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[Goblet cell carcinoid of the vermiform appendix].

The goblet-cell-carcinoid of the appendix vermiformis lies somewhat between the carcinoid and the adenocarcinoma of the appendix concerning the biological behaviour and the histological characteristics. Referring an own well documented case (76 are well known in the available literature) the importance of the very conscientiously managed histological examination of each appendix specimen is emphasized with regard to the 5-year-survival of 73%.

Appendectomy

[A carcinoma of the cecum arising from the orifice of the appendix: a case report].

Reported is the case of a 50-year-old man who was admitted to hospital because of an abdominal pain. A barium enema revealed the shade of a distended, unfilled appendix that had reversed itself on the cecum and the ascending colon, the latter showing compression from the exterior. Further, a colonoscopic examination uncovered a flat, nodular tumor of the cecum that had elevated at the orifice of the vermiform appendix, and 67Ga scintigraphy indicated the uptake at the lower right abdomen. A resected specimen of the tumor showed proliferation in the cecal mucosa at the orifice of the appendix, causing an appendiceal abscess, and the histopathological findings revealed an adenocarcinoma of the cecal mucosa but no malignant transformation of the appendiceal mucosa.

Adenocarcinoma

Crohn's disease of the appendix.

Crohn's disease limited to the appendix is uncommon. The disease may mimic acute appendicitis with fever, leukocytosis, right lower quadrant pain, and occasionally a palpable mass. When Crohn's disease affects the appendix, it typically has a longer clinical period in which the patient has symptoms than do most cases of acute appendicitis. The most common preoperative diagnoses are acute appendicitis and appendiceal abscess. A review of the literature is presented along with our experience in three additional cases of Crohn's disease limited to the appendix. We suggest that Crohn's disease be included in the preoperative differential diagnosis and that extensive intraoperative examination of the gastrointestinal tract be made in any case of suspected appendicitis that has had a protracted preoperative course.

Adolescent

Neuromas of the appendix. A light-microscopic, immunohistochemical and electron-microscopic study of 20 cases.

The neural origin and even the existence of appendiceal neuromas have been questioned. We have studied 20 examples, 7 discovered during a prospective examination of 26 consecutive routine appendectomy specimens (for an incidence of 27%), 2 selected from random cases, and 11 discovered in a retrospective review of 11 randomly selected cases of appendices diagnosed as "fibrous obliteration." By light-microscopy, appendiceal neuromas appear as a loose proliferation of spindle cells usually in a myxoid background, frequently with entrapped fat and connective tissue and infiltrated by eosinophils. Seventeen were located centrally in the appendix without nodule formation. One was central with nodularity and two were confined to the mucosa. The spindle cells were positive for S-100 protein and neuron-specific enolase in all cases. In 12, serotonin positive cells entrapped in the proliferation were present. In 5 of 11 cases with apparent uninvolved appendix present in the specimen, the number of serotonin cells in the crypts was greater than in normal appendix controls. Two appendiceal neuromas contained somatostatin positive cells. Stains for vasoactive intestinal polypeptide, substance P, neurotensin, bombesin and gastrin were negative. Ultrastructural examination of one case confirmed the presence of a mixture of Schwann cells and cells containing neurosecretory granules. We conclude that appendiceal neuroma is a rather common entity, and that most cases of so-called fibrous obliteration actually represent appendiceal neuroma.

Adolescent

The position of the vermiform appendix in Nigerians with a review of the literature.

This is a study of the positions of the appendix in 548 Nigerians 447 of whom were autopsies or cadavers while the rest (101) were appendicectomy patients. Overall, the retrocaecal appendix was the commonest because of its very high frequency in the surgical material. The pelvic appendix as distinct from the retrocaecal or retrocolic was the commonest in the nonsurgical cases and it also had an increasing frequency with age. When previous reports were reviewed, the retrocaecal position was moderately infrequent in blacks compared to causasians.

Adolescent

["Cecal appendix with pellets"].

A case is presented of caecal appendix with birdshots, in a 38 years-old male patient, with a clinical picture of biliary pathology. An elongated and "heavy" caecal appendix was palpated during cholecystectomy and removed. The pathological study showed the presence of 99 ammunitions or lead birdshots in the appendicular lumen, with a diameter of 1-5 mm, without histologic evidence of active appendicitis. The patient was fond of hunting wild animals and is used to eat them pickled. Pertinent literature is revised and works are commented in relation to the incidence of different foreign bodies in the appendix lumen, clinical picture and complications.

Adult

Blood lead levels in patients with lead shot retained in the appendix.

Seven patients with one or two lead shots retained in the appendix were identified by radiography. For each case, two sex- and age-matched control patients without lead shot in the appendix were found. None of the 7 patients with lead shot in the appendix had blood lead levels (median 0.55 mumol/l) approaching the toxic levels, but they averaged almost twice the levels of the controls (median 0.29 mumol/l). Thus, lead shots may add to individual lead exposures, and blood lead analysis should be performed, at least when more than a few lead shots are present.

Appendix

[Endocrinocytes of the appendix in the human fetus].

At light and electron microscopic level endocrine cells of the human embryos (9-31-week-old) appendices have been studied. They appear in the human embryo appendix on the 11th week of development for the first time. Amount of the endocrine cells in the field of vision increases significantly on the 17th-24th and does not change on the 25th-31st weeks. Basing on certain morphological criteria, presence of EC-cells and those resembling S- or I-cells is demonstrated in the human embryo appendix. Thus, already during the embryonal period there are cells in the appendix, main function of which is to produce biogenic amines and peptide hormones, participating in local regulation of homeostasis.

Appendix

Transient gas-filled appendix developing during excretory urography.

Gas-filled appendix is well recognized in association with appendicitis, and in acute abdominal conditions associated with bowel distension. 3 patients who developed gas-filled appendix in the course of excretory urography are reported. The phenomenom is thought to result from the reported property of ionic contrast materials to produce anticholinesterase activity and histamine release, either or both of which could produce increased bowel tone and consequent displacement of cecal gas into the appendix.

Adolescent

Crohn's disease of the appendix, manifested as acute appendicitis with postoperative fistula.

Two cases are reported of Crohn's disease localized to the appendix and manifested as acute appendicitis; after appendectomy a fistula developed. In none of 18 patients with Crohn's disease reported by other authors, where the appendix was the primary site, did a fistula develop postoperatively. When the appendix is the primary site of Crohn's disease the presence of mild inflammation of adjacent organs such as the terminal ileum may be mistakenly attributed to ordinary appendicitis. If, at exploratory laparotomy performed on a tentative diagnosis of appendicitis, Crohn's disease is suspected in the adjacent intestine, it is proposed that appendectomy should be followed by at least 10 days of total parenteral nutrition to minimize the risk of a fistula developing.

Acute Disease

[Histochemical characteristics of the secretory elements of the vermiform appendix following surgical trauma, circulatory hypoxia and immunization].

Histochemical methods were applied to determination of salomycin, dermatansulfate, keratosulfate and neutral mucopolysaccharides in the goblet cells of rabbit appendix. Sialomycin and neutral mucopolysaccharides were found in the glands. Immunization with human gamma globulin was followed in the productive phase of immunogenesis by a rise of the secretory activity of the mucosa of the appendix. An increase of the mucus formation in the appendix occurred after laparatomy and during the initial period of experimental appendicitis. However, surgical trauma caused an opposite effect against the background of increased functional activity of the secretory elements of the immunized animals, and during experimental appendicitis no activation of mucus formation was seen. The influence of the abovementioned factors on the secretory activity of the mucous membrane was accompanied by qualitative changes in the synthesized mucus.

Animals

Complement receptor lymphocytes in the rabbit I. an SIg-negative subpopulation in the appendix.

Complement receptor lymphocytes (CRL) were detected in various rabbit lymphoid tissues by the ability of these CRL to form rosettes with sheep red blood cells coated sequentially with rabbit antiserum directed against sheep red blood cell stroma and horse serum as a nonhemolytic source of complement (EAC). The rosette assay was shown to be specific for complement receptor (CR) activity and the EAC capable of detecting both C3b and C3d specific receptors. With lymphocyte preparations containing less than 5% phagocytic cells, the average per cent CRL in the various tissues studied was as follows: thymus 1%, popliteal lymph node 18%, spleen 30%, appendix 35%, and peripheral blood 45%. Double assays in which the lymphocytes were prestained with an FITC-labeled Fab fragment of a goat anti-rabbit Fab antibody before rosetting indicated that CRL were a subpopulation of surface immunoglobulin (SIg)-bearing lymphocytes in popliteal lymph node, spleen, and peripheral blood. In the appendix, however, in addition to finding SIg+ CR+ and SIg+ CR- populations, an SIg- CR+ population was consistently found. Double assays employing FITC-labeled goat antibodies specific for mu, alpha, and gamma determinants were also performed to determine if there was any relationship between the class of Ig displayed and presence of CR. It appeared that an approximately equivalent percentage of both IgM- and IgG-bearing cells also displayed CR. Experiments in which appendix cells were treated with Pronase to remove SIg and CR and the cells cultured in vitro to allow regeneration of surface markers confirmed the existence of SIg+CR+, SIg+CR-, and SIg-CR+ lymphocyte subpopulations. Whether the SIg-CR+, population represents a developing B cell population which will eventually also express SIg or whether it belongs to the T or "null" cell populations is unclear at present.

Animals

Granular cell tumour of the appendix in a patient irradiated for a rectal carcinoma.

We report on a 47-year-old man with a granular cell tumour of the appendix, discovered incidentally during surgery for a rectal adenocarcinoma that had been irradiated preoperatively. A detailed immunocytochemical analysis revealed positivity for S-100 and neuron-specific enolase (NSE). Electron microscopically, the cytoplasm of the tumour cells contained numerous pleomorphic lysosomes. In the appendix tissue adjacent to the tumour a neuroma and the histological features of radiation injury were present. Our findings suggest that this granular cell tumour may have originated from a pre-existing appendix neuroma which underwent granular degeneration, possibly as a result of radiation.

Appendiceal Neoplasms

Carcinoid tumor of the appendix in the first two decades of life.

Carcinoid tumor of the appendix is the most common neoplasm of the gastrointestinal tract in childhood and adolescence. Sufficient long-term follow-up data after surgical treatment are not currently available for patients diagnosed during the first two decades of life. From 1936 to 1988, 23 patients were observed at this institution with histologically confirmed carcinoid tumors involving the vermiform appendix. In contrast to the adult experience, in which the tumor is most commonly encountered as the result of an incidental appendectomy, 18 of these patients presented with signs and symptoms of an acute abdomen directing the surgeon to the appendix. In the other five cases, surgery was performed for other reasons. Median age at presentation was 13.0 years (range, 6 to 20 years). Fourteen patients were female, nine were male. Simple appendectomy was the initial procedure for all patients. Tumor size ranged from "microscopic" to 2.5 cm in largest dimension. Three patients subsequently underwent right hemicolectomy, and one patient had removal of a residual appendiceal stump, but no residual or metastatic tumor tissue was found in any of the resected specimens. Nineteen patients underwent simple appendectomy alone. Eighteen available specimens were reviewed at the time of this study for confirmation of histology and degree of invasion. The tumor invaded to the serosa in nine of 23 (39%). The mesoappendix or periappendiceal fat was involved in seven of 23 (30%). Vessel invasion was not noted in any specimen. Our median follow-up time was very long, being 26 years (range, 9 months to 51 years). No patient has had evidence of recurrent or metastatic disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

Goblet cell carcinoids and related tumors of the vermiform appendix.

Appendiceal carcinoids with glandular differentiation pose difficulties in classification and prediction of clinical behavior. Sixty-four such cases were divided into three histologic groups on the basis of routine and immunohistochemical stains: (1) Tubular carcinoids were small and confined to the appendix, had small amounts of intraluminal mucin with few or no goblet cells, were nonargentaffin, lacked serotonin, and were diffusely positive for glucagon. All ten with follow-up (mean, 17 months) were without metastasis. (2) Goblet cell carcinoids were confined to the appendix and mesoappendix, circumferentially surrounded the appendiceal lumen, and were often not suspected grossly. Histologically, they were often mixed with small crypt-like glands and were serotonin positive. All 22 with follow-up (mean, 19 months) were without metastasis whether or not right hemicolectomy was performed. (3) Mixed carcinoid-adenocarcinomas showed spread into the cecum or adjacent viscera at the time of diagnosis and had a large carcinomatous pattern with areas of mucinous, signet-ring, or single-file structure, in addition to goblet cell or insular carcinoid. All patients had right hemicolectomies, and all but two with follow-up died of the disease (mean, 16 months). Although a histologic spectrum exists among carcinoid tumors and certain adenocarcinomas of the appendix, it is possible to delineate three biologically distinct groups. Surgical margins should be taken of all appendices because these tumors often do not form discrete masses.

Adenocarcinoma

Primary adenocarcinoma of the appendix in an inguinal hernia.

Primary adenocarcinoma of the appendix and primary carcinomata within hernial sacs are both uncommon clinical problems. A previously undescribed presentation of primary adenocarcinoma of the appendix in a right sided sliding inguinal hernia is presented and discussed. It is important to follow up patients with carcinoma of the appendix in order to exclude other colonic lesions. The St Vincent's Hospital (Melbourne) experience in this condition is limited but parallels that of major series elsewhere.

Adenocarcinoma, Mucinous

A case of primary mucinous cystadenocarcinoma of the appendix with elevated serum carcinoembryonic antigen (CEA).

We report a 69-year-old female patient with mucinous cystadenocarcinoma of the appendix and elevated serum carcinoembryonic antigen (CEA). Serum CEA levels were 27.6-37.8 ng/ml. An oval shaped cystic mass at the ileocecal region was consistently seen by several radiologic procedures such as, barium enema, ultrasonography, computed tomography, and magnetic resonance imaging. The tumor was resected, and the histopathologic findings indicated mucinous cystadenocarcinoma of the appendix. CEA was demonstrated in the neoplastic columnar cells in immunohistochemical studies. The literature on the determination of serum CEA level in adenocarcinoma of the appendix is reviewed.

Aged

Calcified mucocele of the appendix presenting as ureteral obstruction.

Mucocele of the appendix, a rare lesion, occurs in 0.3% of patients undergoing appendectomy. Only 46 cases of calcified mucocele have been reported. Complications reported include appendiceal intussusception, rupture resulting in acute abdomen, and infection. We report the case of a 74-year-old man with a calcified mucocele of the appendix that was discovered in the evaluation of a ureteral obstruction. During exploratory surgery, the patient was found to have a 6 x 5 cm appendiceal tumor and underwent a right ileocolectomy. Pathologic examination showed calcified mucous cystadenoma of the appendix. Calcification of a mucocele is believed to denote chronicity. Our case is the first report of ureteral obstruction secondary to calcified mucocele and the second calcified mucocele to be seen on computerized tomography. Calcified mucocele should be included in the differential diagnosis of any calcified tumor in the right lower quadrant.

Aged