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

Abstract

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.

A histopathological study of unusual findings in appendectomy specimens in a tertiary care hospital of Andhra Pradesh

“…Earlier reports of E. vermicularis incidence in appendectomy specimens were ranged from 0.2% to 41.8%. 7 Enterobius vermicularis was found in 3 cases in the present study and nobody had acuteappendicitis on histology.…”

“…Malignant tumors of the appendix are carcinoids, mucoceles and adenocarcinomas. In this study, seven (7) cases with neoplasm in appendix were observed.…”

Collision Neoplasms of the Vermiform Appendix

“…And the second one, the prolonged exposure and stimulus from carcinogens in the mucosal layer affecting different regions of adjacent tissue and promoting the coexistence of two or more distinct neoplasms. This latter theory could be more significant in the appendix as the appendix is a tubular structure with a blind end which would facilitate a prolonged exposure to retained intestinal carcinogens [4] [12] [13].…”

“…Appendiceal neoplasms are uncommon, representing less than 0.5% to 1% of all gastrointestinal tumors [1]. Appendix tumors include a heterogenous group of epithelial and nonepithelial neoplasms with the 2 main histopathologic types being, 1) neuroendocrine tumors (NETs) in 0.3% -0.9% of appendectomies, followed by 2) epithelial neoplasms, in 0.2% -0.3%, according to incidence reports [2] [3] [4]. Other rare neoplasms may be found, including an atypical hybrid tumor known as goblet cell carcinoma (formerly known as goblet cell carcinoids), which accounts for less than 5% of all appendiceal primary tumors [5].…”

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…”