Crohnʼs Disease Patient with Right Lower Quadrant Abdominal Pain for 20 Years Due to an Appendiceal Neuroma (Fibrous Obliteration of the Appendix)

Patel, Archana; Friedman, Mark; MacDermott, Richard P.

doi:10.1002/ibd.21143

Cited by 12 publications

(6 citation statements)

References 8 publications

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“…Appendiceal neuromas (fibrous obliteration of the appendix) are rare and characterized by fibrous obliteration on HPE of the appendix. The majority of appendiceal neuromas are often incidentally discovered (22). The incidence of appendiceal neuromas in our study was only 0.2%, which is lower than that reported by Yilmaz et al…”

Section: Schistosomiasis Is Another Uncommon Cause Of Appendicitiscontrasting

confidence: 78%

Impact of routine histopathological examination of appendectomy specimens on patient management: a study of 4012 appendectomy specimens

Elfaedy¹,

Benkhadoura²,

Elshaikhy³

et al. 2019

Turk J Surg

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Objective: For a suspected diagnosis of acute appendicitis, appendectomy is one of the most common emergency abdominal operations performed. However, the need for routine histopathological examination (HPE) of all appendectomy specimens has recently been questioned. The aim of this study was to assess whether a routine HPE of appendectomy specimens is needed and whether routine HPE has an impact on further management of patients. , all histopathology reports of 4012 consecutive appendectomy specimens for a clinical suspicion of acute appendicitis were retrospectively analyzed in two university hospitals.Results: Out of the 4012 cases, 3530 (88%) patients showed findings consistent with acute appendicitis on HPE. Perforation rate was 5.8% and was significantly higher in male patients (p< 0.001) and higher in the > 30 years age group (p= 0.024). Negative appendectomy rate was 5.6% and was significantly higher in female patients (p< 0.001). There were 256 (6.4%) patients who demonstrated unusual findings in their HPE, which included chronic appendicitis (n= 207; 5.2%) patients, Enterobius vermicularis (n= 14), Schistosoma (n= 8), Crohn's disease (n= 1), neuroma (n= 10), carcinoid tumour (n= 5) and mucinous cystadenoma (n= 5), mucocele (n= 4) and mucinous cystadenocarcinoma (n= 2).Conclusion: HPE of the appendix does not only confirm the diagnosis of acute appendicitis, but also detects other unusual diagnoses that may have an impact on a patient's management. A number of patients with unusual histopathological findings require anti-helmentic treatment, colectomy, gastroenterology follow-up or periodic surveillance. Hence, all appendectomy specimens must be submitted for routine HPE.

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Section: Schistosomiasis Is Another Uncommon Cause Of Appendicitiscontrasting

confidence: 78%

Impact of routine histopathological examination of appendectomy specimens on patient management: a study of 4012 appendectomy specimens

Elfaedy¹,

Benkhadoura²,

Elshaikhy³

et al. 2019

Turk J Surg

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“…The differential diagnosis between acute appendicitis and appendiceal neuroma is difficult, and it should be established according to the patients' anamnesis, symptoms, and laboratory and physical examination findings. Most of these cases become incidentally evident with pathological examination in asymptomatic patients [18,19]. One study reported that fibrous obliteration was found in 57 (65 %) of 88 appendectomy specimens with unusual findings [3].…”

Section: Discussionmentioning

confidence: 97%

Incidental Findings in Routine Histopathological Examination of Appendectomy Specimens; Retrospective Analysis of 1970 Patients

et al. 2016

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Diseases and tumors of the appendix vermiformis are very rare, except for acute appendicitis. This study aimed to examine rare findings in the histopathologic examinations of specimens of patients undergoing appendectomy due to the diagnosis of acute appendicitis. The files of 1970 patients undergoing appendectomy due to the diagnosis of acute appendicitis between March 2012 and March 2016 were retrospectively investigated. Rare findings were found in 59 (3 %) patients, and these were evaluated in detail. Patients' age, gender, pathology reports, and postoperation follow-ups were recorded. The rare histopathological findings of 59 patients were examined. Of these, 31 were female (52.5 %) and 28 were male (47.5 %). The average age was 33.1 ± 18.2 years. The unusual findings were as follows: 16 fibrous obliteration, 11 , 2 schistosomiasis, 3 appendiceal neuroma, 2 granulomatous appendicitis, 1 Crohn's disease, 3 chronic appendicitis, 1 endometriosis, 2 hyperplastic polyps, 9 mucinous cystadenoma (+mucocele), 8 carcinoid tumors, and 1 lymphoma. All of the malignant tumors were localized in the distal end of the appendix, and all of the patients were treated with appendectomy. Patients with parasitic diseases also underwent anthelmintic treatment, while chemotherapy was administered to the patient with lymphoma. All of the patients diagnosed with malignancy were alive reported no problems at their follow-ups. Although all of the appendectomy samples were normal macroscopically, data from this study suggest that all specimens should be sent for routine investigation.

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“…Obstruction of the appendiceal lumen by various causes seems to be the most likely origin of appendicitis [ 3 ]. Despite the fact that the obstruction resulted usually from lymphoid hyperplasia secondary to inflammatory bowel disease or infections, fecal stasis and fecaliths, It has been less commonly attributed to various unusual causes like bacteria (Yersinia species [ 4 ], adenovirus [ 5 ], cytomegalovirus, actinomycosis [ 4 ], Mycobacteria species, Histoplasma species), parasites [ 3 , 6 ] (e.g., Schistosomes species [ 3 , 5 , 7 ], Entamoeba histolytica [ 8 , 9 ]), Pinworms 'Enterobius vermicularis' [ [10] , [11] , [12] , [13] ], enterocele [ 14 ], Ascariasis [ 11 , 15 , 16 ], serositis [ 10 ], Eosinophilic infiltration [ 5 , 7 , 11 ], foreign bodies [ 4 , 17 ], tuberculosis [ 4 , 7 , [18] , [19] , [20] ], carcinoid [ 3 , 7 , 11 , [21] , [22] , [23] , [24] ], mucocele [ 11 , 16 ], Endometriosis [ 5 , [25] , [26] , [27] , [28] , [29] ],Intussusception [ 17 , 29 , 30 ] Diverticulosis and Diverticulitis [ 17 , [31] , [32] , [33] ], or even malignancy such as adenocarcinoma [ 3 , 5 , 11 , 24 , 25 ] or appendiceal neuroma [ 33 , 34 ].This pape...…”

Section: Introductionmentioning

confidence: 99%

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

Al-Balas

Al-Saffar

Al-Balas

et al. 2021

Annals of Medicine &Amp; Surgery

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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.

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Crohnʼs Disease Patient with Right Lower Quadrant Abdominal Pain for 20 Years Due to an Appendiceal Neuroma (Fibrous Obliteration of the Appendix)

Cited by 12 publications

References 8 publications

Impact of routine histopathological examination of appendectomy specimens on patient management: a study of 4012 appendectomy specimens

Impact of routine histopathological examination of appendectomy specimens on patient management: a study of 4012 appendectomy specimens

Incidental Findings in Routine Histopathological Examination of Appendectomy Specimens; Retrospective Analysis of 1970 Patients

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

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