Neurogenous hyperplasia leading to appendiceal obliteration: an immunohistochemical study of 237 cases

A series of 237 appendices was studied immunohistochemically for neurogenous hyperplasia. This was observed in 195 cases. It was possible to trace a continuum from appendices with intact lumens, featuring intramucosal neurogenous hyperplasia often with co-existent submucosal and muscular nerve growth, to obliterated specimens whose axial portions were composed of varying proportions of nerve tangles and fibrous tissue. Predominantly fibrotic specimens were considered as end-stages of this process. Stromal, argyrophilic cells lying amidst the nerve elements were prominent in the early, non-obliterated cases; their number decreased in the obliterated nerve rich specimens and such cells became inapparent in the late fibrotic stage. Repeated minimal subclinical attacks of inflammation are thought to trigger this lesion.