Peripheral Cytotoxic T Cell Lymphoma of the Appendix Presenting as Acute Appendicitis.

PurposeAppendicoliths are one of the important causes of acute appendicitis. Currently, there is no consensus on the relationship between appendicoliths and complicated appendicitis, and opinions on the treatment of appendicolith-associated appendicitis vary. This study aims to determine the significance of appendicolith in acute complicated appendicitis and to assess the characteristics of appendicoliths and Computed tomography (CT) features associated with complicated appendicitis.MethodsA retrospective analysis was conducted on patients who underwent surgical treatment for acute appendicitis at the affiliated hospital of Qingdao University from January 2016 to October 2023. Acute appendicitis was classified into two groups with and without appendicolith based on CT findings, intraoperative observations, and postoperative pathology. The clinical data of the two groups were analyzed and compared. Further subgroup analysis was performed within the appendicolith group based on pathological findings, comparing the location, size, and number of appendicoliths, as well as the length, diameter, and CT features of the appendix.ResultsAmong 331 patients with acute appendicitis, 179 had appendicolith, of which 106 were complicated appendicitis and 73 were uncomplicated appendicitis. Among 152 patients without appendicolith, 44 had complicated appendicitis and 108 had uncomplicated appendicitis. appendicoliths were independently associated with complicated appendicitis (OR = 1.88, 95% CI: 1.04–3.40, p = 0.036). In patients with appendicolith appendicitis, three factors were independently associated with complicated appendicitis: appendiceal diameter (OR = 1.20; 95% CI: 1.03–1.40), moderate-severe fat stranding (OR = 17.61; 95% CI: 3.19–97.33), and periappendiceal air (OR = 9.78; 95% CI: 1.17–81.46).ConclusionAppendiceal appendicoliths are closely related to acute complicated appendicitis. The diameter of the appendix and moderate-severe fat stranding, periappendiceal air on CT are significant indicators for identifying complicated appendicitis in acute appendicitis with appendicolith.

BackgroundPyosalpinx as a cause of acute appendicitis is very rare. We report the first case of a right pyosalpinx causing an extrinsic compression of the appendiceal lumen and consequently an acute appendicitis following an obstruction.Case presentationA 32 year old female from the North west region of Cameroon, presented with an acute exacerbation of a mild chronic right iliac fossa pain over a 2 day duration. She underwent exploratory laparotomy and intraoperative findings were a bilateral pyosalpinx, with the right fallopian tube adhering to the caecum and the terminal ileum, and obstructing the lumen of an inflammed appendix. A classical appendectomy and a right salpingectomy were done. The post-operative period was uneventful and she returned after 2 weeks for a follow-up visit with no further complaints.ConclusionWe describe to the best of our knowledge, the first case of an acute appendicitis caused by an extrinsic obstruction of the appendiceal lumen by a pyosalpinx. The close proximity of the caecum to the right fallopian tube most likely accounted for this occurrence. Although a rare entity, physicians should always keep in mind very rare causes of an acute appendicitis to guide management. This case highlights the shortcomings of pelvic ultrasonography in the diagnosis this condition. A pelvic computed tomography scanning should therefore be sought in case of a doubtful pelvic ultrasonography result. Finally, there is an urgent need to improve the awareness on sexually transmitted infections in our setting.

Background: Appendiceal diverticulum (AD) is a rare surgical finding. This entity is classified as either congenital or acquired, with a reported incidence of 0.014% and 0.2-1.7%, respectively. AD can often be associated with acute or chronic appendicitis. Clinically, AD must be identified before any surgical procedure as its concomitant presence with acute or chronic appendicitis increases the risk of perforation and may be associated with underlying neoplasia such as low-grade mucinous adenoma. We hereby report a case of incidental appendiceal diverticulosis associated with acute appendicitis in an attempt to increase the physicians’ perception, knowledge, and awareness of this rare medical condition. Case Presentation: We report a 40-year-old male patient, with no relevant family history, who presented to the Emergency Department after four days of vague and moderate epigastric pain and nausea. The physical examination upon presentation was unremarkable. Computed Tomography (CT) scan was done and was suggestive of an inflamed appendix. The patient underwent an urgent laparoscopic appendectomy. The removed appendix was inflamed and grossly abnormal with multiple diverticulae. The patient had a smooth recovery. Conclusion: Diverticulosis of the appendix is a rare clinical entity and, as in our case, is often diagnosed during or after appendectomy. When associated with acute appendicitis, it may be suspected preoperatively with the appropriate imaging technique. This is of paramount importance as it can rapidly progress to perforation and/or lead to a higher mortality rate.

Epiploic appendagitis (EA) is a rare cause of right lower quadrant (RLQ) abdominal pain. We report an unusual case of acute gangrenous appendicitis that developed after laparoscopic treatment of an EA. A 62-year-old man underwent laparoscopy for RLQ abdominal pain. EA was found and a resection was performed. The appendix, which was macroscopically normal, was left undisturbed. One week later, the patient was operated on for acute gangrenous appendicitis. Histologic examination separately confirmed both diagnoses. The definitive outcome was uneventful. The exact origin of this unusual case is unknown: Could acute appendicitis have been secondary to laparoscopic manipulation or initially missed? We conclude that acute appendicitis may be either missed or induced by laparoscopy for RLQ abdominal pain.

BackgroundA villous adenoma is an extremely rare benign tumour in the appendix, in contrast to other benign appendiceal lesions. The clinical features are usually asymptomatic. Acute appendicitis is the most common complication with the lesion obstructing the orifice of the appendiceal lumen. Thus, a villous adenoma is usually found during surgical intervention for acute appendicitis. Mechanical obstruction induced by acute perforated appendicitis has been previously reported. Acute appendicitis caused by a villous adenoma presenting with acute intestinal obstruction has not been previously reported.Case presentationA 78-year-old woman presented to our Emergency Department with diffuse abdominal pain and tenderness. The abdominal plain film and computed tomography revealed an intestinal obstruction. After surgical intervention, the ruptured appendix was shown to be associated with intestinal obstruction. The post-operative pathologic diagnosis was an appendiceal villous adenoma.ConclusionsThis is the first report describing an appendiceal villous adenoma, which is an occasional cause of perforated acute appendicitis, presenting as a complete intestinal obstruction. We emphasize that in elderly patients without a surgical history, the occult cause of complete intestinal obstruction must be determined. If an appendiceal tumour is diagnosed, an intra-operative frozen section is suggested prior to selecting a suitable method of surgical intervention.

NK/T Cell Versus Peripheral T Cell Lymphoma: Significant Differences in Clinical Characteristics and Survival.

Peripheral T cell lymphomas (PTCLs) are uncommon and less well studied. Most PTCLs present as systemic disease and often involve bone marrow. Bone marrow involvement by PTCLs may damage the normal hematopoiesis and bring more challenge to clinical management of these patients. This study focuses on the clinical pathological features and clinical outcomes in 13 patients with nodal peripheral T cell lymphoma and subsequent bone marrow biopsy positive for the same lymphoma. Eight patients were diagnosed of peripheral T cell lymphoma - not otherwise specified (PTCL-NOS), 3 angioimmunoblastic T cell lymphoma (AITL), 1 anaplastic large cell lymphoma (ALCL), and 1 T cell lymphoma of gamma-delta origin (TCL-gamma/delta). All patients had peripheral blood abnormalities: 11 anemia, 7 thrombocytopenia, 5 neutropenia, and 2 lymphocytosis. Of interest, the CD4/CD8 phenotype of PTCL was shown correlating with abnormal peripheral blood findings: CD4+/CD8- phenotype was more often associated with anemia and thrombocytopenia, and CD4-/CD8+ phenotype was associated with lymphocytosis. Chemotherapy remains the choice of first line treatment for these patients with or without stem cell transplantation. 12 patients had treatment and follow up data available for review, 5 were in remission or free of disease during the follow up period; 5 patients were alive or in hospice with persistent disease and 2 died of disease due to multiple complications. The outcome of PTCL treated with the standard chemotherapy has been less favorable compared with B cell lymphomas. Majority of the patients with nodal PTCL have bone marrow involvement at the time of initial diagnosis, which has significant impact on normal hematopoiesis and may be a significant factor in the overall unfavorable prognosis for these patients. Further investigation with better knowledge about this disease will be helpful in the development of more efficient therapy and improve the disease free survival and life quality for these patients.

In this study, we aimed to investigate the correlation of Alvarado scoring with C-reactive protein and leukocytes and the reliability of Alvarado scoring, and to guide clinicians for patient management. This study was planned as a prospective study. Data of the patients who presented to the emergency department with abdominal pain and diagnosed with acute appendicitis, and the control group were examined by the researchers. After a detailed physical examination, patientsÂ’ Alvarado scoring parameters and laboratory outcomes were recorded. Pathologic outcomes of the patients who were considered to have acute appendicitis and operated were studied. A different pathology other than appendicitis was found in 13 (15.1%) of 86 patients who were considered to have acute appendicitis and operated (negative appendectomy). According to the pathologic outcomes of the patient group, the most common cause of acute appendicitis was found to be fecalloids by 84.9%. Whereas simple appendicitis was observed in 85% of the patients, perforation was found in 8.2%. The most common finding of physical examination was right iliac fossa (95.8%), while the most common symptom was nausea / vomiting (67.1%) the in the cases of acute appendicitis. Among the Alvarado scoring parameters, fever was the least common symptom by 12.4%. In our study, we found a significant correlation between Alvarado scoring and leukocytes both in patients and control groups. Whereas there was no correlation between Alvarado scoring and C-reactive protein in the patient group, there was a correlation between these two parameters in the control group. There was a weak negative correlation between Alvarado scoring and acute appendicitis. Although Alvarado scoring has been reported to be a guiding scoring system in management of patients considered to have acute appendicitis, in our study this scoring was found to be statistically insignificant. Alvarado scoring alone is not sufficient in establishing a diagnosis, and the diagnosis should be supported by laboratory tests or imaging methods.

Final Results of a Phase II Trial of Belinostat (PXD101) in Patients with Recurrent or Refractory Peripheral or Cutaneous T-Cell Lymphoma.

A Multicenter, Open-Label, Phase 3, Randomized Controlled Trial of Duvelisib Versus Investigator's Choice of Gemcitabine or Bendamustine in Patients with Relapsed/Refractory Nodal T Cell Lymphoma with T Follicular Helper Phenotype

Peripheral T cell lymphoma (PTCL) is a group of heterogeneous lymphomas with very poor prognosis. Abnormal genes and molecular biology alterations are significant factors in the occurrence and development of PTCL. Currently, therapies of PTCL, based on chemotherapy regimens for aggressive B cell lymphomas, have resulted in insufficient outcomes. As a novel subject related to gene expression and regulation, epigenetics provides an innovative thought for studying on pathogenesis, clinical diagnosis and therapy of PTCL. Meanwhile, numerous novel epigenetic target-drugs and combinations have been developed continually. Therefore, epigenetic regulation offers a new breakthrough for diagnosis and therapy of PTCL. In this review, the mechanism of epigenetic study and application prospect of new epigenetic target-drugs therapies for PTCL are summarized. Key words: Lymphoma, T-cell, peripheral; Epigenetics; Drug therapy

Isolated fallopian tube torsion is very rare which is reported to be 1 in 1.5 million women. Fallopian tube torsion is commonly associated with hydrosalpinx, hematosalpinx or paratubal cysts such as hydatids of Morgagni. Fallopian tube torsion generally presents a diagnostic dilemma because symptoms and signs mimics ovarian torsion such as acute lower abdominal pain, vomiting, tenderness on palpation but ultrasound may show normal ipsilateral ovary. Right sided adnexal torsion may be difficult to differentiate from acute appendicitis clinically. In such cases ultrasound is helpful but diagnostic laparoscopy is gold standard. We encountered a rare case of torsion hematosalpinx concurrent with acute appendicitis. Patient was presented with acute onset severe lower abdominal pain associated with vomiting and tenderness in right iliac fossa. It was diagnosed as acute tip appendicitis and right adnexal cystic mass either hydrosalpinx/hematosalpinx in ultrasonography. Laparoscopy was done and it was found to be right sided torsion hematosalpinx along with inflamed tip of appendix. Right sided salpingectomy and appendicectomy was done laparoscopically. Fallopian tube torsion should be suspected and diagnostic laparoscopy should be considered in cases of acute onset lower abdominal pain in which ovarian pathology was not found in ultrasonography, that helps in earlier intervention and even in early cases fallopian tube can be salvaged.

SummaryBackgroundCutaneous peripheral T cell lymphomas (PTCL) are rare and show an aggressive course with limited response to therapy. The efficacy of brentuximab vedotin in cutaneous peripheral T cell lymphomas has not yet been systematically investigated.Patients and methodsIn this retrospective analysis, we evaluated brentuximab vedotin as monotherapy or in combination therapy in patients with cutaneous CD30‐positive peripheral T cell lymphoma (n = 9).ResultsOverall, the therapy showed good efficacy and acceptable tolerability. One patient achieved an almost complete response, five had a partial response, and two had a mixed response as best overall response. The median time to response was 31.5 days (interquartile range 12–53). The median duration of response was short at 4.3 months. Median overall survival from initiation of brentuximab vedotin was 15.2 months; four of nine patients died from advanced lymphoma and one patient died from an unrelated cause.ConclusionBrentuximab vedotin as monotherapy or combination therapy is a rapidly effective and tolerable treatment option for patients with cutaneous PTCL, although the duration of response is short.

We describe an immunocompetent 12-year-old with pneumococcal appendicitis. The exact mechanism of the appendix seeding by Streptococcus pneumoniae is not known, and primary pneumococcal appendicitis has been described in only 6 children (of a total of 12 cases) in the English literature during the last 30 years. The actual incidence of this infection is thought to be ∼0.3% of all appendicitis cases.

Acute appendicitis of amebic origin is considered a rare cause of acute appendicitis. The clinical notes for 4093 patients over the age of 16 who had undergone appendectomy were reviewed. Particular attention was paid to the histopathologic results, separating out those cases where trophozoites were seen in the appendix. These cases were considered to be of amebic origin. A total of 93 cases reported lesions suggestive of amebiasis (2.3%). This study analyzed 86 of these cases. Comparing the cases in this study against the cases of patients with acute appendicitis in general (excluding the cases of amebic origin), no differences were found in relation to the distribution or presentation according to sex or in the degree of inflammation of the appendix, the incidence of surgical wound infection, or general complications. By contrast, the study noted a statistically significant difference in the age at presentation: Acute appendicitis of amebic origin presents principally among those under 20 years of age and is accompanied by a higher frequency of fecal fistula (2.3%). Acute appendicitis of amebic origin is not seen frequently, and in general it does not behave any differently from other cases of acute appendicitis, except in its earlier presentation and its greater incidence of fecal fistula. The condition is suspected clinically whenever a cecum of hard, "cardboard-like" consistency is discovered.