Neuroendocrine apendicopathy in morphologically normal appendices of patients with diagnosis of acute appendicitis: Diagnostic study

Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia, M. KAPITONOVA, I.B. BROHI, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia, S. GUPALO, Saint James School of Medicine, Valley, Anguilla, A.V. SMIRNOV, 3 Volgograd State Medical University, Volgograd, Russian Federation, V.S. PETRENYUK, Municipal Clinical Emergency Hospital № 7, Volgograd, Russian Federation, A. AHMAD, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Malaysia. THE ROLE OF SCHWANN CELLS IN THE PATHOLOGY OF THE HUMAN APPENDIX IN CHILDREN

Objective: To compare the immunohistochemical (IHC) characteristics of appendices removed from children with acute appendicitis and chronic pain syndrome (CP) in the right lower quadrant of the abdomen (RLQA), as well as to define clinical and morphological correlations. Methods: The structure of fifty-one appendices of children aged 5-14 years who underwent appendectomy for chronic appendicitis/CP in the RLQA (24 patients, Group 1) and acute appendicitis (27 patients, Group 2) was assessed. Image analysis of histological sections stained with hematoxylin-eosin and immunohistochemically for S100 protein and proliferating cell nuclear antigen (PCNA) was performed. Results: Image analysis showed the presence of a significantly higher volume density (VD) and numerical density (ND) (p0.05) of immunoreactive cells when stained for S100 protein, as well as the ND of intramural ganglia (p0.05) against the background of minimal histological changes in the wall of the appendix in patients of Group 1 compared to Group 2. On the contrary, the ND of PCNA-immunoreactive cells was significantly higher in patients of Group 2 against the background of pronounced inflammatory changes in the appendix (p0.01). In the biopsy samples of the Group 1 patients, a significantly higher ND of the lymphoid nodule germinal centers was also noted (p0.05), while the ND of tingible body macrophages was higher in Group 2 patients (p0.001). These results demonstrate differences in neuroimmune parameters in the appendices in the two described nosologic groups and indicate the possible role of the appendiceal neural component as a prerequisite for developing CP in the RLQA in children. Keywords: Appendix, Schwann cell, S100 protein, PCNA, appendicitis, chronic abdominal syndrome.

Differences between inflamed and non inflamed appendices diagnosed as acute appendicitis

Background

Despite the great advances in diagnostic methods, the incidence of the surgical removal of a morphologically normal appendix in patients with clinical and complementary signs of acute appendicitis continues to exceed 20%. This study aimed to compare the clinical, laboratory, and ultrasound findings of inflammatory and noninflammatory appendiceal disorders diagnosed as acute appendicitis.

Methods

The medical records of 208 patients with clinical, laboratory, and ultrasound findings indicative of acute appendicitis were studied. The patients were divided into two groups: group 1 comprising 94 patients whose appendicular histological results suggested a normal appendix and group 2 comprising 114 patients with histopathological tests confirming acute appendicitis. The variables analyzed were age at the time of surgery, sex, nausea and vomiting, inappetence, fever, pain migrating to the right iliac fossa, pain on palpation of the right iliac fossa, Blumberg's sign, blood counts, ultrasound findings, and Alvarado score.

Results

An inflamed appendix was associated with inappetence, pain on palpation of the right iliac fossa, appendiceal diameter >6 mm, and Alvarado score >6 (p < 0.001). In contrast, fever was more frequently found in noninflammatory appendiceal disorders (p < 0.001).

Conclusion

Inappetence, pain on palpation of the right iliac fossa, appendiceal diameter > 6 mm, and Alvarado score > 6 indicate an inflammatory appendiceal disease, whereas fever is more often present in noninflammatory appendiceal diseases.