Unexpected Histopathological Findings in Appendectomy Specimens: a Retrospective Study of 1627 Cases

Abstract

Pathologic evaluation of the appendix after appendectomy is routine and can occasionally identify unexpected findings. The aim of the present study was to determine the incidence and type of pathologic diagnoses found in appendectomy specimens at our institution. The clinicopathological data of 1627 patients who underwent appendectomies for presumed acute appendicitis from January 2008 to October 2014 were reviewed retrospectively. There were 986 men and 641 women (sex ratio M/F=1.5) aged between 16 months and 90 years (mean=30 years). All patients underwent appendectomy (either open or laparoscopic). Histological examination of the surgical specimen showed acute inflammation of the appendix in 1455 cases (89.42 %), fibrosed appendix in 37 cases (2.27 %), and Enterobius vermicularis (n=23). In 101 cases (6.2 %), the appendix was histologically normal. Incidental unexpected pathological diagnoses were noted in 57 appendectomy specimens. They included pinworm (n= 23), mucinous neoplasms (n=12), neuroendocrine tumors (NET) (n=8), adenocarcinoma (n=2), granulomatous inflammation (n=5), tuberculosis (n=2), hyperplastic polyp (n=1), tubular adenoma (n=1), diverticulitis (n=1), endometriosis (n=1), and actinomycosis (n=1). The routine histopathological examination of the appendix is of value for identifying unsuspected conditions requiring further postoperative management. Gross examination alone does not appear to be a good indicator of an unexpected finding on microscopic exam. It is recommended that in order to avoid misdiagnoses, all appendices should be histopathologically examined.

A rare case of subacute appendicitis, actinomycosis as the final pathology reports: A case report and literature review

“…It is reported, that actinomycetes are the etiology of appendicitis in only 0.02%–0.06% [3], [5], [6], having as the final pathology report a chronic inflammatory response. The usual clinical scenario is an indolent course with unspecific symptoms and signs, and less than 10% of the cases are diagnosed before surgery [8], [9], [10].…”

Increased Risk of Neoplasms in Adult Patients Undergoing Interval Appendectomy

“…According to a previous report, the prevalence of NET among all appendectomy specimens was 0.3-0.9%, that of epithelial tumors was 0.2-0.3%, and mucinous neoplasms accounted for 70%. [17] In this study, the most common neoplastic pathology was low-grade appendiceal mucinous neoplasm, which accounted for 75% of all neoplastic lesions. It could be argued that the increased incidence of these neoplasms in interval appendectomy cases is not a significant threat because of the low grade of these tumors.…”

A Case of Mucocele Gallbladder with Review of Literature

“…Even in the presence of severe gallbladder disease, lab values may be within the reference range. Amylase and lipase must also be checked to rule out pancreatitis [5].…”