The value of routine histopathological examination of appendicectomy specimens

Jones, Alun E.; Phillips, Alexander W; Jarvis, J. R.; Sargen, Kevin

doi:10.1186/1471-2482-7-17

Cited by 86 publications

(87 citation statements)

References 17 publications

(21 reference statements)

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“…Appendicectomy and cholecystectomy are the most common procedures performed in a general surgical practice. Importance of routine histopathologic examination of the surgical specimens is now being debated because many incidental findings have little clinical significance [3,4]. However, sometimes the clinician might miss an occult malignancy even intraoperatively, which could be detected only on microscopy.…”

Section: Discussionmentioning

confidence: 99%

“…A small number of literature data studied the benefits of histopathologic examination of these two common surgical specimens [2][3][4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…Only in 0.1-4.2 % of routine histopathologic evaluations does one see abnormal diagnoses other than normal or inflammatory changes. A few of these are clinically significant affecting patient management [2,3,7]. Navez and Therasse did a retrospective study on whether patients undergoing laproscopic exploration for clinical diagnosis of appendicitis should have an appendicectomy.…”

Section: Discussionmentioning

confidence: 99%

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Routine Histopathologic Examination of Two Common Surgical Specimens—Appendix and Gallbladder: Is It a Waste of Expertise and Hospital Resources?

Ramraje

Pawar

2012

Indian J Surg

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This study was undertaken to assess whether a routine histopathologic examination of two common surgical specimens (appendix and gallbladder) is needed and whether routine histopathologic examination has an impact on further management of patients. Histopathology reports of patients who had undergone appendicectomy and cholecystectomy, between 2006 and 2010, were analyzed retrospectively in the department of pathology of a tertiary care hospital. The case notes were retrieved in all cases of malignancies. Patients having a clinical diagnosis or suspicion of malignancy were excluded. The incidence and impact of unexpected pathologic diagnosis on postoperative management were noted. The study period included a total of 1,123 and 711 appendicectomy and cholecystectomy specimens, respectively. Fifteen (1.336 %) cases of appendicectomy specimens revealed incidental unexpected pathological diagnoses, which included tubercular appendicitis (n0 2), parasite (n 08), neuroma (n 01), carcinoid (n 02), pseudomyxoma (n 01), and adenocarcinoma (n 01). About 88 % of such unexpected appendiceal findings had an impact on postoperative treatment. Unexpected pathologic gallbladder findings were found in 12 (1.68 %) of 711 cholecystectomy specimens. In 6 (0.84 %) cases, gallbladder cancer (GBC) was detected. Additional further management was required in 50 % of patients with unexpected gallbladder findings. Twenty of the total 1,834 specimens (1.090 %) had an impact on patient management or outcome and were not suspected on macroscopic examination at the time of surgery. These would have been missed had the specimens not been examined microscopically. The intraoperative diagnosis of the surgeon is therefore sometimes doubtful in detecting abnormalities of the appendix and gallbladder. This study supports the sending of all appendicectomy and cholecystectomy specimens for routine histopathological examination. Appendix and gallbladder should undergo routine histopathological examination. This is important in patients with advanced age and gallstones. Also, it is of great value in identifying unsuspected conditions which require further postoperative management. Selectively sending specimens for histopathological examination can result in reduced workload on the histopathology department without compromising patient safety.

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Section: Discussionmentioning

confidence: 99%

“…A small number of literature data studied the benefits of histopathologic examination of these two common surgical specimens [2][3][4][5][6][7].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Routine Histopathologic Examination of Two Common Surgical Specimens—Appendix and Gallbladder: Is It a Waste of Expertise and Hospital Resources?

Ramraje

Pawar

2012

Indian J Surg

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“…In addition, the low incidence of primary appendicular adenocarcinoma makes it hard to evaluate the value of routine preoperative use of imaging techniques. However, the important role of routine histopathological examination of appendectomy materials should not be discussed (9). Forgotten histopathological examination of these materials may result in delay of diagnosis of primary appendicular adenocarcinoma and poor medicolegal outcomes for the surgeon.…”

Section: Discussionmentioning

confidence: 99%

Appendix adenocarcinoma in an elderly patient from a nursing home

Sönmez

Bayhan

Yaylak

et al. 2016

UCD

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Appendiceal malignancies are rare clinic entities. The clinical presentation of appendiceal malignancies is often atypical. Acute abdominal pain and acute appendicitis, which requires early surgical intervention, are the most common clinical presentations of appendiceal malignancies. In this case report, an adenocarcinoma of the appendix in a 64-year-old male from a nursing home has been presented. He had right lower quadrant pain for the last 5 days. On physical examination, he had significant guarding. Intravenous contrast-enhanced abdominopelvic tomography revealed no pathological features. Laparotomy under general anesthesia was scheduled. During exploration, a perforated appendicitis was observed. Formal appendectomy was performed. The patient was lost due to pneumonia and septic shock 5 days after surgical intervention. In addition, the natural history of the disease and its basic diagnostic and therapeutic aspects are discussed. Preoperative or intraoperative diagnosis may not be available for some patients. Thus, routine histopathological examination is essential for adequate diagnosis and treatment.

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“…Appendiceal endometriosis corresponds to less than 1% of the causes of acute appendicitis 7 . In a study that analyzed the cecal appendix histology of 1,225 patients submitted to surgical treatment with clinical diagnosis of acute appendicitis, only 0.25% of the analyzed specimens presented microscopic diagnosis of endometriosis 17 . Thus, these findings agree with results of other studies that appendiceal endometriosis is more related to the diagnosis of chronic pelvic pain 2,3,5-7,9-11,15 usually associated with pelvic endometriosis 3,11 , and not to acute pain 4,7 .…”

Section: Discussionmentioning

confidence: 99%