Specialespecifikt kursus i Patologisk Anatomi 2009: Fordøjelseskanalens patologi APPENDIX

Transcription

1 Specialespecifikt kursus i Patologisk Anatomi 2009: Fordøjelseskanalens patologi APPENDIX

2

3

4 Appendix Occurrence of lesions (%) Acute appendicitis 72 Normal 16 Fibrosis 3 (Cyst-)Adenoma 3 Diverticulitis 2 Periappendicitis 1 Hyperplastic polyp 1 Chronic appendicitis 1 Metastatic carcinoma 1 Carcinoid tumour 0.4 Endometriosis 0.3 Granulomatous inflam. 0.2 Adenocarcinoma 0.1 Aalborg : ~ 4,400 elective appendectomies Primary diagnosis only

5 Appendix - examination Lenght Normal: 5 12 cm (2 20) Diameter Normal: ~ 0.7 cm Serosal and cut surface Discoloration and exsudate Diverticula Tumor Fecalith

6 Appendix - examination Alternating longitudinal and transverse sections

7

8 Appendix - examination

9 Idiopathic acute appendicitis Life time risk: 5% Peak age: y Range: From neonatal to ancient Pathogenesis: Luminal obstruction infection Fecalith, food fragments, lymphoid hyperplasia, tumour

10 Gross: hyperaemia fibrinopurulent ex. black pus in lumen ectatic lumen ulceration perforation

11 Idiopathic acute appendicitis Histology (classic) Erosion Crypt abscesses Ulceration Mucosal neutrophilic infiltration Transmural neutrophilic infiltration Myocytolysis

12

13 Idiopathic acute appendicitis Acute superficial Acute (NOS) Acute phlegmonous Acute necrotitizing Gangrene

14 Complications of acute appendicitis Perforation 25% (higher in young and old) Periappendiceal absces 5% Pylephlebitis Hepatic absces

15 Protracted inflammation Resolution Crypt distortion Chronic inflammation Granulomatous inflammation Submucosal fibrosis Luminal obliteration Neuronal hyperplasia

16 Protracted inflammation Resolution Crypt distortion Chronic inflammation Granulomatous inflammation Submucosal fibrosis Luminal obliteration Neuronal hyperplasia

17 Protracted inflammation Resolution Crypt distortion Chronic inflammation Granulomatous inflammation Submucosal fibrosis Luminal obliteration Neuronal hyperplasia

18 Protracted inflammation Resolution Crypt distortion Chronic inflammation Granulomatous inflammation Submucosal fibrosis Luminal obliteration Neuronal hyperplasia

19 Protracted inflammation Resolution Crypt distortion Chronic inflammation Granulomatous inflammation Submucosal fibrosis Luminal obliteration Neuronal hyperplasia

20 Protracted inflammation Resolution Crypt distortion Chronic inflammation Granulomatous inflammation Submucosal fibrosis Luminal obliteration Neuronal hyperplasia

21 Appendix diverticulitis 90% of diverticuli acquired Often secondary to luminal obstruction Often multiple Localized inflammation Early perforation Older patients Protracted course

22

23 Appendix infections Bacterial infections Yersinia spp. Salmonella Shigella Campylobacter Actinomyces Viral infections Morbilli Parasitic infections Enterobius vermicularis

24 Appendiceal infections Enterobius

25 Appendiceal infections Yersiniosis

26 Appendiceal infections Yersiniosis

27 Appendiceal infections Yersiniosis

28 Appendix Chronic inflammatory bowel disease Crohn s disease 25-50% of Crohn s patients have granulomas in appendix <5% of granulomatous appendix have Crohn s disease Isolated appendiceal Crohn s disease dubious entity! Ulcerative colitis may appear without right colon involvement!

29 Appendix endometriosis & endosalpingiosis MLH1 MSH2

30 Hyperplastic polyp of appendix Varying from small to involving the whole mucosa Normal nuclei No stratification

31 Appendix tubular adenoma Rare Associated with colon adenomas and FAP

32 Appendix tubular adenoma

33 Appendix villous adenoma Female preponderance (20-) y Gross: Mucosal thickening, mucocele Histology: Diffuse mucosal involvement Cystadenoma Complication: Pseudomyxoma peritonei

34 Appendix villous adenoma

35 Appendix villous adenoma & pseudomyxoma

36 Appendix villous adenoma & pseudomyxoma appendix serosa CK20 bladder wall

37 Appendix villous adenoma & pseudomyxoma

38 Appendix villous adenoma & pseudomyxoma

39 Appendix villous adenoma & pseudomyxoma

40 Appendix villous adenoma & pseudomyxoma

41 Appendix adenocarcinoma Classic colon like adenocarcinoma cystadenocarcinoma Goblet cell carcinoid = crypt cell carcinoma Signet ring cell carcinoma Complication: Pseudomyxoma peritonei

42 Appendix adenocarcinoma

43 Appendix adenocarcinoma MLH1 MSH2

44 Appendix mucocele Etiology Hyperplastic polyp Villous adenoma Adenocarcinoma

45 Appendix other neoplasms: B-cell lymphoma MLH1 T-cell rich B-cell lymphoma MSH2 IgKappa

46

47

48

49