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Vietsch EE, Latifi D, Verheij M, van der Oost EW, de Wilde RF, Haen R, van den Boom AL, Koerkamp BG, Doornebosch PG, van Verschuer VM, Ooms AH, Mohammad F, Willemsen M, Aerts JG, Krog RT, de Miranda NF, van den Bosch TP, Mueller YM, Katsikis PD, van Eijck CH. B cell immune profiles in dysbiotic vermiform appendixes of pancreatic cancer patients. Front Immunol 2023; 14:1230306. [PMID: 38022530 PMCID: PMC10667699 DOI: 10.3389/fimmu.2023.1230306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains one of the deadliest solid tumors and is resistant to immunotherapy. B cells play an essential role in PDAC progression and immune responses, both locally and systemically. Moreover, increasing evidence suggests that microbial compositions inside the tumor, as well as in the oral cavity and the gut, are important factors in shaping the PDAC immune landscape. However, the gut-associated lymphoid tissue (GALT) has not previously been explored in PDAC patients. In this study, we analyzed healthy vermiform appendix (VA) from 20 patients with PDAC and 32 patients with colon diseases by gene expression immune profiling, flow cytometry analysis, and microbiome sequencing. We show that the VA GALT of PDAC patients exhibits markers of increased inflammation and cytotoxic cell activity. In contrast, B cell function is decreased in PDAC VA GALT based on gene expression profiling; B cells express significantly fewer MHC class II surface receptors, whereas plasma cells express the immune checkpoint molecule HLA-G. Additionally, the vermiform appendix microbiome of PDAC patients is enriched with Klebsiella pneumoniae, Bifidobacterium animalis, and Adlercreutzia equolifaciens, while certain commensals are depleted. Our findings may suggest impaired B cell function within the GALT of PDAC patients, which could potentially be linked to microbial dysbiosis. Additional investigations are imperative to validate our observations and explore these potential targets of future therapies.
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Affiliation(s)
- Eveline E. Vietsch
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, Netherlands
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Diba Latifi
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Maaike Verheij
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | | | - Roel Haen
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Anne Loes van den Boom
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
- Department of Surgery, Reinier de Graaf Hospital, Delft, Netherlands
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | | | | | - Ariadne H.A.G. Ooms
- Department of Pathology, Pathan BV, Rotterdam, Netherlands
- Department of Pathology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Farzana Mohammad
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Marcella Willemsen
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Joachim G.J.V. Aerts
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, Rotterdam, Netherlands
| | - Ricki T. Krog
- Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | | | | | - Yvonne M. Mueller
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Peter D. Katsikis
- Department of Immunology, Erasmus University Medical Center, Rotterdam, Netherlands
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Patra A, Kaur H, Chhabra U, Sghar A, Balawender K, Pasternak A, Walocha JA. Reappraisal of the variational anatomy of the vermiform appendix and their possible clinical applicability: a cadaveric analysis. Folia Morphol (Warsz) 2023:VM/OJS/J/96443. [PMID: 37691509 DOI: 10.5603/fm.96443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND The anatomical variations in the position, length, arterial supply and extension of mesoappendix of the vermiform appendix (VA) are pivotal to establishing a standard pattern in the study population of known ethnicity and their clinical applicability. MATERIALS AND METHODS The present study was conducted on 47 adult human cadavers, thirty-five males and twelve female subjects of North Indian ethnicity. RESULTS Retrocaecal appendix was found in 23 cases (48.9%) followed by pelvic in 13 (27.7%), three cases each of pre-ileal, post-ileal, and promontoric (6.4%), one case (2.1%) each of paracaecal and subcaecal reported. The length of VA varied from three to ten centimetres, averaging about 7.37±1.67 cm, both the shortest (2.9 cm) (female) and longest (10 cm) (male) were of retrocaecal type. The main appendicular artery (MAA) showed a widely varied branching pattern within the mesoappendix, ranging from three to seven. Fourteen cases (29.78%) showed the accessory appendicular artery (AAA) or dual arterial supply, arising from the ileocolic artery in ten (21%) and in four from the post-caecal (9%). In the specimens with dual arterial supply, the estimated portions of the VA supplied by the MAA also vary with distal ¾th being supplied in 57.14%. In ten cases (21%), the mesoappendix failed to reach the tip of the VF. CONCLUSIONS Knowledge of anatomical diversities in position, length, course, arterial supply, branching pattern, and mesoappendix is potentially crucial in avoiding surgical catastrophes. Atypical positions of the organ can cause diagnostic confusion and result in delayed treatment. VF supplied by an end artery is one of the causes of the occurrence of appendicitis and mesoappendix not reaching the tip making the organ more vulnerable to necrosis. Vascular variations and anomalies involving the main or accessory appendicular artery are critical to prevent haemorrhage or faulty ligatures.
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Affiliation(s)
- Apurba Patra
- Department of Anatomy, All India Institute of Medical Sciences, Bathinda, India
| | - Harsimarjit Kaur
- Department of Anatomy, Government Medical College, Patiala, India
| | - Usha Chhabra
- Department of Anatomy, Government Medical College, Patiala, India
| | - Adil Sghar
- Department of Anatomy, All India Institute of Medical Sciences, Patna, India
| | - Krzysztof Balawender
- Department of Normal and Clinical Anatomy, Medical University of Rzeszow, Poland
| | - Artur Pasternak
- Department of Anantomy, Jagiellonian University Medical College, Krakow, Poland
| | - Jerzy A Walocha
- Department of Anantomy, Jagiellonian University Medical College, Krakow, Poland.
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Mohammad AA. The human vermiform appendix: morphological and anatomical review. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2023; 31:990-995. [PMID: 37898889 DOI: 10.32687/0869-866x-2023-31-5-990-995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 05/30/2023] [Indexed: 10/31/2023]
Abstract
The article covers aspects of morphological, anatomical, embryological, histological aspects and origin, types, blood supply, innervation, lymph drainage of human vermiform appendix. The purpose of the study is to understand real function and to summarize this information for positive impact on clinical decision in case of appendicitis. Although characteristic features of normal and diseased appendix have been reported for many previous centuries, it still the most common challenge facing every day in operation room. The appendectomy, commonest surgical emergency procedure, may cause little confusion in surgeons due to highly variable situations of it inside the abdominal cavity. However, the recent imaging techniques have increased ability of surgeon for crucial diagnosis of the diseased appendix.
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Affiliation(s)
- A A Mohammad
- The Tikrit University College of Medicine, 28001, Tikrit, Iraq,
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Constantin M, Petrescu L, Mătanie C, Vrancianu CO, Niculescu AG, Andronic O, Bolocan A. The Vermiform Appendix and Its Pathologies. Cancers (Basel) 2023; 15:3872. [PMID: 37568688 PMCID: PMC10417615 DOI: 10.3390/cancers15153872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The vermiform appendix is a muscular cylindrical structure originating near the junction of the cecum and ileum, averaging 9 cm (5-35 cm) in size. As the most mobile viscera, it can adopt several positions, the most common being the retrocecal position. Perceived as an atavistic organ lacking physiological relevance, the vermiform appendix appears to be involved in immune function, serving in the maturation of B lymphocytes and the production of immunoglobulin A, in endocrine function, excreting amines and hormones in the 2-3 mL of mucus secreted daily, and in digestive function, by storing beneficial bacteria from where they can recolonize the colon. With a lumen of about 6 mm, the vermiform appendix has a reduced storage capacity, so any blockage of the appendix with fecoliths (fecaliths), seeds derailed from the colon, or enlarged lymph nodes prevents drainage and intraluminal accumulation of secreted mucus. Unable to relax, the appendix wall severely limits its intraluminal volume, so mucus accumulation leads to inflammation of the appendix, known generically as appendicitis. In addition, the vermiform appendix may be the site of the development of neoplastic processes, which may or may not involve mucus production, some of which can significantly affect the standard of living and ultimately lead to death. In general, mucinous tumors may have a better prognosis than non-mucinous tumors. This review takes a comprehensive path, starting by describing the anatomy and embryology of the vermiform appendix and further detailing its inflammatory pathologies, pathologies related to congenital anomalies, and appendix tumors, thus creating an up-to-date framework for better understanding, diagnosis, and treatment of these health problems.
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Affiliation(s)
- Marian Constantin
- Institute of Biology of Romanian Academy, 060031 Bucharest, Romania;
- The Research Institute of the University of Bucharest, ICUB, 050095 Bucharest, Romania;
| | - Livia Petrescu
- Department of Anatomy, Animal Physiology and Biophysics, DAFAB, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania; (L.P.); (C.M.)
| | - Cristina Mătanie
- Department of Anatomy, Animal Physiology and Biophysics, DAFAB, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania; (L.P.); (C.M.)
| | - Corneliu Ovidiu Vrancianu
- The Research Institute of the University of Bucharest, ICUB, 050095 Bucharest, Romania;
- Microbiology—Immunology Department, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania
- National Institute of Research and Development for Biological Sciences, 296 Splaiul Independentei, District 6, 060031 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- The Research Institute of the University of Bucharest, ICUB, 050095 Bucharest, Romania;
- Department of Science and Engineering of Oxide Materials and Nanomaterials, Politehnica University of Bucharest, 011061 Bucharest, Romania
| | - Octavian Andronic
- University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (O.A.); (A.B.)
| | - Alexandra Bolocan
- University Emergency Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania; (O.A.); (A.B.)
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Abdalla MA. Morphological, Anatomical and Surgical Features of the Vermiform Appendix: A Historical Review. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2022; 30:927-932. [PMID: 36282670 DOI: 10.32687/0869-866x-2022-30-5-926-932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/06/2022] [Indexed: 06/16/2023]
Abstract
The aim of this review is to focus light on the history of the human vermiform appendix from the morphological, anatomical, surgical, classification of the origin, types, blood supply aspects in order to understand the real function and summarized this information that positively impacts the clinical decision in case of appendicitis, the most popular surgical condition. Although the characteristic features of the normal and diseased appendix had been reported for many previous centuries, it was still the most common challenge facing every single day in the operation room. The appendectomy, the commonest surgical emergency procedure, may cause little confusion for the surgeons due to highly variable situations of inside the abdominal cavity. However, the recent imaging techniques have increased the surgeon's ability for crucial diagnosis of the diseased appendix. Besides the above-mentioned criteria, with its clinical features diagnosis and management, the author was deeply searched in many scientific databases including EMBASE, Cochrane Library, PubMed, Pubmed Central (PMC), Medline, Web of Science, and Scopus.
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Collard MK, Bardin J, Laurin M, Ogier‐Denis E. The cecal appendix is correlated with greater maximal longevity in mammals. J Anat 2021; 239:1157-1169. [PMID: 34235746 PMCID: PMC8546507 DOI: 10.1111/joa.13501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/28/2021] [Accepted: 06/14/2021] [Indexed: 01/26/2023] Open
Abstract
The cecal appendix had been considered as a useless vestige since Darwin's work, but recent research questioned this idea demonstrating that the cecal appendix appeared among the mammals at least 80 million years ago and has made multiple and independent appearances without any obvious correlation with diet, social life, ecology, or size of the cecum. However, functions and probable selective advantage conferred by this anatomical structure still remain enigmatic. We found, through analyses of data on 258 mammalian species, that cecal appendix presence is correlated with increased maximal observed longevity. This is the first demonstration of a correlation between cecal appendix presence and life history. Interestingly, the classical evolutionary theory of aging that predicts an increased longevity when the extrinsic mortality is reduced has been questioned several times, but recent comparative studies asserted its validity in the taxa, which experience age-dependent and density-dependent mortality, as in mammals. Thus, the cecal appendix may contribute to the increase in longevity through a reduction of extrinsic mortality. A lower risk of fatal infectious diarrhea is one of the most plausible hypotheses that could explain it. However, several hypotheses coexist about the possible functions of the cecal appendix, and our results provide new insights about this much-disputed question. In addition, we show that the cecal appendix arose at least 16 times and was lost only once during the evolutionary history of the considered mammals, an asymmetry that supports the existence of a positive selective of this structure.
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Affiliation(s)
- Maxime K. Collard
- Centre de Recherche sur l’InflammationINSERMU1149CNRSERL8252Team Gut InflammationUniversité de ParisParisFrance
| | - Jérémie Bardin
- CR2P ("Centre de Recherches sur la Paléobiodiversité et les Paléoenvironnements"UMR 7207CNRS/MNHNMuséum National d'Histoire NaturelleSorbonne UniversitéParisFrance
| | - Michel Laurin
- CR2P ("Centre de Recherches sur la Paléobiodiversité et les Paléoenvironnements"UMR 7207CNRS/MNHNMuséum National d'Histoire NaturelleSorbonne UniversitéParisFrance
| | - Eric Ogier‐Denis
- Centre de Recherche sur l’InflammationINSERMU1149CNRSERL8252Team Gut InflammationUniversité de ParisParisFrance
- INSERM U1242Université de Rennes 1RennesFrance
- Centre de Lutte contre le Cancer Eugène Marquis CLCCRennesFrance
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Wang C, Huang L, Wang P, Liu Q, Wang J. The Effects of Deoxynivalenol on the Ultrastructure of the Sacculus Rotundus and Vermiform Appendix, as Well as the Intestinal Microbiota of Weaned Rabbits. Toxins (Basel) 2020; 12:toxins12090569. [PMID: 32899719 PMCID: PMC7551620 DOI: 10.3390/toxins12090569] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023] Open
Abstract
Deoxynivalenol (DON) is a mycotoxin found in grains that poses a potential threat to human and animal health, and the gastrointestinal tract is the primary target organ. There are few studies focused on the toxicology of DON to rabbits, especially on the relation among DON, microbiota, and the gut-associated lymphoid tissue. A total of 30 weaned rabbits (35 d) were evenly divided into the control group and DON group (1.5 mg/kg bodyweight (BW)) based on their body weight. After a 24-day trial, the ultrastructures of the sacculus rotundus and vermiform appendix were observed using a scanning electron microscope and transmission electron microscopy. The morphology and microflora in the ileum, caecum, and colon were also examined. The results proved that the ultrastructure of the sacculus rotundus and vermiform appendix, as well as the integrity of the intestinal barrier (especially for the ileum), were impaired after DON was administrated to the rabbits. Compared to the control group, the relative abundance and diversity of the microflora decreased in all three intestinal segments in the DON group, particularly in the ileum and caecum. In conclusion, the toxic effect of DON on weaned rabbits may be performed by destroying the structure of the sacculus rotundus and vermiform appendix, as well as affecting the structure and diversity of the intestinal flora.
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Affiliation(s)
- Chunyang Wang
- Shandong Provincial Key Laboratory of Animal Biotechnology and Disease Control and Prevention, College of Animal Science and Veterinary Medicine, Shandong Agricultural University, 61 Daizong Street, Taian 271018, China; (C.W.); (L.H.); (P.W.); (Q.L.)
| | - Libo Huang
- Shandong Provincial Key Laboratory of Animal Biotechnology and Disease Control and Prevention, College of Animal Science and Veterinary Medicine, Shandong Agricultural University, 61 Daizong Street, Taian 271018, China; (C.W.); (L.H.); (P.W.); (Q.L.)
| | - Pengwei Wang
- Shandong Provincial Key Laboratory of Animal Biotechnology and Disease Control and Prevention, College of Animal Science and Veterinary Medicine, Shandong Agricultural University, 61 Daizong Street, Taian 271018, China; (C.W.); (L.H.); (P.W.); (Q.L.)
| | - Quancheng Liu
- Shandong Provincial Key Laboratory of Animal Biotechnology and Disease Control and Prevention, College of Animal Science and Veterinary Medicine, Shandong Agricultural University, 61 Daizong Street, Taian 271018, China; (C.W.); (L.H.); (P.W.); (Q.L.)
| | - Jinquan Wang
- Feed Research Institute, Chinese Academy of Agricultural Sciences, Beijing 100081, China
- Correspondence: ; Tel.: +86-136-0121-7106
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Sidhwa F. Letter to the Editor: Case of Appendix Incarcerated in an Umbilical Hernia. J Laparoendosc Adv Surg Tech A 2020; 30:857-858. [PMID: 32559399 DOI: 10.1089/lap.2020.0333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Umbilical hernias and acute appendicitis are common general surgical problems, but an appendix incarcerated in an umbilical hernia is quite rare. We present a case of such and briefly review the available literature on the topic. We conclude that future authors should include a minimum set of information in such case reports or case series so that readers can gain as much as possible from our collective experience with this uncommon problem.
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Affiliation(s)
- Feroze Sidhwa
- Department of Surgery, San Joaquin General Hospital, French Camp, California, USA
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9
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Kim JH, Jin ZW, Shibata S, Murakami G, Hayashi S, Rodríguez-Vázquez JF. Vermiform Appendix During the Repackaging Process from Umbilical Herniation to Fixation onto the Right Posterior Abdomen: A Study of Human Fetal Horizontal Sections. Clin Anat 2019; 33:667-677. [PMID: 31576606 DOI: 10.1002/ca.23484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/09/2019] [Accepted: 09/14/2019] [Indexed: 11/10/2022]
Abstract
The anatomical position of the vermiform appendix varies among adults, and these variations are responsible for differences in the symptoms of appendicitis. However, to date no study has examined how and when these variations occur during fetal development. The present study examined horizontal sections of 27 midterm fetuses (crown rump length [CRL] 38-97 mm, gestational age approximately 8-15 weeks). There were 10 fetuses (CRL 56 mm or more) in which the cecum and appendix were in a posterosuperior site near the right kidney (postmigration phase), and 12 fetuses (CRL 39-72 mm) in which the ileocecal junction and appendix remained on the visceral surface of the liver in the anterior or anterolateral abdominal cavity (migration phase, after physiological umbilical herniation). Analysis of the 12 fetuses in the migration phase indicated that the appendix extended inferiorly in eight fetuses and superiorly in four fetuses. Likewise, a "preileal" appendix (a morphology in which the distal part of the appendix was in front of the terminal ileum) was present in eight of these fetuses. Extension of the appendix superiorly or inferiorly during the migration phase seems unrelated to the topographical relationship of the appendix with the terminal ileum at the postmigration phase in fetuses and in adults. Conversely, it seems likely that a retroileal appendix leads to a coiled appendix behind the ileocecal junction. "Guidance" by the liver surface seemed to be important for posterior migration, which ended with the ascent of the liver. Clin. Anat., 33:667-677, 2020. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Ji H Kim
- Department of Anatomy, Jeonbuk University Medical School, Jeonju, Korea
| | - Zhe W Jin
- Department of Anatomy, Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu, China
| | - Shunichi Shibata
- Department of Maxillofacial Anatomy, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
| | - Gen Murakami
- Division of Internal Medicine, Jikoukai Clinic of Home Visit, Sapporo, Japan
| | - Shogo Hayashi
- Department of Anatomy, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - José F Rodríguez-Vázquez
- Department of Anatomy and Embryology, Faculty of Medicine, Complutense University, Madrid, Spain
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Zacharzewska-Gondek A, Szczurowska A, Guziński M, Sąsiadek M, Bladowska J. A pictorial essay of the most atypical variants of the vermiform appendix position in computed tomography with their possible clinical implications. Pol J Radiol 2019; 84:e1-8. [PMID: 31019588 DOI: 10.5114/pjr.2018.81158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/02/2018] [Indexed: 01/10/2023] Open
Abstract
Purpose The tip of the appendix may be located in various areas of the abdominal cavity due to its variable length and/or the changeable position of the caecum. Although in the case of an atypical position the tip is usually located behind the caecum, there are possible locations that occur very rarely. Therefore, in the case of appendicitis the symptoms may lead to the wrong diagnosis. The aim of this study is to present the most atypical locations of the tip of the appendix found on CT (computed tomography) scans and thus help to avoid misdiagnoses. Imaging findings The most unusual locations of the tip of the appendix found in healthy subjects included: left inferior quadrant, along the lower edge of the liver near the gallbladder and the right kidney, the tip touching the duodenum, the rectum or appendages, and a long appendix located in the scrotum as the content of a hernia. In these positions, appendicitis may mimic acute diverticulitis, cholecystitis, duodenal ulcer, duodenitis, enteritis, or adnexal or testis pathologies. Conclusions It is important to be aware of atypical locations of the appendix because appendicitis in an unusual area may mimic other acute abdominal diseases and delay the proper treatment.
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Vitetta L, Chen J, Clarke S. The vermiform appendix: an immunological organ sustaining a microbiome inoculum. Clin Sci (Lond) 2019; 133:1-8. [PMID: 30606811 DOI: 10.1042/CS20180956] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 11/29/2018] [Accepted: 12/04/2018] [Indexed: 12/12/2022]
Abstract
The hominoid vermiform appendix has been characterized as a diverticulum of the caecum and describes an entity at the juxtaposition of the colon in the confluence of tanias. The independent development of the lymphoid follicle centres of the appendix is progressed at birth in the presence of the intestinal commensal microbiome, an obligatory prompt for the diversification of intestinal and extra-intestinal mucosal immunological tissue. In the vermiform appendix, this activity is centred on further developing the inventory of primary antibodies and the maturation of T- and B-lymphocyte cells in the follicles within the lymphoid tissue. Furthermore, the columnar epithelia, enterocytes and goblet cells comprise the complement of cells that occupy the lamina propria and muscularis mucosae of the vermiform appendix's mucosa, while macrophages and an abundance of immunoglobulin A and immunoglobulin G generating plasma cells seed the lamina propria Intraepithelial immune cells consisting predominantly of specific CD8+ T regulatory lymphocytes occupy sites in the appendix analogous to those present in the intestinal epithelia of the caecal colon. The complement of bacterial genera concealed in the vermiform appendix is posited extant as a biofilm inoculum of the intestinal commensal microbiome. This facilitates re-inoculation of the proximal colon and to a lesser degree the terminal ilium post an intestinal perturbation such as occurs with daily lifestyle stressors, dietary choices and the short-term administration of antibiotics rather than an infectious fulminant colitis. A plausible appreciation results of the importance of multiple immunological aspects of a healthy vermiform appendix and the provision of a commensal biofilm to the gut that repairs a dysbiotic microbiome contributing to balancing intestinal pro- and anti-inflammatory activity for maintaining homeostasis in the gut. Since the composition of the gut microbiome can vary over the short-term and long-term, it is plausible that the appendix inoculum may be instrumental in maintaining the intestinal microbiome.
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Abstract
We report a rare case of a cystic mass in an appendix in a patient who presented nausea, vomiting, and sharp pain in lower right abdomen and mimicking acute appendicitis. Although this entity is very rare, careful physical observation, imaging, and pathology can be helpful to make an accurate diagnosis.
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Affiliation(s)
- Mahtab Rahbar
- Pathology DepartmentIran University of Medical SciencesTehranIran
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13
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Vass T, Zaránd A, Horányi D, Harsányi L. [Diverticulosis and diverticulitis of the vermiform appendix. Report of a case and review of the literature]. Orv Hetil 2018; 159:768-772. [PMID: 29730945 DOI: 10.1556/650.2018.31010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Diverticulitis of the vermiform appendix is a rare disease with clinical features often similar to conventional acute appendicitis. The importance of appendiceal diverticulosis is the fact that it can lead to an early and a higher incidence of perforation and therefore a higher mortality rate, in contrast to acute appendicitis alone. In this study we present the clinicopathology, diagnosis and therapy of the disease with a review of the literature. A 65-year-old woman presented to the emergency department with a 48-hour history of intermittent pain in the right iliac fossa. Abdominal ultrasound raised the possibility of acute appendicitis but because of the relative asymptomatic state of the patient, the lack of fever and rebound tenderness we started observation. After 2 days with episodic abdominal pain, the patient was taken to the operating theatre for laparoscopic exploration. Intraoperatively, multiple diverticula were noted on the appendix and appendectomy was performed. Histopathological examination revealed diverticulosis and inflammation of the appendiceal wall. Due to the possible complications, the difficult preoperative diagnosis and its frequent association with appendiceal neoplasm, appendiceal diverticulosis requires special attention. For asymptomatic cases, incidentally diagnosed intraoperatively or discovered by radiology prophylactic appendectomy is recommended. Orv Hetil. 2018; 159(19): 768-772.
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Affiliation(s)
- Tamás Vass
- I. Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Attila Zaránd
- I. Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
| | - Dániel Horányi
- Szülészeti-Nőgyógyászati Osztály, Egyesített Szent István és Szent László Kórház Budapest
| | - László Harsányi
- I. Sebészeti Klinika, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest
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14
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Vitetta L, Vitetta G, Hall S. The Brain-Intestinal Mucosa-Appendix- Microbiome-Brain Loop. Diseases 2018; 6:E23. [PMID: 29614774 DOI: 10.3390/diseases6020023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 02/28/2018] [Accepted: 03/29/2018] [Indexed: 12/20/2022] Open
Abstract
The brain and the gut are connected from early fetal life. The mother's exposure to microbial molecules is thought to exert in utero developmental effects on the fetus. These effects could importantly underpin the groundwork for subsequent pathophysiological mechanisms for achieving immunological tolerance and metabolic equilibrium post birth, events that continue through to 3-4 years of age. Furthermore, it is understood that the microbiome promotes cues that instruct the neonate's mucosal tissues and skin in the language of molecular and cellular biology. Post birth mucosal lymphoid tissue formation and maturation (most probably including the vermiform appendix) is microbiota-encouraged co-establishing the intestinal microbiome with a developing immune system. Intestinal mucosal tissue maturation loops the brain-gut-brain and is postulated to influence mood dispositions via shifts in the intestinal microbiome phyla. A plausible appreciation is that dysregulated pro-inflammatory signals from intestinal resident macrophages could breach the loop by providing adverse mood signals via vagus nerve afferents to the brain. In this commentary, we further suggest that the intestinal resident macrophages act as an upstream traffic controller of translocated microbes and metabolites in order to maintain local neuro-endocrine-immunological equilibrium. When macrophages are overwhelmed through intestinal microbiome and intestinal epithelial cell dysbiosis, pro-inflammatory signals are sustained, which may then lead to mood disorders. The administration of probiotics as an adjunctive medicine co-administered with antidepressant medications in improving depressed mood may have biological and clinical standing.
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15
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Tajima T, Tajiri T, Mukai M, Sugiyama T, Hasegawa S, Yamamoto S, Sadahiro S, Shimada H, Makuuchi H. Single-center analysis of appendiceal neoplasms. Oncol Lett 2018; 15:6393-6399. [PMID: 29731850 DOI: 10.3892/ol.2018.8134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/12/2018] [Indexed: 01/25/2023] Open
Abstract
The purpose of the present study was to evaluate the recent trend of diagnosing appendiceal diseases through the analysis of appendectomy materials, stressing the importance of their pathological examination. A clinicopathological assessment of patients undergoing an appendectomy was conducted, based on the pathological examination of resected appendiceal lesions. Using a pathological database of surgical specimens from patients who underwent an appendectomy between March 2002 and September 2014, a retrospective, single-center analysis was performed. Among the 803 patients identified, 752 with appendiceal disease were selected for clinicopathological analysis. The diagnosis was inflammation (i.e. appendicitis) in 97.7% (n=735) and appendiceal neoplasm in 2.3% (n=17) of the patients. The most frequent type of appendiceal neoplasm was an intramucosal neoplasm (23.5%, n=4). In conclusion, the incidence of appendiceal neoplasms has increased in recent years, potentially due to increased and earlier detection by newer imaging modalities.
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Affiliation(s)
- Takayuki Tajima
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Takuma Tajiri
- Department of Pathology, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Masaya Mukai
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Tomoko Sugiyama
- Department of Pathology, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Sayuri Hasegawa
- Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
| | - Souichirou Yamamoto
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Sotaro Sadahiro
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan
| | - Hideo Shimada
- Department of Surgery Tokai University Oiso Hospital, Oiso, Kanagawa 259-0198, Japan
| | - Hiroyasu Makuuchi
- Department of Surgery, Tokai University School of Medicine, Isehara, Kanagawa 259-1193, Japan.,Department of Surgery, Tokai University Hachioji Hospital, Hachioji, Tokyo 192-0032, Japan
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16
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Kaneko M, Kawai K, Murono K, Nishikawa T, Sasaki K, Otani K, Yasuda K, Tanaka T, Kiyomatsu T, Hata K, Nozawa H, Ishihara S, Hayashi A, Shinozaki-Ushiku A, Fukayama M, Watanabe T. Giant gastrointestinal stromal tumor of the vermiform appendix: A case report. Mol Clin Oncol 2017; 7:399-403. [PMID: 28894578 DOI: 10.3892/mco.2017.1334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/04/2017] [Indexed: 01/07/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) of the vermiform appendix are rare, measuring <3 cm in 82.4% of the reported cases. Neoadjuvant therapy with the receptor tyrosine kinase inhibitor imatinib mesylate has the potential to improve resectability and organ preservation rates in locally advanced or metastatic/recurrent GISTs. We herein report the case of a 67-year-old male patient with an unusually large GIST (22 cm in diameter) of uncertain origin in the right lower abdominal quadrant, with a solitary peritoneal metastasis. Due to the size of this GIST and presence of metastatic disease, neoadjuvant therapy with imatinib (400 mg/day orally) was administered. Follow-up imaging studies revealed marked shrinkage of the primary and metastatic tumors. Subsequently, laparoscopic exploration revealed that the main tumor originated from the tip of the vermiform appendix, and that the peritoneal metastasis was located in the ascending mesocolon. The patient underwent laparoscopic appendectomy and excision of the peritoneal metastasis, without tumor rupture. Therefore, in appropriately selected patients, neoadjuvant imatinib for borderline resectable or oligometastatic GISTs may be a reasonable choice.
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Affiliation(s)
- Manabu Kaneko
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Koji Murono
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Takeshi Nishikawa
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kensuke Otani
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Koji Yasuda
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Tomomichi Kiyomatsu
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Keisuke Hata
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Akimasa Hayashi
- Department of Pathology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Aya Shinozaki-Ushiku
- Department of Pathology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Masashi Fukayama
- Department of Pathology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Toshiaki Watanabe
- Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
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17
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Mohammadi S, Hedjazi A, Sajjadian M, Rahmani M, Mohammadi M, Moghadam MD. Morphological variations of the vermiform appendix in Iranian cadavers: a study from developing countries. Folia Morphol (Warsz) 2017; 76:695-701. [PMID: 28353300 DOI: 10.5603/fm.a2017.0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/15/2017] [Accepted: 03/16/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The vermiform appendix is a worm-like tube containing a large amount of lymphoid follicles. In our knowledge, there is a little standard data about the vermiform appendix in Iranian population. Therefore, the objective of this study was to investigate the normal appendix size in Iranian cadavers. MATERIALS AND METHODS A cross-sectional study was undertaken between June 2014 and July 2015, in the autopsy laboratory, Legal Medicine Organisation, Razavi Khorasan province, Iran. A total of 693 cadavers with the mean age of 40.46 ± 20.99 years were divided into 10 groups. After writing down position of the appendix, the length, diameter and weight of the appendix were measured. Statistical analysis was performed using SPSS software. RESULTS The mean values of the demographic characteristics included - age: 40.46 ± 20.99 years; weight: 63.47 ± 17.84 kg; height: 159.95 ± 28.23 cm. The mean values of the appendix length, diameter, weight and index in the cadavers were 8.52 ± 2.99 cm, 12.17 ± 4.53 mm, 6.43 ± 3.26 g and 0.013 ± 0.01, respectively. The most common position of the appendix was retrocaecal in 71.7% of cases. Significant correlations were evident between the value of demographic data and appendix size (p < 0.05). The diameter (p = 0.002) and index of the appendix (p = 0.003) showed significant difference between males and females. CONCLUSIONS Having standard data on the vermiform appendix is useful for clinicians as well as anthropologists. The findings of the present study can provide information about morphologic variations of the appendix in Iranian population.
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Affiliation(s)
| | | | | | | | | | - M D Moghadam
- Department of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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18
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Abstract
Amyand's hernia is a rare and atypical hernia characterized by the herniation of the appendix into the inguinal sac. This hernia may be present without symptoms until inflammation of the appendix may lead to incarceration, strangulation, necrosis, perforation or rupture. Early symptoms include tenderness and inguinal swelling which may be misdiagnosed as a strangulated hernia. This condition can be difficult to diagnose clinically. Ultrasound and Computed Tomography may aid in diagnosis. This article presents a rare case of Amyand's hernia followed by a discussion of the epidemiology, diagnosis, imaging details and treatment options for this condition.
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Affiliation(s)
- Haris N Shekhani
- Division of Emergency Radiology, Emory University, Atlanta, GA 30308, USA
| | - Saurabh Rohatgi
- Division of Emergency Radiology, Emory University, Atlanta, GA 30308, USA
| | - Tarek Hanna
- Division of Emergency Radiology, Emory University, Atlanta, GA 30308, USA
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19
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Abstract
Congenital absence of the vermiform appendix is very rare in human beings with a reported incidence of 1 in 100,000 cases. Here, we report an incidence of a surgeon's dilemma to detect such a rare finding during surgery for a diagnosed case of acute appendicitis.
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Affiliation(s)
- Bikasha Bihary Tripathy
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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20
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Mendes A, Gonçalves A, Vila-Chã N, Moreira I, Fernandes J, Damásio J, Teixeira-Pinto A, Taipa R, Lima AB, Cavaco S. Appendectomy may delay Parkinson's disease Onset. Mov Disord 2015; 30:1404-7. [PMID: 26228745 DOI: 10.1002/mds.26311] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/23/2015] [Accepted: 05/25/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Alpha-synuclein (α-Syn) is particularly abundant in the vermiform appendix, which makes this structure an anatomical candidate for the initiation of Parkinson's disease (PD) pathology. We hypothesized that history of appendectomy might affect PD clinical onset. METHODS A total of 295 PD patients enrolled in a comprehensive observational study were asked about past history of appendectomy. Cox's regression, with a time-dependent covariate, explored the effects of appendectomy on age at PD onset. RESULTS Thirty-four patients (11.5%) had appendectomy before PD onset. There was no significant effect of appendectomy on age at PD onset for the entire cohort (P = 0.153). However, among patients with late onset (≥55 years), we found evidence that those with past appendectomy had more years of life without PD symptoms than patients without appendectomy (P = 0.040). No association was found for the young-onset group (P = 0.663). CONCLUSIONS An apparent relationship was observed between appendectomy and PD onset in the late PD cohort.
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Affiliation(s)
- Alexandre Mendes
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomedica, Instituto Ciências Biomedicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Alexandra Gonçalves
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomedica, Instituto Ciências Biomedicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Nuno Vila-Chã
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomedica, Instituto Ciências Biomedicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Inês Moreira
- Unidade Multidisciplinar de Investigação Biomedica, Instituto Ciências Biomedicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Joana Fernandes
- Unidade Multidisciplinar de Investigação Biomedica, Instituto Ciências Biomedicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Joana Damásio
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal
| | - Armando Teixeira-Pinto
- CINTESIS, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Ricardo Taipa
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal.,Serviço de Neuropatologia, Centro Hospitalar do Porto, Porto, Portugal
| | | | - Sara Cavaco
- Serviço de Neurologia, Centro Hospitalar do Porto, Porto, Portugal.,Unidade Multidisciplinar de Investigação Biomedica, Instituto Ciências Biomedicas Abel Salazar, Universidade do Porto, Porto, Portugal
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21
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Ng D, Falck V, McConnell YJ, Mack LA, Temple WJ, Gui X. Appendiceal goblet cell carcinoid and mucinous neoplasms are closely associated tumors: lessons from their coexistence in primary tumors and concurrence in peritoneal dissemination. J Surg Oncol 2013; 109:548-55. [PMID: 24374723 DOI: 10.1002/jso.23537] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/03/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Goblet cell carcinoid (GCC) and appendiceal mucinous neoplasms (AMNs) are considered as different appendiceal tumors. Coexistence of both tumors was occasionally noted. We further observed the concurrence in both primary tumors and their peritoneal dissemination, that is, peritoneal carcinomatosis (PC) including pseudomyxoma peritonei (PMP). METHODS Review of our 10-year file identified two subgroups of cases with such concurrence. Group 1 is 14 cases of PC/PMP treated by surgical cytoreduction. Morphologic components of GCC, low-grade mucinous neoplasm (LMN), mucinous adenocarcinoma (MCA), and non-mucinous adenocarcinoma (NMCA) were identified separately in different organs/tissues. Group 2 is eight cases of localized primary tumors of appendix and ileocecal junction. RESULTS In Group 1, primary tumors (11 GCC, 1 GCC + LMN, 1 MCA, 1 NMCA) were identified in appendix (13) and in rectum (1). Further review identified mixed morphologic components in 7/12 GCC cases, including GCC + LMN (2), GCC + MCA (2), GCC + NMCA (1), and GCC + MCA + NMCA (2). Over peritoneal dissemination, GCC and/or other components were coexistent at different sites and in variable combinations. In Group 2, primary tumors were initially diagnosed as GCC (7) and MCA (1). Further review identified mixed components in all cases, including GCC + LMN (3), GCC + LMN + MCA (3), GCC + MCA + NMCA (2). CONCLUSIONS GCC may present as a component mixed with AMNs and even with conventional adenocarcinoma in both primary tumors and metastatic lesions. AMN in any given single case may show a wide morphologic spectrum. GCC and AMN may share a common tumor stem cell with potential of multiple lineage differentiations.
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Affiliation(s)
- Denise Ng
- Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada
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22
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Gray MT, Munoz DG, Gray DA, Schlossmacher MG, Woulfe JM. Alpha-synuclein in the appendiceal mucosa of neurologically intact subjects. Mov Disord 2013; 29:991-8. [PMID: 24352892 DOI: 10.1002/mds.25779] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 11/07/2013] [Accepted: 11/12/2013] [Indexed: 12/16/2022] Open
Abstract
Parkinson's disease is characterized by the pathological aggregation of Alpha-synuclein. The dual-hit hypothesis proposed by Braak implicates the enteric nervous system as an initial site of α-synuclein aggregation with subsequent spread to the central nervous system. Regional variations in the spatial pattern or levels of α-synuclein along the enteric nervous system could have implications for identifying sites of onset of this pathogenic cascade. We performed immunohistochemical staining for α-synuclein on gastrointestinal tissue from patients with no history of neurological disease using the established LB509 antibody and a new clone, MJFR1, characterized for immunohistochemistry here. We demonstrate that the vermiform appendix is particularly enriched in α-synuclein-containing axonal varicosities, concentrated in its mucosal plexus rather than the classical submucosal and myenteric plexuses. Unexpectedly, intralysosomal accumulations of α-synuclein were detected within mucosal macrophages of the appendix. The abundance and accumulation of α-synuclein in the vermiform appendix implicate it as a candidate anatomical locus for the initiation of enteric α-synuclein aggregation and permits the generation of testable hypotheses for Parkinson's disease pathogenesis.
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Affiliation(s)
- Madison T Gray
- Centre for Cancer Therapeutics, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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23
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Duque JE, Ríos J. Umbilical-spinous line: a morphological term that should be included in the anatomical terminology. Colomb Med (Cali) 2013; 44:202-4. [PMID: 24892620 PMCID: PMC4002036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 01/29/2013] [Accepted: 05/08/2013] [Indexed: 11/16/2022] Open
Abstract
We argue the need to include in the International Anatomical Terminology the term "Umbilical-spinous line" for its importance as a morphological referent in bioscopic and surface anatomy. Also, in order to avoid using eponyms, it is suggested that the traditional term "McBurney point" be replaced by "supra spinous point" as being more descriptive of location.
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Affiliation(s)
- Jorge Eduardo Duque
- Department of Basic Sciences, School of Medicine. Universidad de Caldas. Manizales, Colombia
| | - John Ríos
- Department of Basic Sciences, School of Medicine. Universidad de Caldas. Manizales, Colombia
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24
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Bakar SMA, Shamim M, Alam GM, Sarwar M. Negative correlation between age of subjects and length of the appendix in Bangladeshi males. Arch Med Sci 2013; 9:55-67. [PMID: 23515519 PMCID: PMC3598144 DOI: 10.5114/aoms.2013.33349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 12/28/2012] [Accepted: 01/02/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The anatomy of the vermiform appendix shows variations in its macroscopic dimensions some of which have potential to influence the clinical aspects of the appendix. Anatomical studies on the appendix using people in Bangladesh as a sample are limited and fall short of producing any standardized anthropometric data. This study is predominantly a cross-sectional observational study which also uses some statistical analysis to understand the relationships amongst variables. MATERIAL AND METHODS Fifty-six adult male postmortem appendices and adnexa were examined for macroscopic features. Possible interrelationships among the variables were assessed through statistical analysis. The age of the samples ranged from 18 to 67 years. The most common position of the appendix was retrocolic (53.57%) followed by pelvic (30.35%), postileal (12.5%), and subcaecal (3.5%). RESULTS In most cases (62.5%) the mesoappendix did not reach the tip of the appendix. The appendicular length varied from 6.00 cm to 16.30 cm with mean (± SD) and median value of 10.21 ±2.50 cm and 10.00 cm respectively. The base of the appendix was 1.90 to 3.80 cm away from the ileocaecal junction. The other macroscopic measurements of the appendix were taken at the base, at the midzone and at the tip of the appendix and the mean of the three measurements was considered as the overall value. Thus, the overall external diameter varied between 0.32 cm and 0.83 cm. Assessment of possible correlations amongst different variables revealed a significant negative correlation between the age of the subjects and the length of the appendix. CONCLUSIONS The data of the present study may provide a baseline along with some previous data in the standardization of the anthropometric information regarding the vermiform appendix of Bangladeshi males.
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Affiliation(s)
| | - Manjare Shamim
- Faculty of Basic Medical Science, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
| | - Gazi Mahabubul Alam
- Academic Performance Enhancement Unit, University of Malaya, Jalan Panati Baharu, Kuala Lumpur, Malaysia
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25
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Abstract
A rare case of Amyand's hernia in an infant who presented with chronic discharging scrotal sinus is reported.
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Affiliation(s)
- Prashant Jain
- Department of Pediatric Surgery, Dr. BL Kapur Memorial Hospital, New Delhi, India
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26
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Abstract
An 8-year-old child ingested a metallic screw 3 months prior to admission. At laparotomy, the foreign body was found to be lodged inside the vermiform appendix, and was removed by appendicectomy.
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Affiliation(s)
- R R Sarkar
- Department of Pediatric Surgery, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, India
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