Diagnostic Significance of Ganglion Cells and Eosinophils in Appendicitis

An Adjunct to Histopathological Diagnosis

  • S Susmitha Gadag Institute of Medical Sciences, Gadag, Karnataka, India
  • Basavaraj P Bommanahalli Gadag Institute of Medical Sciences, Gadag, Karnataka, India
Keywords: Appendicitis, Eosinophils, Ganglion cells, Topography


Background: Appendicectomy is most commonly performed intra-abdominal surgery. The exact etiopathogenesis of appendicitis is not exactly understood. Though eosinophils and ganglion cells are been observed routinely in appendix by many pathologists, little is being highlighted in literature in this regard. Present study was done to access the significance of mean cell count and topography of ganglion cells and eosinophils in association with histological type of appendicitis. Methods: It’s a retrospective study which included 93 appendicectomy specimens, out of which 65 were included. Remaining 28 cases with gangrenous change, perforation and neoplastic lesions were excluded. Mean cell count of eosinophils and ganglion cells was calculated. Topographical distribution and mean cell count of eosinophils and ganglion cells were correlated with histopathological type of appendicitis. The significance of association was calculated by chi-square test. Result: The mean eosinophil count was significantly higher in acute appendicitis compared to recurrent appendicitis with a p-value of <0.001. The ganglion cells were found to be more in acute appendicitis than recurrent appendicitis and was statistically significant (p=0.007). Topographic distribution of ganglion cells was predominantly noted within the circular layer only and between longitudinal and circular muscle layer along with circular layer of the muscularis propria in both acute and recurrent appendicitis. Conclusion: Mean count of eosinophils and ganglion cells were significantly increased in acute appendicitis. Hence, it may be considered as additional diagnostic criteria for acute appendicitis. Atypical localization of ganglion cells in circular layer was noted in both acute and recurrent appendicitis.

Author Biographies

S Susmitha, Gadag Institute of Medical Sciences, Gadag, Karnataka, India
Department of Pathology
Basavaraj P Bommanahalli, Gadag Institute of Medical Sciences, Gadag, Karnataka, India
Department of Pathology


1. Singh UR, Malhotra A, Bhatia A.et al. Eosinophils, mast cells, nerves and ganglion cells in appendicitis. Indian J.Surg 2008;70:231-34.
2. Xiong S, Puri P, Nemeth L, O’Briain DS, Reen DJ. Neuronal hypertrophy in Acute appendicitis. Arch pathol Lab Med. Oct 2000;124:p1429-33.
3. Liu C, Crawford JM. Gastrointestinal tract. In: Kumar V, Abbas AK, Fausto N, eds. Robbins and Cotran Pathologic Basis of Disease. 7 th ed. PhiladelphiaPA: Elsevier Inc., 2004;797-875.
4. Aravindan, KP; Vijayaraghavan, Deepthy; Manipadam, MarieTherese (15 december 2018). "Acute eosinophilic appendicitis and the significance of eosinophil - Edema lesion". Indian Journal of Pathology and Microbiology.53 (2): 258. doi:10.4103/0377-4929.64343
5. Fu M, Tam PKH, Sham MH, Lui VCH. Embryonic development of the ganglion plexuses and the concentric layer structure of human gut: a topographical study. Anat Embryol.2004;208:33-41.
6. Rao NR, Prasad B, Jothi SS, Kommuru H, Rao BN. Topography of ganglion cells in the inflammatory appendicular muscle coat. IOSR-JDMS. July 2016;15(7):51-3.
7. Coskun N, Indel SM, Elpek GO. Mast cell density and neuronal hypertrophy in patients with acute appendicitis. Turk J Gastroenterol.2003;14(1):54-8.
8. Karakus E, Azili MN, Karabulut B, Kabacam GB, Karakus R. Is there a role of interstitial cells of cajal and mast cells and eosinophils in appendicitis in children? Turk J Med Sci.2015;45:800-3.
9. Kubikova E, Sivakova I, Perzelova A. Atypical localization of myenteric ganglia in the human appendical wall: a comparative study with animal appendix. Biologia.2014;69(7):931-5.
10. Emre A, Akbulut S, Bozdag Z, Yilmaz M, Kanlioz M, Emre R et al. Routine histopathological examination of appendectomy specimens: Retrospective analysis of 1255 patients. Int Surg.2013;98:354-62.
11. Otake S, Suzuki N, Takahashi A, Toki F, Nishi A, Yamamoto H et al. Histological analysis of appendices removed during interval appendectomy after conservative management of pediatric patients with acute appendicitis with an inflammatory mass or abscess. Surg today. Aug 2012;44(8):1400-5.
12. Vaos G, Dimopoulou A, Gkioka E, Zavras N. Immediate surgery or conservative treatment for complicated acute appendicitis in children? A meta-analysis. Yjpsu(2018), doi:10.1016/j.jpedsurg.2018.07.017
13. Hanani M. Multiple myenteric networks in the human appendix. Auton Neurosci.2004;110(1):49-54.
Original Article