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- Title
Clinical significance of pathologic abnormalities in biopsy samples from the appendiceal orifice.
- Authors
Castrodad‐Rodríguez, Carlos A.; Choudhuri, Jui; El‐Jabbour, Tony; Cheng, Jerome; Westerhoff, Maria; Panarelli, Nicole C.
- 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.
- Subjects
APPENDIX (Anatomy); IRON deficiency; IRON deficiency anemia; INFLAMMATORY bowel diseases; ULCERATIVE colitis; DRUGS; TREATMENT effectiveness
- Publication
Histopathology, 2021, Vol 79, Issue 5, p751
- ISSN
0309-0167
- Publication type
Article
- DOI
10.1111/his.14418