Amber Safeena, Mathai Alka Mary, Naik Ramadas, Pai Muktha R, Kumar Suneet, Prasad Keerthana
Department of Pathology, Kasturba Medical College, Mangalore, Karnataka, India.
Indian J Gastroenterol. 2010 Mar;29(2):69-73. doi: 10.1007/s12664-010-0016-1. Epub 2010 May 5.
In about 20-25% of appendicectomies performed for clinically suspected acute appendicitis, definite morphological changes are lacking on histopathological examination. The present study was done to investigate whether any changes in neurons and mast cells could be detected in patients presenting with clinical acute appendicitis but found to have normal appendix at histopathology.
A descriptive study was conducted on 50 appendix specimens which were categorized as histology-positive acute appendicitis (HPAA), clinically acute appendicitis but histologically negative (HNAA), appendices resected for other causes and appendices from forensic autopsy. A morphometric and quantitative evaluation of nerve fibers and ganglion plexus and its relation to mast cell density were studied. All sections were subjected to hematoxylin and eosin stain, toluidine blue stain, S 100 protein and neuron specific enolase (NSE) immunostaining and a quantitative image analysis system.
Mucosal and submucosal neuronal components highlighted by NSE and S100 immunostaining observed in cases of HNAA were comparable to cases of HPAA. With S 100 immunostaining in HNAA cases, the increase in number and size of myentric neuronal plexus were mild in 40% (10/25) cases, moderate in 40% (10/25) and marked in 20% (5/25) cases as compared to 66.7% (10/15) cases of HPAA showing moderate and 33.3% (5/15) cases showing marked increase (p = 0.018). The mean mast cell count was highest in the HNAA cases (2.74) in all the four layers as compared to the HPAA (1.85) and control group (2.05). There was no difference in the relationship of the size of ganglion cells and the mast cell concentration.
Neuronal hypertrophy and mast cells may play a role in the pathogenesis of appendicitis-like pain in patients with histologically normal appendices.
在因临床怀疑急性阑尾炎而进行的阑尾切除术中，约20%-25%的病例在组织病理学检查中未发现明确的形态学改变。本研究旨在调查临床诊断为急性阑尾炎但组织病理学检查阑尾正常的患者，其神经元和肥大细胞是否存在任何变化。
对50份阑尾标本进行描述性研究，这些标本分为组织学阳性急性阑尾炎（HPAA）、临床诊断为急性阑尾炎但组织学阴性（HNAA）、因其他原因切除的阑尾以及法医尸检的阑尾。研究了神经纤维和神经节丛的形态计量学和定量评估及其与肥大细胞密度的关系。所有切片均进行苏木精-伊红染色、甲苯胺蓝染色、S100蛋白和神经元特异性烯醇化酶（NSE）免疫染色，并使用定量图像分析系统。
HNAA病例中，经NSE和S100免疫染色突出显示的黏膜和黏膜下神经元成分与HPAA病例相当。在HNAA病例中，经S100免疫染色，40%（10/25）的病例肌间神经节丛数量和大小轻度增加，40%（10/25）的病例中度增加，20%（5/25）的病例显著增加；相比之下，HPAA病例中66.7%（10/15）的病例中度增加，33.3%（5/15）的病例显著增加（p = 0.018）。在所有四层中，HNAA病例的平均肥大细胞计数最高（2.74），高于HPAA病例（1.85）和对照组（2.05）。神经节细胞大小与肥大细胞浓度之间的关系无差异。
神经元肥大和肥大细胞可能在组织学正常阑尾患者的阑尾炎样疼痛发病机制中起作用。
