Unusual histopathological findings in appendectomy specimens: A retrospective analysis and literature review

Akbulut, Sami

doi:10.3748/wjg.v17.i15.1961

Cited by 152 publications

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“…Although lymphoid hyperplasia and fecalith are the most common etiologic factors of acute appendicitis, some unusual factors including pinworms and tumors have been identified [1,2]. Histopathological examination of the appendectomy specimens may be relevant as it yields important clinical information in addition to operative findings [3,4]. The aim of this study was to assess the value of routine histological examination of the resected appendix.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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“…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].…”

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confidence: 99%

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

Guraya¹

2015

JCDR

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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...

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“…4 Oxyuriasis infestation has been reported in 4% of appendicectomy specimens. Granulomatous diseases as Tuberculosis can cause appendicitis.…”

Section: Discussionmentioning

confidence: 99%

“…Appendicular Tuberculosis is reported in up to 3% of all the specimens examined. 4,5,8 Acute Appendicitis can be caused by Appendicular neoplasms with less than 50% identified intraoperatively. [1][2][3][4][5] The reported incidence of neoplasia in Appendectomy specimens is in the range of 3% 4 to 7.1%, wherease Furman etal have shown neoplasm as cause of appendicitis in 29.4% of patients undergoing interval appendicectomy.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Apart from aforementioned causes the The reported incidence of Pinworm infestation in appendicectomy specimen is from 0.2% to 41.8% and inflammation rate due to pin worm infestation is 13% to 37%. 4 Oxyuriasis infestation has been reported in 4% of appendicectomy specimens. The Aim of this study is to find the frequency of such unusual causative factors in our setup.…”

Section: 2mentioning

confidence: 99%

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Appendicectomy Specimens

Jan

Khan

Rehman

2018

TPMJ

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ABSTRACT… Objectives:To determine the frequency of unusual findings in routine histopathological examination of appendicectomy specimens. Setting: Surgical Department of Govt: City Hospital, Lakki Marwat. Study Design: Descriptive study (cross sectional). Period: One year (01/01/2016 to 31/12/2016). Methodology: A total of 497 patients (both male and female) in age range of 18-60 years were studied. A complete history with clinical examination and relevant investigations were performed in all patients. After Establishment of diagnosis standard appendicectomy either open or Laparoscopic depending upon availability was done. Appendicectomy specimen was sent to Pathology Department of the hospital. Histopathology reports were collected by patient or his/her relatives and a copy was provided to the researcher by Pathology Department. All the relevant data received from histopathology report was recorded on predesigned proforma. Results: In this study mean age was 27 years with standard deviation ± 1.26. Forty two percent patients were male and 58% patients were female. Histopathology findings among 497 patients was analyzed as appendix was negative in 20% patients while positive appendix was found in 80% patients, in which 34% patients had lymphoid hyperplasia, 61% patients had fecolith, 4% patients had parasitic infestation (specify), 0.8% patients had tuberculosis and 0.5% patients had neoplasia. Conclusion: Although unusual pathological findings are seldom seen during an appendectomy, all appendectomy specimens should be sent for routine histopathological examination.

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Unusual histopathological findings in appendectomy specimens: A retrospective analysis and literature review

Abstract: Although unusual pathological findings are seldom seen during an appendectomy, all appendectomy specimens should be sent for routine histopathological examination.

Cited by 152 publications

References 95 publications

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

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

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

Appendicectomy Specimens

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