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We retrospectively studied 27 histologically diagnosed cases of schistosomiasis of the appendix at the University of Maiduguri Teaching Hospital between January 1994 and December 2003. Of 1183 cases of appendices histologically examined, schistosomiasis was seen in 27 (2.3%).
We conducted a retrospective clinicopathologic and immunohistochemical study of the biologic significance of mesoappendix infiltration in 15 appendiceal neuroendocrine tumors selected from a series of 42 primary tumors. In all cases, the tumor was found incidentally and measured less than 2 cm (mean, 0.84 cm). In 13 cases, it was located in the tip of the appendix and in the midportion in 2. Histologically, none showed relationship with overlying mucosa. Necrosis was absent; mitotic figures were rare. The Ki-67 labeling index was low (1%-2%). In all cases, S-100 protein immunostaining disclosed positive elements with cytoplasmic dendritic processes closely intermingled with neuroendocrine neoplastic cells. All patients (8 males; 7 females; mean age, 38.2 years) underwent simple appendectomy. A right-sided hemicolectomy was performed subsequently in 1 case. After a mean follow-up of 52.6 months (range, 8-143 months), none had died of disease or had recurrent or metastatic disease. Our results confirm that appendiceal neuroendocrine tumors seem to have a different phenotype from those occurring in other gastrointestinal sites. Tumors less than 2 cm, even with mesoappendiceal infiltration, have an excellent prognosis, and simple appendectomy seems to be the appropriate therapeutic approach.
The lymphatic sinus of the rabbit appendix was examined by scanning and transmission electron microscopy. Luminal surfaces of the sinus were lined by squamous endothelial cells, some of which, however, were blebby in surface relief due to the presence of electron dense granules in the cytoplasm. Many clusters of lymphocytes were present on the endothelial surface, mainly along the blood vessels of the trabeculae and of the sinus wall. Regional differences in collagen fibrillar arrangement of the sinus wall were demonstrated after the removal of the endothelial cells by the NaOH maceration method (OHTANI, 1987). In the upper region of the sinus and the lymphatic plexus of the internodular thymus dependent area (TDA), the fibrillar layer was a delicate network of interwoven thin fibrils. Furthermore, transmission electron microscopy revealed frequent transmural passages of lymphocytes, which suggest the existence of pores or fenestrations in the fibrillar layer of these regions. The fibrillar layer in the lateral and basal sinus was formed by densely interwoven thick bundles or sheets which consisted of thin collagen fibrils. No obvious space was seen between fibrils. These observations suggest that the upper region of the sinus and the lymphatics in the TDA may be active sites of cell migration from the reticular tissue.
A 47-year-old man was admitted with appendicitis, and appendectomy was performed. On microscopic examination of the resected specimen, the presence of goblet cell carcinoid in the tip of appendix was revealed. This tumor showed an aggressive nature with perineural and vascular invasion around the appendiceal serosa. The tumor was composed of two main cell populations: mucin-producing (goblet cell type) and silver-positive cells (endocrine differentiation). Additionally, a few cells were also positive for serotonin and lysozyme, but negative for gastrin and ACTH. These findings suggest that goblet cell carcinoid share some functional and histologic characteristics with carcinoid tumors and adenocarcinomas, although it is a distinct entity.
Intussusception of the appendix is uncommon and an unusual cause of ileocolic intussusception. The pediatric age group is most often affected. Appendiceal intussusception may present as primary appendiceal invagination but more commonly leads to secondary intussusception. Two cases of partial appendiceal intussusception leading to secondary intussusception are presented. Classification, symptomatology, radiographic appearance, and differential diagnosis are discussed.
Mucocele of the appendix is uncommon, and preoperative diagnosis is rare. Diagnosis is important because some of these lesions are malignant, and early identification may reduce the incidence of pseudomyxoma peritonei. In two of three cases reviewed the correct preoperative diagnosis was established with sonography and computed tomography. These findings suggest that, in a patient who has not undergone appendectomy, the presence of a low-attenuating mass at computed tomography and a through-transmitting mass with echogenic content at sonography in the correct location is typical of mucocele.
Mucocele of the appendix is a descriptive term for an abnormal mucous accumulation distending the appendiceal lumen. Pseudomyxoma peritonei is characterized by mucinous ascites and implants throughout the abdominal cavity. Thirty-four cases of appendiceal mucocele and seven cases of pseudomyxoma peritonei of appendiceal origin on file at the Armed Forces Institute of Pathology were reviewed for their clinical, pathologic, and radiologic findings. These cases provided examples of the major radiologic findings reported in this entity. Previously unreported findings of dependent echoes within some mucoceles on sonography and pseudomyxoma peritonei tracking along the umbilical vein remnant or mimicking an intrahepatic mass are presented.
OBJECTIVE: We sought to investigate whether the outer diameter of the vermiform appendix on cross-sectional sonography is as reliable a criterion with which to confirm acute appendicitis in patients with cystic fibrosis as in those without cystic fibrosis. CONCLUSION: The outer appendiceal diameter of 6 mm or more cannot be considered a reliable criterion for the diagnosis of acute appendicitis in patients with cystic fibrosis.
A 67-year old man was presented with a 6-mo history of recurrent right lower quadrant abdominal pain. On physical examination, a vague mass was palpable in the right lumbar region. His routine laboratory tests were normal. Ultrasonography showed a hypoechoic lesion in the right lumbar region anterior to the right kidney with internal echoes and fluid components. Abdominal contrast-enhanced computed tomography (CECT) showed a well-defined hypodense cystic mass lesion lateral to the ascending colon/caecum, not communicating with the lumen of colon/caecum. After complete open excision of the cystic mass lesion, gross pathologic examination revealed a turgid cystic dilatation of appendiceal remnant filled with the mucinous material. On histopathological examination, mucinous cyst adenoma of appendix was confirmed. We report this rare unusual late complication of mucocele formation in the distal viable appendiceal remnant, which was leftover following incomplete retrograde appendectomy. This unusual complication is not described in the literature and we report it in order to highlight the fact that a high index of clinical and radiological suspicion is essential for the diagnosis of mucocele arising from a distal viable appendiceal remnant in a patient who has already undergone appendectomy presenting with recurrent abdominal pain.
The second case of autochthonous Schistosoma japonicum-like infection in man from Indonesia is reported. An appendectomy was performed on a 34-year-old inhabitant of Java of Chinese heritage. Microscopic examination of the necrotic appendix revealed S. japonicum-like eggs in the mucosa, submucosa, muscularis, and serosa layers. There were many degenerated and mineralized eggs, some of which were within giant cells and/or surrounded by scar tissue.
Five hundred consecutive cases of appendicectomy were reviewed. The incidence of non-inflamed appendices removed at operation was 29.6% and was nearly twice as high in females than in males (P less than 0.001). The incidence of perforated appendices in patients with acute appendicitis was low (6.5%), and there were no deaths. Postoperative complications, mostly infections occurred in 6.7% of patients with a non-inflamed appendix and in 19.3% of patients with appendicitis (P less than 0.001). No features of the history or examination were sufficiently discriminatory to enable a definite diagnosis to be reliably established before operation. Appendicectomy remains the safest management option in patients with suspected appendicitis in whom diagnostic doubt remains after thorough clinical evaluation and observation.
Malakoplakia of the appendix is an unusual condition that has been reported to occur in association with tumors, infections, and immunocompromised states. We describe a case of appendicular malakoplakia associated with eggs of Taenia species. The diagnosis was made on histopathologic examination of surgically resected tissue from an appendicular mass. To the best of our knowledge, this is the first time that helminths have been documented to be associated with malakoplakia. We also discuss the implications of helminthic infestation in the pathogenesis of the lesion.
A case of mucinous cystadenocarcinoma of the appendix is presented. The clinical feature is a painful syndrome of the right iliac fossa. In our observation, the diagnosis was not allowed by preoperative imaging. Appendectomy was initially performed and completed by right hemicolectomy and lymphadenectomy after histological diagnosis of the appendicular malignant tumour was forwarded. The prognosis of this tumour is generally excellent providing early diagnosis and wide enough surgery.
The layout of the work has stayed motivated from the recent observation of mixed carcinoid, located to the appendix and wide to the peritoneal cable, joint to our observation in an elderly patient with aspecific demonstration clinical-symptomatologic. The study of the endocrine tumors is in continuous evolution also if, to the actual state, there is a better comprehension of this neoplasm, variegated and complex and, under some appearances, still not known well. Jejunoileal carcinoid tumors differ, under many appearances, from those occurring in other sites of the gut. They have relatively high rate of transmural invasion and aggressive clinical behavior, contrasted by a scarce objectivity; the demonstration of symptoms generally implicates the presence of an illness in advanced stage. Also pharmacological therapy made important progress, with the possibility of administer composed able to interfere with the development and the neoplastic growth.
Entero-cutaneous fistula involving only the vermiform appendix is rare in childhood. We report a case recently managed in our practice, the first of such report from West Africa, along with a review of world literature on the subject.
An unusual case of primary adenocarcinoma of the proximal jejunum with coexisting primary adenocarcinoma of the appendix is presented. The symptomatology, diagnosis, surgical management, and prognosis are also presented. To our knowledge, this is the only such case reported in the medical literature of English-speaking countries.
Ectopic decidua reaction or deciduosis is a physiological phenomenon of pregnancy due to a progesterone induced metaplasia of the pluripotential cells of the subcelomic mesenchyma. Usually it is an incidental finding that has not been associated with clinical symptoms. Isolated cases of ectopic decidua have been reported with symptoms simulating appendicitis. We are reporting a case of deciduosis localized in the appendix with abdominal pain during the last period of pregnancy.
A 58-year-old woman with abdominal complaints had a cystic mass close to the uterus due to a mucocele of the appendix.