Neuroma of the appendix, a rare cause of appendicitis and an important reason for close follow-up

Abstract

Acute appendicitis is the most common surgical pathology worldwide, frequently, the patient history and clinical examination are so similar to other appendicular pathologies that preoperative diagnosis is almost impossible for the medical team. Neuroma of the appendix is a rare tumor of neural origin that usually resembles the symptoms of acute appendicitis. Pathology along with close follow-ups are key, as the diagnosis is based on the presence of nerve neuronal cells in the appendicular lumen. Surgical treatment is recommended due to the possibility of malignancy. We present a case of a 32-year-old male patient who presented with symptoms of acute abdomen, surgery was performed and appendectomy was completed. Neuroma of the appendix was the final diagnosis.

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

“…Other miscellaneous findings of variable clinical significance were reported in our group of patients as well as in the literature include Ovarian Chocolate cyst (i.e. endometrioma) [ [42] , [51] ], para fallopian tube cysts [ 52 ], foreign body granuloma [ 53 ]., cecal abscess [ 54 ], transmural infarction of caecum [ 55 ], Meckel's diverticulum [ 56 ], eosinophilic infiltration [ 5 , 11 , 57 ]., intussusception [ 58 ], Crohn's disease of the appendix [ 59 ], Neuroma of appendix [ 60 ], hyperplastic polyps of appendix, cecal fistula and appendicular diverticulum [ 57 ]. Fig.…”

Appendiceal neuroma presented as acute appendicitis: A rare case report from Syria

“…The process typically begins at the distal part and may affect only the tip or even the entire vermiform appendix [6] . Clinically, it is usually an incidental and asymptomatic finding, but it can mimic appendicitis, as in this case [3] , [7] . The differential diagnosis of stromal tumors of the appendix includes leiomyoma, gastrointestinal stromal tumors, and neurogenic lesions [8] .…”

“…The pathogenesis remains unclear. Several studies believe it may result from the proliferation of neuroendocrine cells due to frequent inflammatory attacks [3] , [7] . The process typically begins at the distal part and may affect only the tip or even the entire vermiform appendix [6] .…”

“…Immunohistochemical staining confirms the diagnosis of appendiceal neuroma, where the neoplasm cells are stained with S-100 protein [1] , [2] , [6] . The treatment of choice is surgical excision of the appendix [1] , [7] .…”

Neuroma of the appendix; an unusual histopathological finding in a case of appendicitis

“…Therefore, a thorough clinicopathological evaluation of the appendix is necessary for diagnosis, adequate management and follow-up. 1 2 3 4…”