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Fibrous obliteration of appendix7/26/2023 The final diagnosis was appendiceal neuroma. Most of these cells were positive for S-100 protein ( Fig. The lumen of the appendix's tip was obliterated by a proliferation of spindle cells with wavy nuclei arranged in bundles ( Fig. 2A) with infiltration of polynuclear cells ( Fig. Microscopic examination of the H&E-stained sections showed mild crypt hyperplasia in the appendix's base ( Fig. The external surface of the appendix was grey-white with congested blood vessels, and the lumen of the distal part was absent in serial sections ( Fig. The specimen was sent to the pathology department. A diagnosis of acute appendicitis was made, and an appendectomy was performed. An abdominal ultrasound showed a dilated vermiform appendix in the right lower fossa with a peri-appendiceal fluid collection. Other routine blood values were within normal limits. Laboratory tests showed white blood cells (6000 mm 3) with neutrophilia (79 %). She had no history of ganglioneuromatosis, neurofibromatosis, or MEN 2B syndrome. The patient was a non-smoker and non-alcoholic. The physical examination revealed localized tenderness by palpation at the right iliac fossa with evidence of rebound. Occasionally, however, appendiceal neoplasia that is secondary from another site may dominate the clinical picture and lead to potential pathologic misdiagnosis as primary appendiceal disease.A 76-year-old woman patient presented to the emergency department at Tishreen University Hospital in 2022 with right lower quadrant abdominal severe pain for 4 days. Secondary involvement of the appendix by carcinomas of the female genital tract, particularly ovary, and diverse other sites are in aggregate common but only rarely a clinical or pathological difficulty. Secondary involvement of the appendix by leukemia has been reported. Lymphoma affects the appendix exceptionally in children, Burkitt lymphoma is most common whereas in adults, large cell lymphomas and low grade B-cell lymphomas predominate. Mesenchymal tumors of the appendix are most often of smooth muscle type, usually leiomyoma but rarely leiomyosarcoma nonmyogenic neoplasms such as gastrointestinal stromal tumor, granular cell tumor, Kaposi's sarcoma, and miscellaneous other curiosities occur rarely. Neural proliferations of the appendix include lesions associated with von Recklinghausen's disease, as well as mucosal and axial neuromas that are theorized to progress to fibrous obliteration of the appendix. Vasculitis may be either isolated to the appendix or part of a systemic vasculitis, most often polyarteritis nodosa. Peritoneal endosalpingiosis often involves the appendiceal serosa and occasionally the wall but has no clinical manifestations in contrast to endometriosis. Endometriosis of the appendix, which usually occurs in the setting of generalized gastrointestinal endometriosis, often presents as acute appendicitis, but may present as intussusception, lower intestinal bleeding, and, particularly during pregnancy, perforation. Diverticular disease may be an incidental finding, but when inflamed, can be clinically confused with appendicitis. Congenital abnormalities of the appendix are rare the two most commonly reported are congenital absence and appendiceal duplication. A variety of miscellaneous conditions affect the appendix, both as incidental findings and as causes of clinical signs and symptoms that often mimic appendicitis.
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