In a study of 101 autopsy appendices and over 3000 surgically resected appendices the range of histopathological features seen in each group is described. Fibrosis and faecoliths were more common in the older autopsy group than in the younger surgically resected group. The high incidence of fibrosis in the autopsy group suggests that this is an age-related change, although some may be due to previous inflammation. The low incidence of faecoliths in the surgically resected group does not support the hypothesis that they are a major cause of appendicitis.
The nomenclature of non-carcinoid epithelial proliferations of the appendix is confused and many of the terms used have no histogenetic basis. A classification based on the well-established diagnostic categories of colonic epithelial polyps has been proposed recently. We have applied this classification to 42 benign epithelial lesions of the appendix in order to determine its suitability for routine diagnostic use, and in order to determine the prognosis of patients with these lesions. All lesions could be classified as either hyperplastic, adenomatous, mixed hyperplastic/adenomatous or dilated appendices. Six cases were associated with a synchronous carcinoma of the colon with all types of appendiceal histology being represented. Follow-up of the remainder of the patients revealed two subsequent colonic carcinomas, at 3 and 6 years post-appendicectomy respectively. In both of these patients, the appendix had shown adenomatous epithelium. We suggest that adenomas of the appendix may have a similar prognostic significance to adenomas elsewhere in the large bowel.
The diagnosis and classification of soft tissue sarcomas can pose difficult problems for the histopathologist. Many sarcomas are too poorly differentiated to exhibit morphological features specific enough to define their histogenesis. Using the immunoperoxidase technique with commercially available antisera as a routine adjunct to other diagnostic aids, it is possible to arrive at more accurate diagnoses on which treatment protocols can be based. In addition a better understanding of mesenchymal neoplasms and their origins can be obtained by functional immunohistochemical studies.
There is considerable confusion surrounding the histogenesis and nomenclature of squamous cell carcinomas of the oesophagus with spindle cell elements. These tumours, many of which are polypoid, have been variously called carcinosarcoma, pseudosarcoma and polypoid carcinoma of the oesophagus. A study of three recent cases strongly supports the theory that these tumours are squamous cell carcinomas with spindle cell metaplasia. They are not necessarily polypoid and adenocarcinomatous elements may also be present.
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