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PubMed1979

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↗

PubMed1976

[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↗

PubMed1984

[Development of the mucosa and differentiation of the lymphocytes of the vermiform appendix of the human fetus].

One hundred and twenty-two appendices have been obtained from 12-30-week-old human fetuses and studied histologically (90) and immune-morphologically (32). Lymphoid follicles in the organ appear on the 17th week. Character of the epithelial and the reticular tissue structure in the area of the cupola including the lymphoid follicle have been studied. T- and B-lymphocytes have been stated to be present in the appendix of a 17-week-old fetus. As the fetus is further developing, the number of lymphocytes in the appendix increases: the amount of T-lymphocytes is practically constant, and that of B-lymphocytes increases. Direction of the lymphocytes migration out of the follicle is demonstrated. The lymphoid formations of the appendix are necessary for certain local protective reactions and already in the fetus they begin to participate in the general system of the organism's immunogenesis.

Appendix↗

PubMed1976

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↗

PubMed1990

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↗

PubMed1984

Metastatic carcinoid tumor of the appendix. Report of a case and review of the literature.

A case of regional metastatic carcinoid of the appendix is presented and the literature reviewed for indications for right colectomy. Five cases of lymph-node metastasis from primary appendiceal carcinoids less than 2 cm in diameter have been reported. There is no reported case of systemic metastasis occurring after appendectomy for a carcinoid with a diameter of less than 2 cm. Perineural involvement, lymphatic invasion, mesoappendiceal invasion, histologic appearance, and location of the tumor in the appendix seem to be unreliable predictors of clinically significant regional node involvement. It is concluded that a right colectomy is indicated only in patients with carcinoid tumors of the appendix 2 cm or more in diameter, or with residual tumor at the margin of resection.

Adult↗

PubMed1990

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↗

PubMed1990

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↗

PubMed1988

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↗

PubMedDate not supplied

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↗

PubMed1991

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↗

PubMed1990

[An inflammatory pseudotumor of the appendix].

A 41-year-old male, complaining of an abdominal pain and suspected of having acute appendicitis, underwent examination on hospitalization. Ultrasonography revealed a tumorous lesion of the appendix. Thus, a laparotomy was performed and mass lesions were found in the mid and distal parts of the appendix. A subsequent histological examination revealed an inflammatory pseudotumor consisting of remarkable eosinophilic cell and fibroblastic infiltrations, similar to that seen in a inflammatory fibroid polyp (Helwig). Although such lesions, polypoid in appearance, have been found to occur in the stomach and intestines, to find them in the appendix is extremely rare. In this instance, as the growth of this mass of lesions was more predominant in the wall rather than in intraluminal area, it was decided that pseudotumor was the appropriate term to describe this case.

Adult↗

PubMed1988

Goblet cell carcinoids of the appendix.

A review of goblet cell carcinoid of the appendix was undertaken. This interesting tumor appears to lie somewhere between an ordinary carcinoid and a well differentiated adenocarcinoma of the appendix in regard to its biologic behavior. The histologic features of the goblet cell carcinoid of the appendix are distinctive enough to facilitate a diagnosis, although the histogenesis remains controversial and unsettled. The prognosis is generally good in a patient treated by simple appendectomy, the treatment of choice in the majority of patients.

Acute Disease↗

PubMedDate not supplied

Endometriosis of the appendix.

Endometriosis has been encountered in different sites of the gastrointestinal tract. Involvement of the vermiform appendix, however, is rather unusual. Two cases of appendiceal endometriosis are reported in the present study: one patient had symptoms simulating acute appendicitis; in another patient it was an incidental finding during pelvic surgery. There are no clinical signs and findings pathognomonic of endometriosis of the appendix, but the condition may present as appendicitis. At surgery, the diagnosis can only be suspected when it is associated with obvious genital endometriosis. Correct diagnosis is established by microscopic examination of the lesion. Symptomatic endometriosis of the appendix will be cured by appendectomy.

Adenocarcinoma↗

PubMedDate not supplied

[Carcinoid tumor of the appendix in children].

Carcinoid tumor of the appendix has been known since 1808, and currently we know that it may appear all along the intestinal tract, biliary tree, ovaries, bronchi, lungs and pancreas. It is usually uncommon during infancy, representing 1.8% of all the tumors of the intestinal tract, approximately 70% of the appendiceal tumors and 0.16 to 0.7% of all operated appendixes. It is more frequent in females. With no typical clinical picture, it is usually an incidental finding, as well as a cause of inflammatory processes of the appendix. When the diameter is less than 1.0 cm, the treatment of choice is appendectomy; and in tumors of larger size, surgery is more extensive. Two cases are reported.

Appendectomy↗

PubMed1983

Adenocarcinoma of the vermiform appendix: retrospective study and literature review.

Adenocarcinoma of the vermiform appendix is a rare clinical entity, fewer than 200 cases having been reported. The authors carried out a retrospective review over a 25-year period and found five patients admitted to the Vancouver General Hospital with primary appendiceal adenocarcinoma. Four other patients, initially reported as having appendiceal adenocarcinoma, were found after critical microscopic review to have had either benign disease or mucinous carcinoid. Primary epithelial neoplasms of the appendix demonstrate a wide variety of histologic types and because of the different clinical behaviour, an accurate diagnosis must be made. For the benign tumours, appendectomy alone will suffice but for adenocarcinoma of the appendix, right hemicolectomy is recommended.

Adenocarcinoma↗

PubMed1984

The appendix stump: should it be invaginated?

In a prospective trial of 103 patients undergoing appendicectomy, one group of patients had the appendix stump treated by ligation alone and the other group underwent ligation and invagination. The two groups of patients were similar with respect to age, sex, incision and degree of inflammation of the appendix. Perforated appendices were excluded and in neither group were drains used or antibiotics given. No significant difference between the two methods of treatment of the appendix stump was noted, either with respect to wound infection or postoperative stay in hospital.

Adolescent↗

PubMed1984

[Carcinoid tumors of the appendix and small intestine as unusual secondary findings during gynecologic operations in and outside of pregnancy].

Report is given on 9 patients suffering from a carcinoid observed at the Department of Gynecology of the Medical Academy of Erfurt from 1963 till 1982: one carcinoid of the small intestine with metastases and abdominal syndrome and eight cases with carcinoid of appendix. Two of these during pregnancy and the carcinoid of small intestine show the difficulties of the differential diagnosis and the possible combinations in face of gynecologic diseases. In 2 cases of carcinoid of the appendix during pregnancy the children didn't show any malformations. On the strength of supervision of the course we think in accordance to the international literature the sole appendectomy will be sufficient. Nevertheless we make demands for a careful investigation and palpation of the appendix in all gynecologic operations and if necessary the appendectomy.

Adolescent↗