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Non-neoplastic Lesions of the Appendix

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Surgical Pathology of the Gastrointestinal System

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Abstract

The vermiform appendix is often regarded as a rudimentary or vestigial organ in human beings. This view has been challenged time and again, and contrary to earlier considerations, its role in immunological surveillance of the gut is now well understood. The histology of the appendix to some extent overlaps and probably represents a transition between the terminal ileum and colon. Nevertheless, the appendix have several unique features and specialized cells. The different layers of appendix include an innermost columnar-lined mucosa with enterocytes, specialized cells like goblet cells, entero-endocrine cells, and Paneth cells, surrounded by submucosa with an externally located muscularis externa and serosa. The large lymphoid follicles, often with prominent germinal centers and with unique immunophenotype and functions, may represent an embryological extension of the Peyer’s patches of the terminal ileum. This chapters covers the congenital malformations, different forms of appendicitis with related granulomatous and infectious etiologies, and also provides an immunological perspective of the appendix. This is followed by a brief account on some of the rare non infectious conditions.

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References

  1. Kooij IA, Sahami S, Meijer SL, Buskens CJ, Te Velde AA. The immunology of the vermiform appendix: a review of the literature. Clin Exp Immunol. 2016;186(1):1–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Sahami S, Kooij IA, Meijer SL, Van den Brink GR, Buskens CJ, Te Velde AA. The link between the appendix and ulcerative colitis: clinical relevance and potential immunological mechanisms. Am J Gastroenterol. 2016;111(2):163–9.

    CAS  PubMed  Google Scholar 

  3. Deshmukh S, Verde F, Johnson PT, Fishman EK, Macura KJ. Anatomical variants and pathologies of the vermix. Emerg Radiol. 2014;21(5):543–52.

    PubMed  PubMed Central  Google Scholar 

  4. Schumpelick V, Dreuw B, Ophoff K, Prescher A. Appendix and cecum. Embryology, anatomy, and surgical applications. Surg Clin North Am. 2000;80(1):295–318.

    CAS  PubMed  Google Scholar 

  5. Vitetta L, Chen J, Clarke S. The vermiform appendix: an immunological organ sustaining a microbiome inoculum. Clin Sci (Lond). 2019;133(1):1–8.

    CAS  Google Scholar 

  6. Chivers DJ, Hladik CM. Morphology of the gastrointestinal tract in primates: comparisons with other mammals in relation to diet. J Morphol. 1980;166:337–86.

    CAS  PubMed  Google Scholar 

  7. Vignali DA, Collison LW, Workman CJ. How regulatory T cells work. Nat Rev Immunol. 2008;8:523–32.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Mabbott NA, Donaldson DS, Ohno H, et al. Microfold (M) cells: important immunosurveillance posts in the intestinal epithelium. Mucosal Immunol. 2013;6:666–77.

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Collins JK, Cashman S, Morgan J, O’Sullivan GC. The gastrointestinal immune system: recognising microbes in the gut. Ann Gastroenterol Hepatol. 2012;3:23–37.

    Google Scholar 

  10. Corr SC, Gahan CC, Hill C. M-cells: origin, morphology and role in mucosal immunity and microbial pathogenesis. FEMS Immunol Med Microbiol. 2008;52:2–12.

    CAS  PubMed  Google Scholar 

  11. Ishimoto Y, Tomiyama-Miyaji C, Watanabe H, Yokoyama H, Ebe K, Tsubata S, et al. Age-dependent variation in the proportion and number of intestinal lymphocyte subsets, especially natural killer T cells, double-positive CD4+ CD8+ cells and B220+ T cells, in mice. Immunology. 2004;113:371–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Comerford I, Harata-Lee Y, Bunting MD, Gregor C, Kara EE, McColl SR. A myriad of functions and complex regulation of the CCR7/CCL19/CCL21 chemokine axis in the adaptive immune system. Cytokine Growth Factor Rev. 2013;24:269–83.

    CAS  PubMed  Google Scholar 

  13. Gorfu G, Rivera-Nieves J, Ley K. Role of beta7 integrins in intestinal lymphocyte homing and retention. Curr Mol Med. 2009;9:836–50.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Smith P, MacDonald T, Blumberg R, editors. Principles of mucosal immunity. New York: Garland Science; 2013.

    Google Scholar 

  15. Randal Bollinger R, Barbas AS, Bush EL, Lin SS, Parker W. Biofilms in the large bowel suggest an apparent function of the human vermiform appendix. J Theor Biol. 2007;249:826–31.

    CAS  PubMed  Google Scholar 

  16. Bollinger RR, Everett ML, Palestrant D, Love SD, Lin SS, Parker W. Human secretory immunoglobulin A may contribute to biofilm formation in the gut. Immunology. 2003;109:580–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Gebbers JO, Laissue JA. Bacterial translocation in the normal human appendix parallels the development of the local immune system. Ann N Y Acad Sci. 2004;1029:337–4.

    PubMed  Google Scholar 

  18. Chinen T, Rudensky AY. The effects of commensal microbiota on immune cell subsets and inflammatory responses. Immunol Rev. 2012;245:45–55.

    CAS  PubMed  Google Scholar 

  19. Round JL, Mazmanian SK. The gut microbiota shapes intestinal immune responses during health and disease. Nat Rev Immunol. 2009;9:313–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Masahata K, Umemoto E, Kayama H, et al. Generation of colonic IgA secreting cells in the caecal patch. Nat Commun. 2014;5:3704.

    PubMed  Google Scholar 

  21. Somekh E, Serour F, Gorenstein A, Vohl M, Lehman D. Phenotypic pattern of B cells in the appendix: reduced intensity of CD19 expression. Immunobiology. 2000;201:461–9.

    CAS  PubMed  Google Scholar 

  22. Ruber M, Berg A, Ekerfelt C, Olaison G, Andersson RE. Different cytokine profiles in patients with a history of gangrenous or phlegmonous appendicitis. Clin Exp Immunol. 2006;143:117–24.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Jo Y, Matsumoto T, Yada S, et al. Histological and immunological features of appendix in patients with ulcerative colitis. Dig Dis Sci. 2003;48:99–108.

    PubMed  Google Scholar 

  24. Matsushita M, Uchida K, Okazaki K. Role of the appendix in the pathogenesis of ulcerative colitis. Inflammopharmacology. 2007;15:154–7.

    CAS  PubMed  Google Scholar 

  25. Kronman MP, Zaoutis TE, Haynes K, Feng R, Coffin SE. Antibiotic exposure and IBD development among children: a population-based cohort study. Pediatrics. 2012;130:e794–803.

    PubMed  PubMed Central  Google Scholar 

  26. Bernstein CN. Epidemiologic clues to inflammatory bowel disease. Curr Gastroenterol Rep. 2010;12:495–501.

    PubMed  Google Scholar 

  27. Abramson DJ. Vermiform appendix located within the cecal wall. Anomalies and bizarre locations. Dis Colon Rectum. 1983;26(6):386–9.

    CAS  PubMed  Google Scholar 

  28. Vieira EPL, Bonato LM, da Silva GGP, Gurgel JL. Congenital abnormalities and anatomical variations of the vermiform appendix and mesoappendix. J Coloproctol. 2019;39:279–87.

    Google Scholar 

  29. Tsimogianni AM, Flevari A, Betrosian A, et al. Fasciitis and septic shock complicating retrocecal appendicitis. Am J Med Sci. 2012;343(2):168–70.

    PubMed  Google Scholar 

  30. Kim S, Lim HK, Lee JY, Lee J, Kim MJ, Lee AS. Ascending retrocecal appendicitis: clinical and computed tomographic findings. J Comput Assist Tomogr. 2006;30(5):772–6.

    PubMed  Google Scholar 

  31. Martínez DG, Sánchez AW, Rivera FV, Romano RC, Torreblanca CB. Agenesiaapendicular. Acta Med GrupÁng. 2010;8:167–71.

    Google Scholar 

  32. Greenberg SLL, Eyers AA, Mackay S. Congenital absence of thevermiform appendix. ANZ J Surg. 2003;73:166–7.

    PubMed  Google Scholar 

  33. Iuchtman M. Autoamputation of appendix and the absentappendix. Arch Surg. 1993;128:600.

    CAS  PubMed  Google Scholar 

  34. Cserni T, Magyar A, Nemeth T, Paran TS, Csízy I, Józsa T. Atresia of the ileocecal junction with agenesis of the ileocecal valve and vermiform appendix: report of a case. Surg Today. 2006;36:1126–8.

    PubMed  Google Scholar 

  35. Vincent MV, Doyle A, Bernstein S, Jackman S. Absence of the appendix discovered during childhood. Springerplus. 2014;3:522.

    PubMed  PubMed Central  Google Scholar 

  36. Smithells RW. Thalidomide, absent appendix, and sweating. Lancet. 1978;1(8072):1042.

    CAS  PubMed  Google Scholar 

  37. Shand JE, Bremner DN. Agenesis of the vermiform appendix in a thalidomide child. Br J Surg. 1977;64(3):203–4.

    CAS  PubMed  Google Scholar 

  38. Tilson MD, Touloukian RJ. Agenesis of the vermiform appendix. J Pediatr Surg. 1972;7(1):74.

    CAS  PubMed  Google Scholar 

  39. Rosa RF, Rosa RC, Zen PR, Graziadio C, Paskulin GA. Trisomy 18: review of the clinical, etiologic, prognostic, and ethical aspects. Rev Paul Pediatr. 2013;31(1):111–20.

    PubMed  Google Scholar 

  40. Rothberg RM, ten Bensel RW. Thymic alymphoplasia with immunoglobulin synthesis. Am J Dis Child. 1967;113(6):639–48.

    CAS  PubMed  Google Scholar 

  41. Collins DC. A study of 50000 specimens of human vermiform appendix. Surg Gynecol Obstet. 1955;101(4):165–8.

    Google Scholar 

  42. Cave AJ. Appendix vermiformis duplex. J Anat. 1936;70(Pt 2):283–92.

    CAS  PubMed  PubMed Central  Google Scholar 

  43. Wallbridge PH. Double appendix. Br J Surg. 1962;50:346–7.

    CAS  PubMed  Google Scholar 

  44. Mesko TW, Lugo R, Breitholtz T. Horseshoe anomaly of the appendix: a previously undescribed entity. Surgery. 1989;106(3):563–6.

    CAS  PubMed  Google Scholar 

  45. Tinckler LF. Triple appendix vermiformis--a unique case. Br J Surg. 1968;55(1):79–81.

    CAS  PubMed  Google Scholar 

  46. Biermann R, Borský D, Gogora M. Die Appendicitis duplex – einepathologischeRarität [Double appendicitis – a rare pathologic entity]. Chirurg. 1993;64(12):1059–61.

    CAS  PubMed  Google Scholar 

  47. Nageswaran H, Khan U, Hill F, Maw A. Appendiceal duplication: a comprehensive review of published cases and clinical recommendations. World J Surg. 2018;42(2):574–81.

    CAS  PubMed  Google Scholar 

  48. Aubrey DA. Gastric heterotopia in the vermiform appendix. Arch Surg. 1970;101(5):628–9.

    CAS  PubMed  Google Scholar 

  49. Droga BW, Levine S, Baber JJ. Heterotopic gastric and esophageal tissue in the vermiform appendix. Am J Clin Pathol. 1963;40:190–3.

    CAS  PubMed  Google Scholar 

  50. de la Fuente AA. Septa in the appendix: a previously undescribed condition. Histopathology. 1985;9(12):1329–37.

    PubMed  Google Scholar 

  51. Hsu M, Young RH, Misdraji J. Ruptured appendiceal diverticula mimicking low-grade appendiceal mucinous neoplasms. Am J Surg Pathol. 2009;33(10):1515–21.

    PubMed  Google Scholar 

  52. Abdullgaffar B. Diverticulosis and diverticulitis of the appendix. Int J Surg Pathol. 2009;17(3):231–7.

    PubMed  Google Scholar 

  53. Rakovich G. Diverticulosis of the appendix. Dig Surg. 2006;23(1–2):26.

    PubMed  Google Scholar 

  54. Deschênes L, Couture J, Garneau R. Diverticulitis of the appendix. Report of sixty-one cases. Am J Surg. 1971;121(6):706–9.

    PubMed  Google Scholar 

  55. Lipton S, Estrin J, Glasser I. Diverticular disease of the appendix. Surg Gynecol Obstet. 1989;168(1):13–6.

    CAS  PubMed  Google Scholar 

  56. Endo K, Sato M, Saga K, Higashio A, Yuba Y, Morotomi Y. Torsion of vermiform appendix: case report and review of the literature. Surg Case Rep. 2020;6(1):6.

    PubMed  PubMed Central  Google Scholar 

  57. Hamada T, Kosaka K, Shigeoka N, et al. Torsion of the appendix secondary to appendiceal mucocele: gray scale and contrast-enhanced sonographic findings. J Ultrasound Med. 2007;26(1):111–5.

    PubMed  Google Scholar 

  58. Khizer M, Ram S, Khan AM. A rare cause of right iliac fossa pain. J Indian Assoc Pediatr Surg. 2009;14(1):34–5.

    PubMed  PubMed Central  Google Scholar 

  59. De Bruin AJ. Torsion of the appendix. Med J Aust. 1969;1(11):581.

    PubMed  Google Scholar 

  60. Wan Hassan WA, Tay YK, Ghadiri M. Torsion of the vermiform appendix: a case report and review of literature. Am J Case Rep. 2018;19:365–8.

    PubMed  Google Scholar 

  61. D’Souza GF, Abdessalam S. Volvulus of the appendix: a case report. J Pediatr Surg. 2011;46(8):e43–4.

    PubMed  Google Scholar 

  62. Musa DH, Mohammed AA. Intussusception of the vermiform appendix caused by mucinous tumor of the appendix: Case report. Int J Surg Case Rep. 2020;67:51–3.

    PubMed  PubMed Central  Google Scholar 

  63. Mann WJ, Fromowitz F, Saychek T, Madariaga JR, Chalas E. Endometriosis associated with appendiceal intussusception. A report of two cases. J Reprod Med. 1984;29(8):625–9.

    CAS  PubMed  Google Scholar 

  64. Ashrafi M, Joshi V, Zammit M, Telford K. Intussusception of the appendix secondary to mucinous cystadenoma: a rare cause of abdominal pain. Int J Surg Case Rep. 2011;2(2):26–7.

    CAS  PubMed  Google Scholar 

  65. Sweetser S, Sanderson SO, Ahlquist DA. Education and imaging. Gastrointestinal: colocolonic intussusception by adenocarcinoma arising from diffuse serrated adenoma of the appendix. J Gastroenterol Hepatol. 2011;26(6):1081.

    CAS  PubMed  Google Scholar 

  66. Pumberger W, Hörmann M, Pomberger G, Hallwirth U. Sonographic diagnosis of intussusception of the appendix vermiformis. J Clin Ultrasound. 2000;28(9):492–6.

    CAS  PubMed  Google Scholar 

  67. Levine MS, Trenkner SW, Herlinger H, Mishkin JD, Reynolds JC. Coiled-spring sign of appendiceal intussusception. Radiology. 1985;155(1):41–4.

    CAS  PubMed  Google Scholar 

  68. McSwain B. Intussusception of the appendix. South Med J. 1941;34:263–71.

    Google Scholar 

  69. Forshall I. Intussusception of the vermiform appendix with a report of seven cases in children. Br J Surg. 1953;40:305–12.

    CAS  PubMed  Google Scholar 

  70. Park BS, Shin DH, Kim DI, Son GM, Kim HS. Appendiceal intussusception requiring an ileocecectomy: a case report and comment on the optimal surgery. BMC Surg. 2018;18(1):48.

    PubMed  PubMed Central  Google Scholar 

  71. Ruiz J, Ríos A, Oviedo MI, Rodríguez JM, Parrilla P. Neurogenic ppendicopathy. A report of 8 cases. Rev Esp Enferm Dig. 2017;109(3):180–4.

    PubMed  Google Scholar 

  72. Masson P. Carcinoids (Argentaffin-Cell Tumors) and nerve hyperplasia of the appendicular mucosa. Am J Pathol. 1928;4(3):181–212.19.

    CAS  PubMed  PubMed Central  Google Scholar 

  73. Stanley MW, Cherwitz D, Hagen K, Snover DC. Neuromas of the appendix. A light-microscopic, immunohistochemical and electron-microscopic study of 20 cases. Am J Surg Pathol. 1986;10(11):801–15.

    CAS  PubMed  Google Scholar 

  74. Olsen BS, Holck S. Neurogenous hyperplasia leading to appendiceal obliteration: an immunohistochemical study of 237 cases. Histopathology. 1987;11(8):843–9.

    CAS  PubMed  Google Scholar 

  75. Malone PS, Ransley PG, Kiely EM. Preliminary report: the antegrade continence enema. Lancet. 1990;336(8725):1217–8.

    CAS  PubMed  Google Scholar 

  76. Mitrofanoff P. Cystostomie continente trans-appendiculaire dans le traitement des vessies neurologiques [Trans-appendicular continent cystostomy in the management of the neurogenic bladder]. Chir Pediatr. 1980;21(4):297–305.

    CAS  PubMed  Google Scholar 

  77. Martin LW. Use of the appendix to replace a ureter. Case report. J Pediatr Surg. 1981;16(6):799–800.

    CAS  PubMed  Google Scholar 

  78. Estevão-Costa J. Autotransplantation of the vermiform appendix for ureteral substitution. J Pediatr Surg. 1999;34(10):1521–3.

    PubMed  Google Scholar 

  79. Valla JS. Hepaticoportoappendicostomy. J Pediatr Surg. 1988;23(11):1057–8.

    CAS  PubMed  Google Scholar 

  80. Shah AA, Shah AV. Appendix as a biliary conduit for choledochal cysts in children. Eur J Pediatr Surg. 2005;15(2):128–31.

    CAS  PubMed  Google Scholar 

  81. Sarin YK, Sinha A. Acute appendicitis complicating Mitrofanoff procedure. J Pediatr Surg. 2004;39(8):1294–5.

    PubMed  Google Scholar 

  82. Stewart B, Khanduri P, McCord C, et al. Global disease burden of conditions requiring emergency surgery. Br J Surg. 2014;101:e9–22.

    CAS  PubMed  Google Scholar 

  83. Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management [published correction appears in Lancet. 2017 Oct 14;390(10104):1736]. Lancet. 2015;386(10000):1278–87.

    PubMed  Google Scholar 

  84. Humes DJ, Simpson J. Acute appendicitis. BMJ. 2006;333(7567):530–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  85. Carr NJ. The pathology of acute appendicitis. Ann Diagn Pathol. 2000;4(1):46–58.

    CAS  PubMed  Google Scholar 

  86. Barker DJ, Morris J, Nelson M. Vegetable consumption and acute appendicitis in 59 areas in England and Wales. Br Med J (Clin Res Ed). 1986;292(6525):927–30.

    CAS  Google Scholar 

  87. van Laar JM, Smit VT, de Beus WM, et al. Rheumatoid vasculitis presenting as appendicitis. Clin Exp Rheumatol. 1998;16(6):736–8.

    PubMed  Google Scholar 

  88. Kim CJ, Chung HY, Kim SY, et al. Acute appendicitis in Henoch-Schonlein purpura: a case report. J Korean Med Sci. 2005;20(5):899–900.

    PubMed  PubMed Central  Google Scholar 

  89. Cellini C, Hoda SA, Spigland N. Lupus-associated vasculitis manifesting as acute appendicitis in a 16 year old girl. Pediatr Rheumatol. 2008;6:10.

    Google Scholar 

  90. Osarumwense DT, Pararajasingam R, Gudur LD, Walker SR. Arteritis in the appendix: an unusual cause of right iliac fossa pain. Eur J Gastroenterol Hepatol. 2004;16(9):947–8.

    PubMed  Google Scholar 

  91. Gray GF Jr, Wackym PA. Surgical pathology of the vermiform appendix. Pathol Annu. 1986;21(Pt 2):111–44.

    PubMed  Google Scholar 

  92. Pieper R, Kager L, Tidefeldt U. Obstruction of appendix vermiformis causing acute appendicitis. An experimental study in the rabbit. Acta Chir Scand. 1982;148(1):63–72.

    CAS  PubMed  Google Scholar 

  93. Parthiban N, Harish M. A study on microbiology culture of acute appendicectomy specimen and its correlation with wound infection. Int Surg J. 2017;4:2212–5.

    Google Scholar 

  94. Guinane CM, Tadrous A, Fouhy F, et al. Microbial composition of human appendices from patients following appendectomy. mBio. 2013;4(1):e00366–12.

    CAS  PubMed  PubMed Central  Google Scholar 

  95. Riddle R, Jain D. Lewin, Weinstein, and Riddell’s gastrointestinal pathology and its clinical implication. 2nd ed. Philadelphia: Lippincott Wlliams & Wilkins; 2014. p. 814–47.

    Google Scholar 

  96. Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med. 2004;141(7):537–46.

    PubMed  Google Scholar 

  97. Horton LW. Pathogenesis of acute appendicitis. Br Med J. 1977;2(6103):1672–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  98. Butler C. Surgical pathology of acute appendicitis. Hum Pathol. 1981;12(10):870–8.

    CAS  PubMed  Google Scholar 

  99. Carr NJ, McCarthy WF, Sobin LH. Epithelial noncarcinoid tumors and tumor-like lesions of the appendix. A clinicopathologic study of 184 patients with a multivariate analysis of prognostic factors. Cancer. 1995;75(3):757–68.

    CAS  PubMed  Google Scholar 

  100. Carr NJ, Montgomery E. Patterns of healing in the appendix: the morphologic changes in resolving primary acute appendicitis and a comparison with Crohn’s disease. Int J Surg Pathol. 1994;21:23–30.

    Google Scholar 

  101. Handra-Luca A. Acute appendicitis and periappendicitis revealing squamous and transitional cystic and solid nests in adult patients: metaplasia or vestigeal remnants? Int Surg. 2016;101:212–6.

    Google Scholar 

  102. Guo G, Greenson JK. Histopathology of interval (delayed) appendectomy specimens: strong association with granulomatous and xanthogranulomatous appendicitis. Am J Surg Pathol. 2003;27(8):1147–51.

    PubMed  Google Scholar 

  103. Singh V, John KM, Malik A, Pareek T, Dutta V. Xanthogranulomatous appendicitis: uncommon histological variant of a common entity. Med J Armed Forces India. 2015;71(Suppl 1):S19–21.

    PubMed  Google Scholar 

  104. Rex JC, Harrison EG Jr, Priestley JT. Appendicitis and ligneous perityphlitis. Arch Surg. 1961;82:735–45.

    CAS  PubMed  Google Scholar 

  105. Durgun AV, Baca B, Ersoy Y, Kapan M. Stump appendicitis and generalized peritonitis due to incomplete appendectomy. Tech Coloproctol. 2003;7(2):102–4.

    CAS  PubMed  Google Scholar 

  106. Dikicier E, Altintoprak F, Ozdemir K, et al. Stump appendicitis: a retrospective review of 3130 consecutive appendectomy cases. World J Emerg Surg. 2018;13:22.

    PubMed  PubMed Central  Google Scholar 

  107. Leff DR, Sait MR, Hanief M, Salakianathan S, Darzi AW, Vashisht R. Inflammation of the residual appendix stump: a systematic review. Color Dis. 2012;14(3):282–93.

    CAS  Google Scholar 

  108. Chaudhary P, Nabi I, Arora MP. Periappendicitis: our 13 year experience. Int J Surg. 2014;12(9):1010–3.

    PubMed  Google Scholar 

  109. Fink AS, Kosakowski CA, Hiatt JR, Cochran AJ. Periappendicitis is a significant clinical finding. Am J Surg. 1990;159(6):564–8.

    CAS  PubMed  Google Scholar 

  110. Kang H, Kang S, Kang W, Lee D, Lee J. Treatment of acute appendicitis in the patients with severe neutropenia. J Med Case. 2013;4(12):799–802.

    Google Scholar 

  111. Forghieri F, Luppi M, Narni F, et al. Acute appendicitis in adult neutropenic patients with hematologic malignancies. Bone Marrow Transplant. 2008;42(10):701–3.

    CAS  PubMed  Google Scholar 

  112. Kothadia JP, Katz S, Ginzburg L. Chronic appendicitis: uncommon cause of chronic abdominal pain. Ther Adv Gastroenterol. 2015;8(3):160–2.

    Google Scholar 

  113. See TC, Watson CJ, Arends MJ, Ng CS. Atypical appendicitis: the impact of CT and its management. J Med Imaging Radiat Oncol. 2008;52(2):140–7.

    CAS  PubMed  Google Scholar 

  114. Mattei P, Sola JE, Yeo CJ. Chronic and recurrent appendicitis are uncommon entities often misdiagnosed. J Am Coll Surg. 1994;178(4):385–9.

    CAS  PubMed  Google Scholar 

  115. Bronner MP. Granulomatous appendicitis and the appendix in idiopathic inflammatory bowel disease. Semin Diagn Pathol. 2004;21(2):98–107.

    PubMed  Google Scholar 

  116. Meyerding EV, Bertram HF. Nonspecific granulomatous inflammation (Crohn’s disease) of the appendix; a case report. Surgery. 1953;34(5):891–4.

    CAS  PubMed  Google Scholar 

  117. Stĕrba J, Vlcek M. Appendiceal enterobiasis--its incidence and relationships to appendicitis. Folia Parasitol (Praha). 1984;31(4):311–8.

    Google Scholar 

  118. Mittal VK, Khanna SK, Gupta NM, Aikat M. Isolated tuberculosis of appendix. Am Surg. 1975;41(3):172–4.

    CAS  PubMed  Google Scholar 

  119. Ariel I, Vinograd I, Hershlag A, et al. Crohn’s disease isolated to the appendix: truths and fallacies. Hum Pathol. 1986;17(11):1116–21.

    CAS  PubMed  Google Scholar 

  120. Moyana TN, Kulaga A, Xiang J. Granulomatous appendicitis in acute myeloblastic leukemia: expanding the clinicopathologic spectrum of invasive candidiasis. Arch Pathol Lab Med. 1996;120(2):203–5.

    CAS  PubMed  Google Scholar 

  121. Lewin J, Dhillon AP, Sim R, Mazure G, Pounder RE, Wakefield AJ. Persistent measles virus infection of the intestine: confirmation by immunogold electron microscopy. Gut. 1995;36(4):564–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  122. Lamps LW, Madhusudhan KT, Greenson JK, Pierce RH, Massoll NA, Chiles MC, Dean PJ, Scott MA. The role of Yersinia enterocolitica and Yersinia pseudotuberculosis in granulomatous appendicitis: a histologic and molecular study. Am J Surg Pathol. 2001;25(4):508–15.

    CAS  PubMed  Google Scholar 

  123. AbdullGaffar B. Granulomatous diseases and granulomas of the appendix. Int J Surg Pathol. 2010;18(1):14–20.

    PubMed  Google Scholar 

  124. Dudley TH Jr, Dean PJ. Idiopathic granulomatous appendicitis, or Crohn’s disease of the appendix revisited. Hum Pathol. 1993;24(6):595–601.

    PubMed  Google Scholar 

  125. Payan HM, Gilbert EF, Hafez R. Granulomatous appendicitis. Dis Colon Rectum. 1981;24(6):432–6.

    CAS  PubMed  Google Scholar 

  126. Clarke H, Pollett W, Chittal S, Ra M. Sarcoidosis with involvement of the appendix. Arch Intern Med. 1983;143(8):1603–4.

    CAS  PubMed  Google Scholar 

  127. Veress B, Alafuzoff I, Juliusson G. Granulomatous peritonitis and appendicitis of food starch origin. Gut. 1991;32(6):718–20.

    CAS  PubMed  PubMed Central  Google Scholar 

  128. Mazziotti MV, Marley EF, Winthrop AL, Fitzgerald PG, Walton M, Langer JC. Histopathologic analysis of interval appendectomy specimens: support for the role of interval appendectomy. J Pediatr Surg. 1997;32(6):806–9.

    CAS  PubMed  Google Scholar 

  129. Park SH, Loftus EV Jr, Yang SK. Appendiceal skip inflammation and ulcerative colitis. Dig Dis Sci. 2014;59(9):2050–7.

    CAS  PubMed  Google Scholar 

  130. Andersson RE, Olaison G, Tysk C, Ekbom A. Appendectomy and protection against ulcerative colitis. N Engl J Med. 2001;344(11):808.

    CAS  PubMed  Google Scholar 

  131. Yaeger AA, Cheng PM, Tatishchev S, Whang G. Acute eosinophilic appendicitis: a radiologic-pathologic correlation. Clin Imaging. 2018;51:337–40.

    PubMed  Google Scholar 

  132. Rha B, Kelly DR, Shimamura M. Eosinophilic appendicitis attributable to Strongyloides infection in a pediatric renal transplant patient. J Pediatr Infect Dis Soc. 2013;2:274–7.

    Google Scholar 

  133. Aggelidou M, Kambouri K, Kouroupi M, Cassimos D, Foutzitzi S, Deftereos S. Acute eosinophilic appendicitis after generalized skin reaction due to unknown cause in a child: case report and literature review. Clin Pract. 2019;9(3):1177.

    PubMed  PubMed Central  Google Scholar 

  134. Manuel DL, Neufeld M, Piechura LM, et al. Barium-induced allergic appendicitis: a case report. J Case Rep Image Surg. 2017;3:25–8.

    Google Scholar 

  135. Aravindan KP, Vijayaraghavan D, Manipadam MT. Acute eosinophilic appendicitis and the significance of eosinophil - Edema lesion. Indian J Pathol Microbiol. 2010;53(2):258–61.

    CAS  PubMed  Google Scholar 

  136. Rajeshwari K, Dravid NV, Karibasappa GN, Surana A. Acute eosinophilic appendicitis: case report of three cases with brief review of literature. Ann Appl Bio-Sci. 2015;2:18–21.

    Google Scholar 

  137. Lamps LW. Infectious causes of appendicitis. Infect Dis Clin N Am. 2010;24(4):995–1018.

    Google Scholar 

  138. Shaktawat SS, Sissons MC. Malakoplakia of the appendix, an uncommon entity at an unusual site: a case report. J Med Case Rep. 2008;2(1):1–3.

    Google Scholar 

  139. Barayan SS, Al-Anazi AR. Malakoplakia in the appendix: unusual association with mucinous cystadenoma: case report and review of literature. Saudi J Gastroenterol. 2002;8(1):28.

    PubMed  Google Scholar 

  140. Kashani A, Kahn M, Jamil LH. Malakoplakia of the appendiceal orifice mimicking adenomatous epithelium. Clin Gastroenterol Hepatol. 2015;13(10):e153–4.

    PubMed  Google Scholar 

  141. Kojima M, Morita Y, Shimizu K, Yoshida T, Yamada I, Togo T, Johshita T. Immunohistological findings of suppurative granulomas of Yersinia enterocolitica appendicitis: a report of two cases. Pathol Res Pract. 2007;203(2):115–9.

    PubMed  Google Scholar 

  142. Sung YN, Kim J. Appendiceal actinomycosis mimicking appendiceal tumor, appendicitis or inflammatory bowel disease. J Pathol Transl Med. 2021;55(5):349. https://doi.org/10.4132/jptm.2020.05.17.

    Article  PubMed  Google Scholar 

  143. Krishna M, Dayal S, Kumar A. Primary tuberculosis of the appendix: a common disease with rare location - a rare case report from rural India. North Clin Istanb. 2020;7(3):298–301.

    PubMed  PubMed Central  Google Scholar 

  144. Brown TA, Rajappannair L, Dalton AB, Bandi R, Myers JP, Kefalas CH. Acute appendicitis in the setting of Clostridium difficile colitis: case report and review of the literature. Clin Gastroenterol Hepatol. 2007;5(8):969–71.

    PubMed  Google Scholar 

  145. Westerman LJ, Schipper ME, Stel HV, Bonten MJ, Kusters JG. Appendiceal spirochetosis in children. Gut Pathog. 2013;5(1):40.

    PubMed  PubMed Central  Google Scholar 

  146. Weidner AS, Panarelli NC, Rennert H, Jessurun J, Yantiss RK. Immunohistochemistry improves the detection of adenovirus in gastrointestinal biopsy specimens from hematopoietic stem cell transplant recipients. Am J Clin Pathol. 2016;146:627–31.

    CAS  PubMed  Google Scholar 

  147. Grynspan D, Rabah R. Adenoviral appendicitis presenting clinically as acute appendicitis. Pediatr Dev Pathol. 2008;11(2):138–41.

    PubMed  Google Scholar 

  148. Berrebi D, Ferkdadji L, Delagausie P, Aigrain Y, Peuchmaur M. Adenovirus and intranuclear inclusions in the appendix in children with acute intussusception. Ann Pathol. 1997;17(2):89–93.

    CAS  PubMed  Google Scholar 

  149. Kothari A, Caradine KD, Rico Crescencio JC, Sasapu A, Veeraputhiran MK, Jethava Y, Burgess MJ. Cytomegalovirus appendicitis after hematopoietic stem cell transplantation. Transpl Infect Dis. 2017;19(5):e12747.

    Google Scholar 

  150. Lopez-Navidad A, Domingo P, Cadafalch J, Farrerons J, Allende L, Bordes R. Acute appendicitis complicating infectious mononucleosis: case report and review. Rev Infect Dis. 1990;12(2):297–302.

    CAS  PubMed  Google Scholar 

  151. Stadlmann S, Lenggenhager DM, Alves VA, Nonogaki S, Kocher TM, Schmid HR, Singer G. Histopathologic characteristics of the transitional stage of measles-associated appendicitis: case report and review of the literature. Hum Pathol. 2011;42(2):285–90.

    PubMed  Google Scholar 

  152. Lukšić B, Mladinov S, Goić-Barišić I, Srzić A, Brizić I, Perić L. Acute appendicitis, a rare complication of varicella: a report of three cases. J Infect. 2012;64(4):430–3.

    PubMed  Google Scholar 

  153. Katzoli P, Sakellaris G, Ergazaki M, Charissis G, Spandidos DA, Sourvinos G. Detection of herpes viruses in children with acute appendicitis. J Clin Virol. 2009;44(4):282–6.

    PubMed  Google Scholar 

  154. Kim HS, Yeo HJ, Shin DH, Cho WH, Kim D. Isolated acute appendicitis caused by Aspergillus in a patient who underwent lung transplantation: a case report. Transplant Proc. 2018;50(4):1199–201.

    CAS  PubMed  Google Scholar 

  155. ter Borg F, Kuijper EJ, van der Lelie H. Fatal mucormycosis presenting as an appendiceal mass with metastatic spread to the liver during chemotherapy-induced granulocytopenia. Scand J Infect Dis. 1990;22(4):499–501.

    PubMed  Google Scholar 

  156. Yabanoğlu H, Aytac HQ, Turk E, Karagulle E, Calışkan K, Belli S, Kayaselcuk F, Tarım MA. Parasitic infections of the appendix as a cause of appendectomy in adult patients. Turkiye Parazitol Derg. 2014;38:12–6.

    PubMed  Google Scholar 

  157. Anwar I, Hassan S, Khalid A. Parasitic infestation of the appendix, masquerading as acute appendicitis. Int J Pathol. 2016;14:74–8.

    Google Scholar 

  158. Zakaria OM, Zakaria HM, Daoud MY, et al. Parasitic infestation in pediatric and adolescent appendicitis: a local experience. Oman Med J. 2013;28:92–6.

    PubMed  PubMed Central  Google Scholar 

  159. Amer AS, Saad AE, Antonios SN, Hasby E. A Prevalence of parasitic infections in surgically removed appendices: parasitological and histopathological studies. Helminthologia. 2018;55:33–44.

    CAS  PubMed  PubMed Central  Google Scholar 

  160. Da Silva DF, da Silva RJ, da Silva MG, Sartorelli AC, Rodrigues MA. Parasitic infection of the appendix as a cause of acute appendicitis. Parasitol Res. 2007;102:99–102.

    PubMed  Google Scholar 

  161. Gupta SC, Gupta AK, Keswani NK, Singh PA, Tripathi AK. Krishna Vatsala Pathology of tropical appendicitis. J Clin Pathol. 1989;42:1169–72.

    CAS  PubMed  PubMed Central  Google Scholar 

  162. Flum DR, Koepsell T. The clinical and economic correlates of misdiagnosed appendicitis. Arch Surg. 2002;137:799–804.

    PubMed  Google Scholar 

  163. Aydin Ö. Incidental parasitic infestations in surgically removed appendices: a retrospective analysis. Diagn Pathol. 2007;2:16. https://doi.org/10.1186/1746-1596-2-16.

    Article  PubMed  PubMed Central  Google Scholar 

  164. Ahmed SA, Mohammed U, Sanda RB, Makama J, Shehu MB, Ameh EA, Mayun AA. Schistosomiasis of the appendix in a tertiary hospital in Northern Nigeria: a 22-year review. J Lab Physicians. 2014;6:18–21.

    PubMed  PubMed Central  Google Scholar 

  165. Hamdona SH, Lubbad AM, Al-Hindi I. Histopathological study of Enterobius vermicularis among appendicitis patients in Gaza strip. Palestine J Parasit Dis. 2016;40:176–83.

    PubMed  Google Scholar 

  166. Altun E, Avci V, Azatçam M, et al. Parasitic infestation in appendicitis. A retrospective analysis of 660 patients and brief literature review. Saudi Med J. 2017;38:314–8.

    PubMed  PubMed Central  Google Scholar 

  167. Zarbaliyev E, Celik C. Parasitic appendicitis: a novel laparoscopic approach for the prevention of peritoneal contamination. Can J Infect Dis Med Microbiol. 2018;2018:3238061. https://doi.org/10.1155/2018/3238061.

    PubMed  PubMed Central  Google Scholar 

  168. Yıldırım S, Nursal TZ, Tarım A, Kayaselcuk F, Noyan T. A rare cause of acute appendicitis: parasitic infection. Scand J Infect Dis. 2005;37:757–9.

    PubMed  Google Scholar 

  169. Vinuela A, Fernandez RF, Martinez MA. Oxyuriasis granulomas of pelvic peritoneum and appendicular wall. Histopathology. 1979;3:69–77.

    CAS  PubMed  Google Scholar 

  170. Saxena AK, Springer A, Tsokas J, Willital GH. Laparoscopic appendectomy in children with Enterobius vermicularis. Surg Laparosc Endosc Percutan Tech. 2001;11:284–6.

    CAS  PubMed  Google Scholar 

  171. Ariyarathenam AV, Nachimuthu S, Tang TY, Courtney ED, Harris SA, Harris AM. Enterobius vermicularis infestation of the appendix and management at the time of laparoscopic appendectomy: case series and literature review. Int J Surg. 2010;8:466–469.

    Google Scholar 

  172. Chakrabarti I, Gangopadhyay M, Bandopadhyay A, Das NK. A rare case of gangrenous appendicitis by eggs of Taenia species. J Parasit Dis. 2014;38:135–7.

    PubMed  Google Scholar 

  173. Lejbkowicz F, Abel AB, Tsilman B, Cohen HI. Taenia infestation in the appendix: a report of two cases. J Med Microbiol. 2002;51:90–1.

    PubMed  Google Scholar 

  174. Cicek AC, Sehitoglu I, Eksi S. Taenia infestation in the appendix: a case report. Southeast Asian J Trop Med Public Health. 2013;44:959–62.

    PubMed  Google Scholar 

  175. Ilhan E, Senlikci A, Kızanoglu H, et al. Do intestinal parasitic infestations in patients with clinically acute appendicitis increase the rate of negative laparotomy? Analysis of 3863 cases from Turkey. Prz Gastroenterol. 2013;8:366–9.

    PubMed  PubMed Central  Google Scholar 

  176. Akbulut S, Tas M, Sogutcu N, et al. Unusual histopathological findings in appendectomy specimens: a retrospective analysis and literature review. World J Gastroenterol. 2011;17:1961–70.

    PubMed  PubMed Central  Google Scholar 

  177. Emre A, Akbulut S, Bozdag Z, et al. Routine histopathologic examination of appendectomy specimens: retrospective analysis of 1255 patients. Int Surg. 2013;98:354–62.

    PubMed  PubMed Central  Google Scholar 

  178. Egilmez R, Saygı G, Aker H, Elagöz Ş. Retrospective analysis of appendix vermiformis specimens for intestinal helminths. Türkiye Ekopatoloji Dergisi. 2000;6:1–4.

    Google Scholar 

  179. Ramsden K, Freeth M. Cryptosporidial infection presenting as an acute appendicitis. Histopathology. 1989;14(2):209–11.

    CAS  PubMed  Google Scholar 

  180. Gustofson RL, Kim N, Liu S, Stratton P. Endometriosis and the appendix: a case series and comprehensive review of the literature. Fertil Steril. 2006;86(2):298–303.

    PubMed  Google Scholar 

  181. Vyas M, Wong S, Zhang X. Intestinal metaplasia of appendiceal endometriosis is not uncommon and may mimic appendiceal mucinous neoplasm. Pathol Res Pract. 2017;213(1):39–44.

    PubMed  Google Scholar 

  182. Chai D, Wijesuriya R. Deciduosis of the appendix: diagnostic dilemma continues despite MRI evidence. Ann R Coll Surg Engl. 2016;98(8):e200–2.

    CAS  PubMed  PubMed Central  Google Scholar 

  183. Pollheimer MJ, Leibl S, Pollheimer VS, Ratschek M, Langner C. Cystic endosalpingiosis of the appendix. Virchows Arch. 2007;450(2):239–41.

    PubMed  Google Scholar 

  184. Hill DA, Dehner LP, White FV, Langer JC. Gliomatosis peritonei as a complication of a ventriculoperitoneal shunt: case report and review of the literature. J Pediatr Surg. 2000;35(3):497–9.

    CAS  PubMed  Google Scholar 

  185. Dadmanesh F, Miller DM, Swenerton KD, Clement PB. Gliomatosis peritonei with malignant transformation. Mod Pathol. 1997;10(6):597–601.

    CAS  PubMed  Google Scholar 

  186. Coughlin JP, Gauderer MW, Stern RC, Doershuk CF, Izant RJ Jr, Zollinger RM Jr. The spectrum of appendiceal disease in cystic fibrosis. J Pediatr Surg. 1990;25(8):835–9.

    CAS  PubMed  Google Scholar 

  187. Moyana TN. Necrotizing arteritis of the vermiform appendix: a clinicopathologic study of 12 cases. Arch Pathol Lab Med. 1988;112:738–41.

    CAS  PubMed  Google Scholar 

  188. Graf NS, Arbuckle S. Melanosis of the appendix: common in the paediatric age group. Histopathology. 2001;39(3):243–9.

    CAS  PubMed  Google Scholar 

  189. Rutty GN, Shaw PA. Melanosis of the appendix: prevalence, distribution and review of the pathogenesis of 47 cases. Histopathology. 1997;30(4):319–23.

    CAS  PubMed  Google Scholar 

  190. Ramdass MJ, Young Sing Q, Milne D, Mooteeram J, Barrow S. Association between the appendix and the fecalith in adults. Can J Surg. 2015;58(1):10–4.

    PubMed  PubMed Central  Google Scholar 

  191. Veerankutty FH, Saleem S, Chacko S, Sreekumar VI, Krishnan P, Varma D, Kurumboor P. IgG4-related disease of the appendix. J Gastrointest Surg. 2018;22(6):1124–6.

    PubMed  Google Scholar 

  192. Saran RK, Majumdar K, Kaur S, Mishra PK, Gondal R. Organizing mucinous ascites masquerading as pseudomyxoma peritonei; a process probably due to metaplasia, but not neoplasia. J Surg Educ. 2008;65:221–4.

    PubMed  Google Scholar 

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The authors agree to the fact that all biopsy procedures and surgical resections were performed after taking informed consent from respective patients as per the individual Institutional policies, which also includes consent for publishing the unidentified clinical images for publication or research purposes. The authors also declare no conflict of interest.

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Authors and Affiliations

  1. Department of Pathology, NRS Medical College, Kolkata, India

    Arghya Bandyopadhyay

  2. Department of Pathology, Al Sabah Hospital, Kuwait City, Kuwait

    Kaushik Majumdar

  3. Department of Pathology, MLN Medical College, Allahabad, UP, India

    Vatsala Mishra

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  1. Arghya Bandyopadhyay
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  3. Vatsala Mishra
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  1. Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

    Prasenjit Das

  2. Department of Pathology, Al Sabah Hospital, Kuwait City, Kuwait

    Kaushik Majumdar

  3. Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

    Siddhartha Datta Gupta

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Bandyopadhyay, A., Majumdar, K., Mishra, V. (2022). Non-neoplastic Lesions of the Appendix. In: Das, P., Majumdar, K., Datta Gupta, S. (eds) Surgical Pathology of the Gastrointestinal System. Springer, Singapore. https://doi.org/10.1007/978-981-16-6395-6_13

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