Grynspan David, Rabah Raja
Department of Pathology, Children's Hospital of Michigan and Wayne State University, 3901 Beaubien Street, Detroit, MI 48201-2119, USA.
Pediatr Dev Pathol. 2008 Mar-Apr;11(2):138-41. doi: 10.2350/07-06-0299.1. Epub 2007 Jul 20.
The vermiform appendix may react as part of a generalized viral infection, but histological documentation of appendiceal viral infection is rare. Adenovirus has been described in association with mesenteric adenitis and ileocecal intussusception, but to our knowledge there are no well-documented cases of adenoviral appendiceal infection presenting clinically as acute appendicitis without intussusception. We reviewed the pathology records of all appendectomies performed at our institution from 2001 through 2005. All incidental appendectomies and appendices with acute appendicitis or other pathological findings were excluded. We selected all negative appendices with lymphoid hyperplasia and reviewed hematoxylin and eosin-stained slides. Representative sections of each of these cases were immunostained with adenovirus antibody. Eight hundred seventy-seven appendectomies were performed during the study period. Of these, there were 94 cases that had a clinical diagnosis of acute appendicitis and that were pathologically negative. Sixty-three of the 94 cases had lymphoid hyperplasia and were stained for adenovirus. We identified 2 positive cases, which also showed epithelial proliferation and viral inclusions. One involved a 6-year-old male and the other involved a 5-year-old female, without intussusception. Adenovirus can infect the appendix and clinically mimic acute appendicitis without intussusception. We recommend that all negative appendices be evaluated for lymphoid hyperplasia and epithelial viral changes and possibly be stained with immunoperoxidase staining if indicated. We speculate that adenovirus may play a role in the pathogenesis of acute appendicitis.
阑尾可能作为全身性病毒感染的一部分而产生反应，但阑尾病毒感染的组织学证据很少见。腺病毒已被描述与肠系膜淋巴结炎和回盲部肠套叠有关，但据我们所知，尚无充分记录的腺病毒性阑尾感染病例在临床上表现为无肠套叠的急性阑尾炎。我们回顾了2001年至2005年在我们机构进行的所有阑尾切除术的病理记录。所有偶然的阑尾切除术以及患有急性阑尾炎或其他病理表现的阑尾均被排除。我们选择了所有伴有淋巴组织增生的阴性阑尾，并复查了苏木精-伊红染色切片。这些病例中的每个代表性切片均用腺病毒抗体进行免疫染色。在研究期间共进行了877例阑尾切除术。其中，有94例临床诊断为急性阑尾炎但病理检查为阴性。94例中的63例有淋巴组织增生并进行了腺病毒染色。我们鉴定出2例阳性病例，其也显示上皮增生和病毒包涵体。1例为6岁男性，另1例为5岁女性，均无肠套叠。腺病毒可感染阑尾，并在临床上模拟无肠套叠的急性阑尾炎。我们建议对所有阴性阑尾评估淋巴组织增生和上皮病毒变化，如有指征，可能需进行免疫过氧化物酶染色。我们推测腺病毒可能在急性阑尾炎的发病机制中起作用。
