus-like structures adds support to those investigators who believe that pseudomyxoma peritonei reflects a form of malignant disease.
We present an immunohistochemical study of accessory cells in acute appendicitis and ulcerative colitis (UC). By comparing these two diseases, it is possible to distinguish between changes associated with inflammatory bowel disease and those resulting from nonspecific intestinal inflammation. Nine total colectomy specimens from patients with UC, in which the appendix was also involved, were compared with nine cases of acute appendicitis. Accessory cells were stained for CD68 (PGMI), ACPI (acid cysteine proteinase inhibitor), S100 protein, MAC387 (calgranulin), CD1a, factor XIIIa, and WR18 (HLA class II). In ulcerative colitis, but not acute appendicitis, there was extension of a network of S100 positive dendritic cells into the crptal mucosa, and these S100-positive dendritic cells were closely aligned with the epithelium. The epithelium in UC, but not in acute appendicitis, showed intense upregulation of HLA class II, and this was particularly marked at the crypt bases. Dendritic, MAC387-positive cells were seen only in UC. In both diseases there were abundant ACPI-positive accessory cells in the cryptal areas, a population normally restricted to the dome areas. Factor XIIIa- and PGM1-positive cells, although abundant in both conditions, had distributions similar to those that we had previously shown in normal controls. No CD1a-positive cells were identified in either UC or acute appendicitis. We hypothesize that S100 identifies a subpopulation of activated macrophages. The concentration of this subpopulation, in close contact with the epithelium, which also shows altered expression of HLA class II antigens, suggests that a component of the immune response is targeting this area in UC. In addition, we also suggest that the identification of MAC387-positive dendritic cells in UC reflects increased macrophage turnover in inflammatory bowel disease.
To identify individuals who could be at high risk of developing vCJD, a sensitive immunohistochemical technique was used to detect prion protein in a retrospective series of over 3000 tonsil and appendix specimens. No positives were detected but further studies are required to help reduce uncertainties about possible future numbers of vCJD cases in the UK.
A case with carcinoid tumor of the appendix was encountered incidentally during an elective cesarean section. The tumor was discovered as a result of the routine exploration of the whole abdomen. The investigation for metastasis proved no evidence of spread and the patient was treated solely by surgery.
Perforation of the uterus by an intrauterine contraceptive device (IUD) is a rare, and serious complication, occurring in 1/350 to 1/2500 insertions. Perforation by IUDs can involve several neighboring organs such as the bladder and rectosigmoid. We report two cases of IUD perforations involving the appendix, both inserted during lactation. The first case is an asymptomatic patient in early pregnancy and the second is a woman whose original presentation was chronic lower abdominal pain. The presence of copper in the abdominal cavity can lead to adhesion formation and subsequent abdominal pain, bowel obstruction or infertility. Thus, we believe that when an IUD is located in the abdominal cavity it should be removed even in an asymptomatic patient. In addition, these cases might suggest postponing the use of this contraceptive method in lactating women.
Villous adenoma confined to the distal appendix has not been previously reported in conjunction with acute apendicitis. The presence of an adenoma indicates a need for further investigation due to an association with neoplasia elsewhere.
Appendix has routinely been utilized by the urologists as an intermittent catheterization route to empty a continent urinary reservoir. However it is utilized very rarely for ureteric substitution. We present here our experience with the use of an appendicular conduit for substitution of a complete ureteric stricture and discuss the implications of its use for ureteric reconstruction.
AIM: We report an unusual case of mucinous metaplasia and epithelial dysplasia occurring in endometriotic epithelium in the appendix. METHODS AND RESULTS: A 39-year-old woman developed an appendiceal endometriosis in which the endometrial glands displayed extensive areas consisting of mucinous epithelium and Paneth cells. Focally the mucinous epithelium showed low-grade epithelial dysplasia. These changes occurred in portions of the endometriotic tissue closest to the appendiceal lumen. Both the intestinal and endometrial epithelial components were surrounded by typical endometrial-type stroma showing positive reactivity for oestrogen receptor. CONCLUSIONS: Formation of the mucinous epithelium most likely represents a metaplastic process of the endometrial epithelium rather than a result of a simple 'collision' of the appendiceal and endometrial epithelium. Further support for this being a metaplastic process was the presence of glandular structures containing a mixture of mucinous cells, goblet cells, Paneth cells, ciliated and nonciliated endometrial cells, and ciliated and nonciliated mucinous cells, all showing the same positive reactivity for oestrogen receptor. The disposition of mucinous epithelium in the foci of endometriosis in this case suggests that the appendiceal mucosa or extracellular mucin may play a role as an inducer of mucinous cell metaplasia in endometriotic epithelium.
This report presents a case of precursor T-cell acute lymphoblastic leukemia/lymphoma (ALL) involving the uterine cervix, myometrium, endometrium, and appendix. The patient was a 38-year-old woman with a history of ALL who had been in remission for 4 years following chemotherapy. The malignant lymphoid infiltrate was characterized by blasts, showing scant cytoplasm, irregular hyperchromatic nuclei, and occasional prominent nucleoli. They were immunoreactive for CD45RB, CD3, CD43, CD34, and focally for TdT. Curiously, the blasts replaced the endometrial stroma and spared the associated epithelium. The patient was again treated with chemotherapy but her disease did not respond. She succumbed to her disease approximately 10 months after her initial evaluation for symptoms related to ALL relapse. Precursor T-cell ALL most commonly presents as a mediastinal mass in adolescent males. Although any organ may be affected, involvement of the female reproductive organs is rare. This case shows some of the varied manifestations of precursor T-cell ALL and highlights the necessity of considering the female reproductive tract as a possible location of relapsing disease.
Granulomatous appendicitis is a rare condition, accounting for less than 2% of all cases of appendicitis. The initial belief that it represented a manifestation of Crohn's disease is incorrect in the great majority of cases, as only 5-10% of patients with granulomatous appendicitis develop Crohn's disease elsewhere in their gastrointestinal tract. The remaining etiologies are diverse. Unusual causes include sarcoidosis, foreign body reaction, and infection by mycobacteria, fungi, or parasites. These conditions combined explain less than 10% of cases. More recently, two etiologies have been recognized that potentially account for most of the previous "idiopathic" cases of granulomatous appendicitis. The first is infection by pathogenic Yersinia species, now demonstrated in approximately 25% of cases. The second cause may be the most common of all, namely subacute/recurrent appendicitis with interval appendectomy. This condition likely produces a granulomatous reaction in relation to a protracted secondary inflammatory response to appendicitis and temporizing measures to delay appendectomy, such as antibiotic therapy. Thus, granulomatous appendicitis only rarely represents a manifestation of Crohn's disease. Rather, the overwhelming majority of patients with this condition are cured by appendectomy alone. The appendix, however, can be involved by idiopathic inflammatory bowel disease, both Crohn's disease and ulcerative colitis. It can be involved by ulcerative colitis in patients with distal colonic involvement and sparing of the intervening colonic segment, a phenomenon known as the appendiceal "skip lesion" or "cecal patch" and this pattern of involvement does not necessarily indicate Crohn's disease. Interestingly, appendectomy has been shown to provide some protection against developing inflammatory bowel disease and in reducing its severity if performed before the onset of disease.
In this brief report, the authors present a case of duplication of the vermiform appendix with appendicitis occurring in both appendices and causing small bowel obstruction.
Mucocele of the appendix is uncommon, and preoperative diagnosis is rare. This case report presents the clinical, ultrasound and computed tomographic imaging findings mimicking those of an ovarian cyst. Appendectomy resulted in no complications.
This is a case report of a fourteen year old boy with Crohn's disease of the terminal ileum, and a carcinoid tumor of the appendix. This association is very rare and, to our knowledge, has not been previously reported.
We describe a technique used to provide urinary continence to a group of teenagers with neuropathic bladders. The technique gives continence to a urinary reservoir by utilising the appendix as a continent catheterisable conduit. Of the first five patients to have this procedure performed in this institute, four became fully continent. We feel that this procedure can be of great benefit to both children and adults with urinary incontinence.
Ultrasonography in a 73-year-old woman revealed two cystic structures in the region of the right adnexa. Magnetic resonance imaging suggested two morphologically distinct, space-occupying lesions, findings confirmed at operation and histological examination of the surgical specimen, which demonstrated a serous cystadenoma of the right ovary and a mucocele of the appendix.
A rare intestinal malformation is reported in a boy 11 years old with a 3-year history of abdominal pain and chronic anemia. Laparotomy revealed a large cecal mass extending beyond the ileocecal valve in the place of the appendix, with bleeding mucosal ulcers.
BACKGROUND: In patients with clinically suspected appendicitis, computed tomography (CT) is diagnostically accurate. However, the effect of routine CT of the appendix on the treatment of such patients and the use of hospital resources is unknown. METHODS: We performed appendiceal CT on 100 consecutive patients in the emergency department who, on the basis of history, physical examination, and laboratory results, were to be hospitalized for observation for suspected appendicitis or for urgent appendectomy. Outcomes were determined at surgery and by pathological examination in 59 patients, and by clinical follow-up two months later in 41 patients. Treatment plans made before CT were compared with the patients' actual treatment. We also determined the costs of surgery that revealed no appendicitis (from data on 61 patients), one day of observation in the hospital (from data on 350 patient-days in patients with suspected appendicitis), and appendiceal CT (from data on all pelvic CT examinations in 1996). RESULTS: Fifty-three patients had appendicitis, and 47 did not. The interpretations of the appendiceal CT scans were 98 percent accurate. The results of CT led to changes in the treatment of 59 patients. These changes resulted in the prevention of unnecessary appendectomy in 13 patients, admission to the hospital for observation in 18 patients, admission to the hospital for observation before necessary appendectomy in 21 patients, and admission to the hospital for observation before the diagnosis of other conditions by CT in 11 patients. The effects of performing appendiceal CT on the use of hospital resources included the prevention of unnecessary appendectomy in 13 patients (for a savings of $47,281) and the prevention of unnecessary hospital admission for 50 patient-days (for a savings of $20,250). After the cost of 100 appendiceal CT studies ($22,800) was subtracted, the overall savings was $447 per patient. CONCLUSIONS: Routine appendiceal CT performed in patients who present with suspected appendicitis improves patient care and reduces the use of hospital resources.