Acute Eosinophilic Appendicitis

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					      6th ASIA PACIFIC CONGRESS
 INTERNATIONAL ACADEMY OF PATHOLOGY


     Gastrointestinal Pathology
          Illustrational case


Acute Eosinophilic Appendicitis


              KP Aravindan
         Professor of Pathology
       Medical College, Calicut, India
24 year old male

• Admitted for acute abdominal pain of 12
  hours duration
• Right iliac fossa tenderness
• Temperature: 37.70 C
• Total Leukocyte count: 12,500/ mm3

• DLC: P72 L22 E3 M3

• ESR: 34 mm / 1st hr
Course

• Appendicectomy done after 12 hours


• The appendix was swollen and red. No
  surface exudate, adhesions or evidence of
  peritonitis
Microscopy shows no ulceration or luminal exudate
The submucosa is considerably widened and edematous.
         Muscle fiber separation can be seen
Inflammatory infiltrate between the widened muscle fibers.
              These are mostly eosinophils.
Muscle fibers separated by edema and many eosinophils seen in
 the spaces. This is the Eosinophil - Edema lesion (E-E lesion).
Summary of Pathology
• Grossly edematous inflamed appendix
• No ulceration or luminal exudate
• Submucosal edema
• Eosinophils the only inflammatory cells
• No neutrophils
• ‘Eosinophil - Edema lesion’ characteristic
  – Muscle fiber separation by edema; eosinophils in
    spaces
  – Distinct lesion
E-E lesion – Link with Acute appendicitis




    E-E lesion seen in a section of Focal appendicitis.
           Other sections showed suppuration
E-E lesion – Link with Acute appendicitis




   E-E lesion seen in acute appendicitis along with few
                       neutrophils
E-E lesion – Link with Acute appendicitis




  E-E lesion and marginated neutrophils in capillaries in
               a case of acute appendicits
Conclusion
• Acute Eosinophilic Appendicitis is a definite
  clinical entity
• Characterized by distinct ‘E-E lesion’
• Maybe forerunner of acute appendicitis
• Likely to be allergic in origin