Clinicopathological Data of the 16 Study Patients These patients should undergo colonoscopy 6 weeks after surgery to exclude the possibility of a coexistent colorectal cancer. The odds ratio of colon cancer incidence had a 38.5-fold increase among patients older than 40 with acute appendicitis.Ĭonclusions: In patients over 40 years who present with symptoms of acute appendicitis the possibility of a coexistent colonic neoplasm should always be kept in mind. From the Taiwan Cancer Research Annual Report, the incidence of colon cancer was 31.91/100 000 in the year 2000. The time from appendectomy to the recognition of colonic cancer was at a median delay of 5.8 months. The incidence of appendicitis associated with colon cancer was 0.85%. Results: A total of 1873 patients were diagnosed as having appendicitis of whom 16 were found to have colon cancer. Patients found to have colon cancers immediately or subsequently after appendectomy were included and analyzed. Patients diagnosed with acute appendicitis from January 1998 to December 2003 at the Taipei Veterans General Hospital were surveyed. The association between appendicitis and colon cancer has not been sufficiently investigated, and this study was designed to clarify this association. Tumors could obstruct this lumen and cause appendicitis in the elderly. 1986 10:801–15.Background and Aim: Obstruction of the lumen of the appendix is the major cause of appendicitis. A light-microscopic, immunohistochemical and electron microscopic study of 20 cases. Stanley MW, Cherwitz D, Hagen K, Snover DC. ![]() Neurogenous hyperplasia leading to appendiceal obliteration: an immunohistochemical study of 237 cases. Franke C, Gerharz CD, Bohner H, Ohmann C, Heydrich G, Krämling HJ, et al.“Extraepithelial enterochrmaffin cell- nerve fibre complexes” in the normal appendix, and in neurogenic appendicopathy. Carcinoids (argentaffin-cell tumours) and nerve hyperplasia of the appendicular mucosa. As neurogenic appendicopathy can be diagnosed only histologically, it is to be encouraged that all appendicectomy specimens, even when macroscopically unremarkable should be examined. Neuromas usually show endocrine cells within the hypertrophied nerve bundles which may be the cells of origin for carcinoid tumor. Some authors believe that these may be secondary to hyperplasia of neuroendocrine cells. The pathogenesis of the process remains unknown. Most cases of so called fibrous obliteration actually represent appendiceal neuroma. The spindle cells are positive for S-100 protein and neuron-specific enolase in all cases. Majorities are located centrally in the appendix without nodule formation but occasional cases present with central nodularity. On lightmicroscopy, 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. Repeated minimal subclinical attacks of inflammation are thought to trigger this lesion. Predominantly fibrotic specimens are considered as end-stage of this process. ![]() There is continuum of the disease process from appendices with intact lumens, featuring intramucosal neurogenous hyperplasia to obliterated specimens whose axial portions are composed of varying proportions of nerve tangles and fibrous tissue. History and clinical examination cannot differentiate preoperatively between acute appendicitis and neurogenic appendicopathy. Neurogenous hyperplasia is a histopathological entity that can be identified by hematoxylin-eosin staining. In addition, there was an increased number of Schwann cells along with fibroblasts in submucosa admixed with few lymphomononuclear cells suggesting repeated attacks of inflammation which might be asymptomatic. These cells were confirmed to be Schwann cells by S-100 immunoreactivity (Figure 1c). The lesion was composed of proliferating spindle cells arranged in short fascicles with elongated, wavy nuclei (Figure 1b). Microscopic examination of the section from the tip revealed a circumscribed nodular lesion (Figure 1a) completely disrupting the mucosa and obliterating the lumen. The wall of appendix was thickened throughout its length with complete fibrous obliteration of the distal tip of the appendix. Grossly, the appendix measured 5 cm in length. We report an incidental finding of an appendiceal neuroma in a 40-year-old male where intestinal resection was done following traumatic intestinal perforation. It represents a hyperplastic proliferation of unmyelinated nerves and Schwann cells, possibly due to an increased number of extra-epithelial enteroendocrine cells. Neurogenous hyperplasia of the appendix or appendiceal neuroma, first described by Pierre Masson in 1928 is a relatively common entity characterized by obliteration of the lumen of the appendix by proliferation of neural tissue.
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