Significance of acquired diverticular disease of the vermiform appendix: a marker of regional neoplasms?

2012 ◽  
Vol 65 (7) ◽  
pp. 638-642 ◽  
Author(s):  
Klaus Kallenbach ◽  
Sofie Vetli Hjorth ◽  
Ulla Engel ◽  
Nis Hallundbæk Schlesinger ◽  
Susanne Holck
Keyword(s):  
Diverticular Disease ◽  
Vermiform Appendix ◽  
Diagnostic Process ◽  
Pathology Report ◽  
Colorectal Carcinomas ◽  
Valuable Contribution ◽  
Appendiceal Neoplasms ◽  
Neoplastic Lesions ◽  
Putative Marker ◽  
Space Occupying Lesion

AimTo assess the prevalence of acquired diverticulum of the appendix (DA), including incipient forms and its possible significance as a marker of local/regional neoplasms.Materials and MethodsThe pathology database at Hvidovre Hospital was searched for appendix specimens, received between 2001 and 2010, coded for DA or for a space-occupying lesion. Slides were reviewed to determine DA status and the nature of lesions possibly causing DA.ResultAmong 4413 appendix specimens, DA were identified in 39 (0.9%, CI 0.6% to 1.2%) cases, 17 (43.6%, 28.0% to 59.2%) of which additionally harboured an appendiceal neoplasm/neoplastic precursor, whereas this figure was 1.2% (CI 0.9% to 1.6%) for non-DA specimens (p<0.0001). Six of the 39 DA specimens comprised incipient DA, three of which coexisted with appendiceal neoplasms. In addition, local/regional non-neoplastic lesions (six cases) and colorectal carcinomas (four cases) coexisted with DA.ConclusionDA has significance as a putative marker of local/regional neoplasms. Therefore, a DA specimen proved significantly more likely to harbour a neoplastic growth than a non-DA counterpart. Submission for microscopy of the entire DA specimen, whether transmural or only incipient, and a comment in the pathology report on the occasional concurrence of local/regional neoplasms in this setting seem appropriate. The observation of DA may thus provide a valuable contribution in the diagnostic process.

scholarly journals Diverticular Disease of the Appendix Is Associated with Complicated Appendicitis

2020 ◽  
pp. 1-7
Author(s):  
Ming Li Chia ◽  
Shaun Wen Yang Chan ◽  
Vishal G. Shelat
Keyword(s):  
Diverticular Disease ◽  
Clinical Pathology ◽  
Vermiform Appendix ◽  
Complicated Appendicitis ◽  
Perioperative Outcomes ◽  
Alvarado Score ◽  
Single Center Experience ◽  
Modified Alvarado Score ◽  
Qsofa Score ◽  
Sirs Criteria

<b><i>Introduction:</i></b> Diverticular disease of the vermiform appendix (DDA) has an incidence of 0.004 to 2.1% in appendicectomy specimens. DDA is variably associated with perforation and malignancy. We report a single-center experience of DDA. The primary aim is to validate the association of DDA with complicated appendicitis or malignancy, and the secondary aim is to validate systemic inflammatory response syndrome (SIRS) criteria and quick Sepsis-related Organ Failure Assessment (qSOFA) scores. <b><i>Methods:</i></b> The histopathology reports of 2,305 appendicectomy specimens from January 2011 to December 2015 were reviewed. Acute appendicitis was found in 2,164 (93.9%) specimens. Histology of the remaining 141 (6.1%) patients revealed: normal appendix (<i>n</i> = 110), DDA (<i>n</i> = 22), endometriosis of appendix (<i>n</i> = 6), and an absent appendix (<i>n</i> = 3). Patient demographics, clinical profile, operative data, and perioperative outcomes of DDA patients are studied. Modified Alvarado score, Andersson score, SIRS criteria, and qSOFA scores were retrospectively calculated. <b><i>Results:</i></b> The incidence of DDA was 0.95%. Ten patients (45.5%) had diverticulitis. The mean age of DDA patients was 39.5 years (range 23–87), with male preponderance (<i>n</i> = 12, 54.5%). The median Modified Alvarado score was 8 (range 4–9), and the median Andersson score was 5 (range 2–8). Fourteen patients (63.6%) had SIRS, and none had a high qSOFA score. Eight patients (36.4%) had complicated appendicitis (perforation [<i>n</i> = 2] or abscess [<i>n</i> = 6]). Eleven (50%) patients underwent laparoscopic appendicectomy. There were three 30-day readmissions and no mortality. <b><i>Conclusion:</i></b> DDA is a distinct clinical pathology associated with complicated appendicitis.

scholarly journals Acquired Diverticulosis of the Vermiform Appendix: A Rare Case Report

2021 ◽  
Author(s):  
Saeedeh Hosseini ◽  
Nakisa Niknejad ◽  
Arash Dehghan ◽  
Nasim Niknezhad ◽  
Sorena Hedayati
Keyword(s):  
Diverticular Disease ◽  
Laboratory Data ◽  
Vermiform Appendix ◽  
Definitive Treatment ◽  
Lower Quadrant Pain ◽  
Abdominal Sonography ◽  
Lower Quadrant ◽  
Chronic Appendicitis ◽  
Right Lower Quadrant Pain ◽  
Presenting Symptoms

Diverticulosis of the appendix, as a rare and incident disorder, mimics acute or chronic appendicitis and is characterized by herniation of the appendiceal mucosa through the muscular wall. Symptom and laboratory data of diverticular disease usually represent chronic inflammation. In this study, a 43-year-old female with a history of right lower quadrant pain and anorexia represented abdominal tenderness and rebound tenderness in the physical examination and normal laboratory tests. Abdominal sonography did not show any evidence of acute appendicitis. The removed appendix was 12 cm in length and had multiple diverticular protrusions along with it. The histologic examination showed diverticulosis without evidence of inflammation. The patient was discharged two days later in optimal clinical condition. Diverticulosis of the appendix often is confused with acute or chronic appendicitis based on similar presenting symptoms and imaging studies. Although surgery is the definitive treatment of both conditions, an appropriate diagnosis of diverticular disease before surgery is very important because of the association of appendiceal diverticular disease with neoplasm and other complications.

Diverticular disease of the vermiform appendix: a diagnostic clue to underlying appendiceal neoplasm

2008 ◽  
Vol 39 (12) ◽  
pp. 1823-1826 ◽  
Author(s):  
Marc P. Dupre ◽  
Irfan Jadavji ◽  
Evan Matshes ◽  
Stefan J. Urbanski
Keyword(s):  
Diverticular Disease ◽  
Vermiform Appendix ◽  
Appendiceal Neoplasm ◽  
Diagnostic Clue

Diverticular disease of the vermiform appendix

Surgery ◽  
2014 ◽  
Vol 155 (5) ◽  
pp. 954-955
Author(s):  
Gianpiero Gravante ◽  
Sonpreet Rai ◽  
Vijay Jadhav
Keyword(s):  
Diverticular Disease ◽  
Vermiform Appendix

scholarly journals Lipoid Proteinosis: A Rare Disease In Pediatric Dentistry

2020 ◽  
Vol 31 (2) ◽  
pp. 186-189
Author(s):  
Alan Grupioni Lourenço ◽  
Vera Cavalcanti Araújo ◽  
Fabricio Passador-Santos ◽  
Marcelo Sperandio ◽  
Brad Wesley Neville ◽  
...  
Keyword(s):  
Buccal Mucosa ◽  
Histopathological Examination ◽  
Periodic Acid ◽  
Female Child ◽  
Pediatric Dentistry ◽  
Diagnostic Process ◽  
Pathology Report ◽  
Periodic Acid Schiff ◽  
Lower Lip ◽  
Lipoid Proteinosis

Abstract This report describes the diagnostic process of a rare disorder in a Brazilian female child. The patient presented initially as a 7-year-old with multiple whitish submucosal nodules of a fibrous consistency in the lower lip, but with an inconclusive pathology report. When she turned 9 years of age, she presented with exacerbation of the original clinical findings, which then involved the upper lip, buccal mucosa, tongue and lingual frenulum. In addition, dermatological lesions were noted on the child’s limbs and face, as well as a hoarse voice. Histopathological examination of the buccal mucosa revealed dense connective tissue with hyaline foci, which were positive with periodic acid-Schiff (PAS) staining and resistant to diastase digestion. Clinical and histopathological findings led to the diagnosis of a rare genetic disease with fewer than 300 reported cases - lipoid proteinosis. Magnetic resonance imaging revealed calcium deposits in her amygdaloid region of the brain, and nasopharyngolaryngoscopy revealed lesions in her vocal cords. The patient currently is stable and under multidisciplinary follow-up, but no treatment has been recommended to date.

scholarly journals Diverticular Disease of the Vermiform Appendix - Is it a Distinctive ClinicoPathological Entity?

2021 ◽  
Vol 02 ◽  
Author(s):  
Offir Ben-Ishay ◽  
Narmeen Abdalqader ◽  
Yaniv Zohar ◽  
Yoram Kluger
Keyword(s):  
Diverticular Disease ◽  
Clinical Presentation ◽  
Cohort Analysis ◽  
Postoperative Bleeding ◽  
Disease Process ◽  
Postoperative Outcome ◽  
Vermiform Appendix ◽  
Control Group ◽  
Definition Of ◽  
Postoperative Mechanical Ventilation

Background: Diverticular disease of the appendix [DDOA] is a rare occurrence. Although acquired in nature, its impact on the disease process of appendicitis is not well-defined. The purpose of the current study is to include a comprehensive clinico-pathological definition of the disease through a retrospective single-center cohort analysis with a prospective pathological re-evaluation. Methods: A retrospective analysis of post-appendectomy patients over a period of 16 years [2000-2015] was carried out. Patients with DDOA were identified and compared to a control group of patients with acute appendicitis. Histology was re-evaluated prospectively by a senior pathologist. Primary measures of the outcome included clinical and surgical differences. Pathological macroscopic differences between the two groups and a comprehensive description of the DDOA itself were performed. Results: 6846 post appendectomy patients were operated on during the study period, and 127 [1.9%] were diagnosed with DDOA. The DDOA group showed significantly higher age, longer duration of complaints, and a different clinical presentation. Operative time was significantly longer in the study group and had higher rates of severe postoperative complications such as postoperative bleeding, need for ICU recovery, and need for postoperative mechanical ventilation. All diverticula were pseudo-diverticula and were significantly shorter and wider. Multivariate analysis showed that age, length, and width of the appendix were independently associated with DDOA. Conclusions: The results of this study suggest that DDOA is an independent clinical entity, showing differences in etiology, clinical presentation, and postoperative outcome. Prospective studies are needed to assess whether the preoperative diagnosis is feasible and will change conventional surgical management.

scholarly journals Impact of Referral Center Pathology Review on Diagnosis and Management of Patients With Appendiceal Neoplasms

2019 ◽  
Vol 144 (6) ◽  
pp. 764-768 ◽  
Author(s):  
Jolanta Jedrzkiewicz ◽  
Yoko Tateishi ◽  
Richard Kirsch ◽  
James Conner ◽  
Danielle Bischof ◽  
...  
Keyword(s):  
Goblet Cell ◽  
Clinical Management ◽  
Tertiary Care ◽  
Low Grade ◽  
Goblet Cell Carcinoid ◽  
Referral Center ◽  
Appendiceal Neoplasm ◽  
Appendiceal Neoplasms ◽  
Neoplastic Lesions ◽  
Pathology Review

Context.— Data regarding the clinical impact of subspecialist pathology review of appendiceal neoplasms are limited. Objective.— To determine whether pathology review by gastrointestinal pathologists at a tertiary-care referral center resulted in significant changes in the diagnosis and clinical management of appendiceal neoplastic lesions. Design.— We conducted a retrospective review of all patients with an initial diagnosis of appendiceal neoplasm referred to a tertiary-care referral center in Ontario, Canada, from 2010–2016. The discordance rate between original and review pathology reports, the nature of discordances, and the impact of any discordance on patient management were recorded. Results.— A total of 145 patients with appendiceal lesions were identified (low-grade mucinous appendiceal neoplasm [n = 79], invasive mucinous adenocarcinoma [n = 12], “colorectal type” adenocarcinoma [n = 12], goblet cell carcinoid and adenocarcinomas ex goblet cell carcinoid [n = 24], and other lesions/neoplasms [n = 20]). One or more changes in diagnoses were found in 36 of 145 cases (24.8%), with changes within the same category of interpretation (n = 10), stage (n = 7), grade (n = 6), and categoric interpretation (n = 5) being the most common. In 10 of 36 patients (28%), the diagnostic change led to a significant change in management, including recommendation for additional surveillance, systemic chemotherapy, additional surgery, or discontinuation of surveillance. Conclusions.— Subspecialist pathology review of appendiceal neoplastic lesions led to a change in diagnosis in 36 of 145 cases (24.8%), of which nearly 30% (10 of 36 cases) led to a change in clinical management. The overall rate of clinically significant discordances was 7% (10 of 145). Our findings suggest that subspecialist pathology review of appendiceal neoplasms referred to specialized centers is justified.

scholarly journals Incidental Colorectal Computed Tomography Abnormalities: Would You Send every Patient for a Colonoscopy?

2008 ◽  
Vol 22 (9) ◽  
pp. 758-760 ◽  
Author(s):  
Edy Stermer ◽  
Alexandra Lavy ◽  
Tova Rainis ◽  
Omer Goldstein ◽  
Dean Keren ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Diverticular Disease ◽  
Occult Blood ◽  
Wall Thickening ◽  
Fecal Occult Blood ◽  
Abdominal Ct ◽  
Colorectal Tumour ◽  
Fecal Occult ◽  
Neoplastic Lesions ◽  
History Of

BACKGROUND: The clinical significance of colorectal wall thickening (CRWT) in patients undergoing abdominal computed tomography (CT) has not yet been definitively established.OBJECTIVES: To compare alleged findings on abdominal CT with those of a follow-up colonoscopy.METHODS: Ninety-four consecutive patients found to have large-bowel abnormalities on abdominal CT were referred for colonoscopy. Of these patients, 48 were referred for a suspected colorectal tumour and 46 for CRWT. Colonoscopy was performed and findings were compared.RESULTS: Of the 48 suspected colorectal tumours, 34 were determined to be neoplastic lesions on colonoscopy. Of these, 26 were malignant and eight were benign. Colonoscopy revealed no abnormality in 30 of 46 patients with CRWT as a solitary finding, and revealed some abnormality in 16 patients (12 had diverticular disease, four had benign neoplastic lesions).CONCLUSIONS: CRWT as an incidental and solitary finding on CT should not be regarded as a pathology prompting a colonoscopy. Approximately two-thirds of the patients had a normal colonoscopy and the remaining patients had benign lesions (12 had diverticular disease and four had benign neoplastic lesions). However, many of these patients seem to warrant colonoscopy regardless of CT findings, particularly patients who have a family history of colorectal cancer, have positive fecal occult blood test results or who are older than 50 years of age.

scholarly journals Clinicopathological Study of 25 Cases of Diverticular Disease of the Appendix: Experience from Farwaniya Hospital

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Nabeel Al-Brahim ◽  
Ibrahim Al-Kandari ◽  
Musaad Munahai ◽  
Prem Sharma
Keyword(s):  
Acute Appendicitis ◽  
Rare Disease ◽  
Diverticular Disease ◽  
Relevant Information ◽  
Control Group ◽  
Adult Age ◽  
Factors Associated ◽  
Appendiceal Neoplasms ◽  
The Mean ◽  
Male Sex

Background. Diverticular disease of the appendix (DDA) is a rare disease and it has been shown to be associated with locoregional neoplasms. This study was conducted to characterize clinicopathological features and to investigate its association with appendiceal neoplasms. Methods. We searched the records of the Department of Pathology at Farwaniya Hospital for cases of diverticular disease of the appendix between 2003 and 2011. Histological slides and patient charts were reviewed for relevant information. Consecutive cases of acute appendicitis were selected as a control group. Results. We identified 25 cases of DDA, 24 of which occurred in men. Mean age of DDA patients was 35 ± 10.1 years and was significantly greater than that of appendicitis patients (P=0.027). The mean temperature of cases (37.9°) was significantly higher (P=0.012) than that of the controls (37.3°). The cases had lower white blood cell (WBC) counts compared to controls (13.6 versus 16.7, P=0.04). Pathological diagnosis identified 4 cases of diverticulosis, 5 cases of diverticulitis, 6 cases of diverticulosis with acute appendicitis, and 10 cases of diverticulitis and appendicitis. None of the cases was associated with any type of neoplasm. Conclusions. DDA is a rare disease, and clinicians and radiologists should be aware of it. Male sex and adult age seem to be risk factors associated with DDA. The disease may not have any direct association with any neoplasm.

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