Differential expression of cell adhesion molecules in inflamed appendix: Correlation with clinical stage

The diagnosis of 'early inflamed', 'recurrent' or 'sub-acute' appendicitis is often difficult and accompanied by controversies between clinical data, histological findings, and their interpretation. The expression of the inte rcellular cell adhesion molecule-1 (ICAM-1), the vascular cell adhesion mol ecule-1 (VCAM-1), and E-selectin has been studied in 61 appendicectomy spec imens for possible use as a diagnostic tool. This study demonstrates a diff erent expression of CAM by endothelial (EC) and mesothelial cells (MC) in t he various stages of appendicitis, with early E-selectin and ICAM-1 express ion in EC, followed bq VCAM-1 in EC and MC. Appendices from patients with p rolonged clinical symptoms defined by clinicians as 'chronic' appendicitis showed VCAM-1 expression and occasionally weak expression of E-selectin in EC. In several cases, discrepancies were found between the pre-operative 'c linical' diagnosis, the histomorphological findings, and the immunohistolog ical results. In this context, the expression of E-selectin and VCAM-1 in c omparison with the histological features has potential significance In the diagnosis of 'early acute', 'sub-acute' or 'recurrent' appendicitis. In add ition, a correlation was demonstrated between the histological stages of ap pendicitis and the kinetics of CAM expression. The study also indicates tha t the time course of E-selectin expression vivo is longer than is suggested from in vitro data. (C) 1998 John Wiley & Sons, Ltd.