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Morphological Features and Differential Diagnosis of Crohn's Disease Limited to the Appendix and Cecum Adjacent to the Appendiceal Orifice Hidenobu Watanabe 1 , Akinori Iwashita 2 , Yoichi Ajioka 1 1The First Department of Pathology, Niigata University Faculty of Medicine 2Department of Pathology, Fukuoka University Chikushi Hospital Keyword: 虫垂・盲腸Crohn病 , 特発性肉芽腫性虫垂炎 , 敷石像 , 炎症性ポリポーシス pp.183-194
Published Date 2001/2/25
DOI https://doi.org/10.11477/mf.1403103111
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 Aims : To clarify the morphological features of Crohn's disease (CD) limited to the appendix and cecum adjacent of the appendiceal orifice, and the differential diagnosis among granulomatous lesions of the appendix.

 Materials : Nine cecal lesions showing a cobblestone appearance admixed with or without inflammatory polyposis (Table 1), and eleven cases with granulomatous appendicitis (Table 2).

 Results : Nine cecal lesions were preoperatively diagnosed as tumor in all, but, pathologically, 6 of them were definite CD and 3 of them were suspected CD. The definite CD showed transmural lymphoid aggregates, non-caseating epithelioid cell granulomas, and fissures. However, the suspected CD showed mild transmural inflammation, and multiple fissuring scars, but no granulomas. The cecal CD had appendiceal CD simultaneously. Out of 11 cases of granulomatous appendicitis, two (Case 2-9~11 in Table 2) were diagnosed as definite CD by the similar histology to that of intestinal CD of another part of the intestine. Two were diagnosed as suspicious CD because of the presence of granulomas in the appendix with normal appearance (Case 2-7, 8 in Table 2), and in acute appendicitis with a f ew (1~6) granulomas.

 Conclusion : First, cecal CD has the macroscopic features of localized cobblestone appearance at the orifice of the appendix, and should not be misdiagnosed as cecal or appendiceal tumor. Second, primary appendiceal CD has microscopic features different from other lesions with granulomas, and should be discriminated from other granulomatous appendicitis.


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