Intravascular lymphocytosis in acute appendicitis: potential mimicry of chronic lymphocytic leukaemia

• Published in: Histopathology Vol. 55; no. 6; pp. 660 - 664
• Main Authors: Lee, Sandra, Ogilvie, Robert T, Dupre, Marc, Gao, Zu-Hua
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.12.2009; Blackwell
• Subjects: acute appendicitis; Adolescent; Adult; Aged; Aged, 80 and over; Antigens, CD - metabolism; Appendectomy; Appendicitis - complications; Appendicitis - diagnosis; Appendicitis - surgery; Appendix - pathology; Biological and medical sciences; chronic lymphocytic leukaemia; Diagnosis, Differential; Female; Gastroenterology. Liver. Pancreas. Abdomen; Hematologic and hematopoietic diseases; Humans; Immunohistochemistry; intravascular lymphocytosis; Investigative techniques, diagnostic techniques (general aspects); Leukemia, Lymphocytic, Chronic, B-Cell - diagnosis; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphocytosis - complications; Lymphocytosis - diagnosis; Lymphocytosis - surgery; Male; Medical Records; Medical sciences; Middle Aged; Other diseases. Semiology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Appendicitis; Acute; Malignant hemopathy; Anatomic pathology; Chronic lymphocytic leukemia; intravascular lymphocytosis; chronic lymphocytic leukaemia; acute appendicitis; Lymphoproliferative syndrome; Digestive diseases; Intestinal disease; Lymphocytosis; Cancer
• ISSN: 0309-0167; 1365-2559
• DOI: 10.1111/j.1365-2559.2009.03431.x

Aims:  Intravascular lymphocytosis (IVL) in appendectomy specimens is a fairly common phenomenon but has not been described and studied in detail. The aim was to describe the IVL phenomenon in appendiceal specimens removed for appendicitis that can mimic chronic lymphocytic leukaemia and to investigate factors that could contribute to the development of IVL. Methods and results:  The clinicopathology of 100 appendectomy cases and the appendices from 20 right hemicolectomy cases were reviewed. The IVL phenomenon was more commonly seen in laparoscopic appendectomy specimens [Fisher’s exact 0.011, odds ratio (OR) 3.14] and in patients <38 years old (Fisher’s exact 0.012, OR 3.01). Conclusions:  Surgical manipulation and the patient’s innate immunity are contributary factors to the development of the IVL phenomenon. Pathologists should be aware of this histological artefact in order to prevent overdiagnosis of intravascular lymphoid neoplasia.