Do We Still Need to Perform Routine Histological Examination of Appendectomy Specimens?

Abstract

Appendiceal cancer is exceedingly rare,accounting for 0.5% of all gastrointestinal neoplasms with the age-adjusted incidence of 0.12 case per 1,000,000 people per year [1]. Owing to its vague and bizarre presentations, primary appendiceal cancer cannot be diagnosed preoperatively and is diagnosed in only 0.9%-1.4% of appendectomy specimens. Carcinoid tumours have been reported to be the most frequent primary tumours of appendix, accounting for 32%-85% of all appendiceal tumours, followed by adenocarcinomas that comprise further 4%-6% of tumours [2]. Appendiceal adenocarcinomas are extremely aggressive tumours behaving similar to that of colonic adenocarcinomas, requiring right hemicolectomy for curative intent.A retrospective study showed 10 cases of adenocarcinoma of the appendix from a total of 9323 appendectomies [Table/ Fig-1] (0.1%: 8 men and 2 women with a mean age of 53.1 years) [3]. Akbulut et al., reported unusual histological findings in 54 of 5462 (1%) appendectomy specimens; 37 enterobiasis, 6 carcinoids, 4 mucinous cystadenomas, 2 eosinophilic infiltrations, 2 mucoceles, 2 tuberculosis, and 1 neurogenic hyperplasia [4]. An examination of 4545 appendectomy specimens, performed for acute appendicitis, showed 44 (0.97%) unexpected tumours of appendix including an adenocarcinoma and a primary lymphoma of the appendix [5]. Another series analysed histological reports of 324 appendectomy specimens and reported 8 unexpected lesions [6]. The study concluded that surgeons should bear in mind the possibility of unusual pathologies justifying the need for the routine Surgery SectionDo We Still Need to Perform Routine Histological Examination of Appendectomy Specimens?histopathological examination of appendices. Meticulous attention to the gross operative findings such as abnormally hard part of appendix, grossly visible/palpable lymph nodes in peri-appendiceal region, and the arrangements for frozen-section during surgery can help identify the tumours at an earlier stage.Although fecoliths and lymphoid hyperplasia are the common aetiologies of acute appendicitis, some rare but vitally fatal lesions may also cause appendicitis. On the same note, intraoperative observations alone are not enough to identify the unexpected disease. The most frequent unusual findings in appendectomy specimens are parasites and benign or malignant tumours. Although the routine histological examination of appendectomy specimens poses a burden on the financial and technical resources, current research strongly justifies this practice. There is a need for routine histopathologic examination of the appendectomy specimens. The histologic examination is valuable in identifying unexpected conditions which may require further management depending on the nature of the disease process. Specimens from patients with suspected acute appendicitis may exhibit a myriad of histological variations including cancerous growths [7]. With increasing emphasis on cost-effectiveness in surgery, routine pathological examination of appendectomy specimens, alt...

Increased risk of malignancy for patients older than 40 years with appendicitis and an appendix wider than 10 mm on computed tomography scan: A post hoc analysis of an EAST multicenter study

“…However, the reported incidence of appendiceal malignancy in our patient population was in accordance with the literature. 10,12 Second, we did not find age as a continuous variable to be associated independently with underlying malignancy. Failure to achieve significance in the multivariable regression and due to our small population size, we decided not to use specific age cutoffs in our multivariable regression models and to use historic data for the age from the literature.…”

“…9 Appendiceal cancer is responsible for 0.5% of all gastrointestinal neoplasms and for about 1% of all colon cancers. 10,11 The rate of appendiceal cancer in appendicectomy specimens varies between 0.5% and 1.7% in the literature. 10,12 Appendiceal tumors are classified into 2 main groups: neuroendocrine tumors (most common primary typeeformerly known as carcinoids) and adenocarcinomas.…”

“…10,11 The rate of appendiceal cancer in appendicectomy specimens varies between 0.5% and 1.7% in the literature. 10,12 Appendiceal tumors are classified into 2 main groups: neuroendocrine tumors (most common primary typeeformerly known as carcinoids) and adenocarcinomas. 13 Adenocarcinomas are very aggressive tumors that may require a right hemicolectomy for an oncologic safe resection.…”

“…13 Adenocarcinomas are very aggressive tumors that may require a right hemicolectomy for an oncologic safe resection. 10 Due to the low incidence and lack of sensitive diagnostic tools, the presence of appendiceal malignancy is rarely suspected preoperatively and appendiceal malignancies are usually discovered incidentally on postoperative pathology reports. 2,14e16 Even when symptomatic, appendiceal malignancies most commonly present with symptoms indistinguishable from acute appendicitis.…”

Tumor carcinoide del apéndice cecal: cuando un hallazgo incidental modifica drásticamente el pronóstico y tratamiento del paciente

“…El estudio histopatológico de la pieza quirúrgica se realiza rutinariamente; sin embargo, la poca frecuencia en la que se encuentran hallazgos inusuales en ella hace que en la literatura aún se cuestione su utilidad (3). En un estudio retrospectivo a 14 años se encontró que de 1466 apendicectomías practicadas, el porcentaje de hallazgos inusuales correspondía al 3,88%; de estos, los tumores neuroendocrinos correspondían al 0,47% (4).…”