Clinical significance of pathologic abnormalities in biopsy samples from the appendiceal orifice. Issue 5 (6th August 2021)

• Record Type: Journal Article
• Authors: Castrodad‐Rodríguez, Carlos A.; Choudhuri, Jui; El‐Jabbour, Tony; Cheng, Jerome; Westerhoff, Maria; Panarelli, Nicole C.
• Is Part Of: Histopathology. Volume 79:Issue 5(2022)
• Page Start: 751
• Page End: 757
• Publication Date: 2021-08-06
• Subjects: active inflammation -- appendix -- chronic inflammation -- microscopic colitis -- ulcerative colitis; Histology, Pathological -- Periodicals; 611.018
• DOI: 10.1111/his.14418
• Languages: English
• ISSNs: 0309-0167

Abstract

Abstract : Aims: Appendiceal orifice mucosa often appears inflamed endoscopically, even when other colonic segments appear normal. Histological findings in biopsy samples taken from endoscopically abnormal mucosa may simulate a variety of inflammatory colitides. We performed this study to evaluate the clinical implications of inflammatory changes isolated to the appendiceal orifice. Methods and results: In this double cohort study, biopsy samples from 26 histologically abnormal appendiceal orifices were reviewed. Twenty‐five control cases were culled from endoscopically normal ( n = 11) and abnormal ( n = 14) appendiceal orifices that were histologically normal. Histological findings were correlated with presentation, medication history, findings at other colonic sites and clinical outcomes. Study cases displayed active inflammation ( n = 12), chronic active inflammation ( n = 13) or features simulating collagenous colitis ( n = 1). Eighteen patients had biopsies taken from other colonic sites; these revealed benign polyps ( n = 10) or displayed active ( n = 4) or chronic active ( n = 4) inflammation. All patients with findings isolated to the appendiceal orifice were asymptomatic at most recent clinical follow‐up. Four of eight (50%) of the patients with inflammation in other biopsy samples were ultimately diagnosed with ulcerative colitis, in keeping with the well‐established role of the appendix as a 'skip lesion' in that disorder. Control patients presented for screening colonoscopy ( n = 19), iron deficiency anaemia ( n = 3) or change in bowel habits ( n = 3) and none reported gastrointestinal symptoms upon follow‐up, regardless of the endoscopic appearance of the appendiceal orifice. Conclusion: Isolated inflammation of the appendiceal orifice mucosa should not be regarded as a feature of evolving inflammatory bowel disease or other types of chronic colitis. Abstract :