Neuromas da mucosa do apêndice

Abstract

A general survay was made of the so-called neuromata of the appendix mucosa and the works of Masson, Maresch and Rossle were mainly focussed. The author accepts the hypothesis that the nervous hyperplasia that give rise to the so-called neuromata possibily results from inflamation stimuli but these structures are not amputation neuromata. Regarding the clinical meaning of such structures the author calls attention to the difficulty in stablishing the facts. The wrong conclusions come to a certain extent from a too short follow-up postoperative period but mainly from the unreliable informations of the patients whether conscious or, more commonly, subconsciously. The great cure percentages formerly reported after operations for chronic appendicitis were, in the past, highly exaggerated and, on such false basis, wrong conclusions were drawn regarding the value of the minor pathological findings of the appendicis. Even Masson may have been partially misled. Of course one may admit that, very exceptionally, these so-called neuromata of the mucosa may be so numerous and bulky as to cause stenosis of the appendix lumen and give rise to disease curable by appendectomy; but that is nothing compared to the enormous number of cases operated on for chronic appendicitis in whose appendicis there were neuromata, with or without active inflamation, but which did not obtain cure because a chronic typhlo-colitis and not amputation neuromata of the cut basis of the appendix was at the botton of the disease. The author reports 45 cases operated on by him with the diagnosis of chronic appendicitis. The histological sections of the appendicis were stained by the trichromic method of Masson and some by silver impregnation. In nine of the above mentioned appendicis there were found the so-called neuromata. One patient was cured, but, in his appendix there was also a focus infiltrated with leucocytes situated in the muscular coats and extending down to the submucosa, occupying an area of about one millimeter. Five of the patients were not relieved of their symptoms and they have now a chronic inespecific colitis which they probably had concommittantly with the appendicitis, from the begining, for two of them had obliterating appendicitis which the author regards as sugestive of chronic colitis when met with in young people. Since the symptomatology of chronic appendicitis is as a rule equal to that of chronic typhlitis (colitis) and since these two affections often coexist it is impossible in such cases to assign the roles played by the appendix lesions even when such organ is extirpated. Various types of these so-called neuromata described by Masson are illustrated