The role of cell adhesion molecules in the inflammed Appendix vermiformis - Pathophysiological and diagnostic aspects

The diagnosis of appendicitis, especially in borderline cases, is often difficult and discrepancies between clinical and histological data are not uncommon. In this context the literature yields a rate of 15-33% of histological normal appendices after clinical diagnosis of appendicitis. In the present study in 61 appendectomy specimens we have analysed the expression of the cell adhesion molecules ICAM-1, VCAM-1 and E-selectin in endothelial and mesothelial cells as a possible diagnostic tool. In different stages of appendicitis we demonstrated an early expression of E-selectin and ICAM-1 in endothelial cells, followed by VCAM-1.

Specimens from patients with prolonged symptoms showed an expression of VCAM-1 and occasionally of E-selectin. In cases with discrepancies between pre-operative clinical diagnosis and histomorphological findings we could demonstrate the diagnostic relevance of the E-selectin and VCAM-1 expression especially in the cases of ”early acute”, ”sub-acute” and ”recurrent appendicitis”.

Furthermore, a correlation was demonstrated between the histological stages of appendicitis and the kinetic of cell adhesion molecules.

This study presents an in situ model for a long-term analysis of inflammatory reactions and facilitates the correlation of morphological and clinical data. Our results indicate that in vitro data are not totally representative for the in situ situation.

Based on the MD thesis from C. Brochhausen, presented from the Department of Pathology, Johannes Gutenberg-University, Mainz (Germany). This study with complete results and pictures will be published by Verlag Neue Wissenschaft, Frankfurt/ Main (Germany, ISBN 3-932492-46-3) and is available directly from the author or the publisher.

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C.Brochhausen, F. Bittinger, C.J. Kirkpatrick
Department of Pediatrics, Philipps-University, Marburg/Germany
Scientific and Technical Information
Edition CDR 5, p. 52-74
December 2001