Immunohistochemical inflammation in histologically normal appendices in patients with right iliac fossa pain

Psaltis, Emmanouil; Zaitoun, Abed M.; Neal, Keith R.; Lobo, Dileep N.

Abstract

Background
Histologically normal appendices resected for right iliac fossa pain in children demonstrate immunohistochemical markers of inflammation. We aimed to establish if subclinical inflammation was present in histologically normal appendices resected from adults with right iliac fossa pain.

Methods
Immunohistochemistry was performed on formalin-fixed paraffin-embedded appendices for tumour necrosis factor (TNF)-α, interleukin (IL)-6, IL-2R and serotonin in four groups: Group I (n = 120): uncomplicated appendicitis, Group II (n = 118): complicated appendicitis (perforation or gangrene), Group III (n = 104): histologically normal appendices resected for right iliac fossa pain and Group IV (n = 106) appendices resected at elective colectomy. Expression was quantified using the H-scoring system.

Results
Median, interquartile range expression of TNF-α was increased in Groups I (5.9, 3.1–9.8), II (6.8, 3.6–12.1) and III (9.8, 6.2–15.2) when compared with Group IV (3.0, 1.4–4.7, p ≤ 0.01). Epithelial expression of IL-6 in Groups II (44.0, 8.0–97.0) and III (71.0, 18.5–130.0) was increased when compared with Group IV (9.5, 1.0–60.2, p ≤ 0.01). Expression of mucosal IL-2R in Groups I (47.4, 34.8–69.0), II (37.8, 25.4–60.4) and III (18.4, 10.1–34.7) was increased when compared with Group IV (2.8, 1.2–5.7, p ≤ 0.01). Serotonin content in Groups I (3.0, 0–30.0) and II (0, 0–8.5) was decreased when compared with Groups III (49.7, 16.7–107.5) and IV (43.5, 9.5–115.8, p ≤ 0.01).

Conclusion
Histologically normal appendices resected from symptomatic patients exhibited increased proinflammatory cytokine expression on immunohistochemistry suggesting the presence of an inflammatory process not detected on conventional microscopy.

Citation

Psaltis, E., Zaitoun, A. M., Neal, K. R., & Lobo, D. N. (2021). Immunohistochemical inflammation in histologically normal appendices in patients with right iliac fossa pain. World Journal of Surgery, 45(12), 3592-3602. https://doi.org/10.1007/s00268-021-06288-w

• Journal Article Type: Article
• Acceptance Date: Aug 1, 2021
• Online Publication Date: Aug 15, 2021
• Publication Date: Dec 1, 2021
• Deposit Date: Aug 12, 2021
• Publicly Available Date: Aug 16, 2022
• Journal: World Journal of Surgery
• Print ISSN: 0364-2313
• Electronic ISSN: 1432-2323
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 45
• Issue: 12
• Pages: 3592-3602
• DOI: https://doi.org/10.1007/s00268-021-06288-w
• Public URL: https://nottingham-repository.worktribe.com/output/6013685
• Publisher URL: https://www.springermedizin.de/immunohistochemical-inflammation-in-histologically-normal-append/19571918