A rare pathological trinity: an appendiceal ectopic pregnancy, acute appendicitis and a carcinoid tumour

Al-Saffar

Annals of Medicine &Amp; Surgery

et al. 2021

Introduction While appendicitis is considered one of most common acute surgical conditions, several studies have reported abnormal histopathological findings in appendectomy specimens; however, sending all appendices to histopathology is not yet routinely done.Here we report many unusual findings. Those unusual findings played a role not only in confirming acute appendicitis as a cause of the presentation in some cases but also discovering etiologies that mimic it with great impact on its management. Methods Between January 2011 and December 2017, a total of 1510 patients were operated with appendectomy for a primary diagnosis of acute appendicitis. Among them, a total of 72 patients had incidental histopathologic findings in association with acute appendicitis or other pathologies instead of acute appendicitis. A retrospective analysis for those 72 patients was performed with all data being retrieved from the electronic health record system. Results Patients ages ranged between 4 and 71 years with a mean age equal to 23.1 years (SD = 14.2). Majority of patients were women (n = 52; 72.2%). Sixty of the seventy-two cases were seen in patients with negative appendectomies (n = 333) with an overall rate of 18% among this group of patients. The remaining 12 patients had additional findings in histopathology specimens beside acute appendicitis (n = 1131) with an overall rate of 1%. The most commonly reported pathologies were serositis, ovarian cysts, and Enterobius vermicularis in descending frequency. Conclusion Identification of unusual histopathological findings during microscopic examination of resected appendices is more common in female patients and in patients with negative appendectomy. histopathologic assessment of specimens will allow detection of congenital, infectious or malignant pathologies that mimic acute appendicitis clinically even in the absence appendicitis microscopically.

Section: Discussionmentioning

confidence: 99%

Unusual histopathological findings in appendectomy specimens with clinical diagnosis of acute appendicitis: A retrospective cohort analysis

Al-Saffar

Annals of Medicine &Amp; Surgery

et al. 2021

J Case Rep Images Obstet Gynecol

“…For these patients, surgical management is often necessary to prevent morbidity and mortality. After thorough review of the literature, there is only one report of appendiceal adenocarcinoma mimicking ectopic pregnancy [8]. Our report highlights a case of appendiceal carcinoma in the setting of a molar pregnancy.…”

Section: Discussionmentioning

confidence: 81%

Appendiceal adenocarcinoma: Case report of an unexpected mimicker of ectopic pregnancy

Kristen¹,

Sheldon²

2021

Introduction: Appendiceal neoplasms comprise a low percentage of gastrointestinal malignancies. These malignancies are most often noted incidentally on imaging or during surgery. There are few case reports describing malignancy of the appendix during pregnancy and even fewer that involve abnormal pregnancies, such as molar or ectopic pregnancy.Case Report: This is the case of a 32-year-old female who presented with an unknown last menstrual period (LMP), positive home pregnancy test, and right adnexal mass. Due to the concern for ectopic pregnancy, she underwent laparoscopic assessment, revealing an appendiceal neoplasm. She was subsequently diagnosed with a concurrent molar pregnancy. Conclusion:Given the proximity of the appendix to right-sided adnexal structures, appendiceal tumors can be mistaken for ovarian masses, or vice versa. Appendiceal adenocarcinoma often presents with symptoms of acute appendicitis and can mimic the pain of a ruptured ectopic pregnancy in reproductive aged women. Therefore, it is important for clinicians to consider involvement of both structures while evaluating an adnexal mass. Ultrasound imaging is the standard of care for women presenting with pelvic pain and an elevated b-hCG; however, alternative imaging modalities should be considered when ultrasound findings are not definitive.

“…22 In an ectopic pregnancy, Thompson and Hawe reported a case of dual pathology of acute inflammation and appendiceal carcinoid. 23 Poiana et al. 24 reported a case of appendiceal carcinoid, where the patient decided upon an elective termination of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

A case of pulmonary carcinoid in pregnancy and review of carcinoid tumours in pregnancy

et al. 2017

Carcinoid tumours are rare slow growing tumours which arise from primitive neuroendocrine cells. The effect of the pregnant state on carcinoid tumours and vice versa remains unclear, as does the optimal management of carcinoid tumours during the pregnancy including labour. We report the rare case of a 36 year old primigravida woman with large bilateral pulmonary carcinoid tumours. The patient's disease was minimally symptomatic with no clinical suspicion of carcinoid syndrome. Under close observation, the pregnancy progressed well and the patient proceeded to a spontaneous vaginal delivery of a healthy child. We conduct the the first literature review in 30 years of all reported cases in this area and make suggestions as to assessment and monitoring of cases of carcinoid during pregnancy.