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.
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References
Alemayehu H, Charles L, Snyder SD, St Peter D, Ostlie J (2014) Incidence and outcomes of unexpected findings after appendectomy. J Pediatr Surg 49:1390–1393
Carr N (2000) The pathology of acute appendicitis. Ann Diagn Pathol 4:46–58
Akbulut S, Tas M, Sogutcu N, Arikanoglu Z, Basbug M, Ulku A, Semur H, Yagmur Y (2011) Unusual histopathological findings in appendectomy specimens: a retrospective analysis and literature review. World J Gastroenterol 21:1961–1970
Duzgun AP, Moran M, Uzun S, Ozmen M, Ozer VM, Seckin S (2004) Unusual findings in appendicectomy specimens. evaluation of 2458 cases and review of literature. Indian J Surg 66:221–226
Nemeth L, Reen DJ, O’Briain D, McDermott M, Pui P (2001) Evidence of an inflammatory pathologic condition in “normal” appendices following emergency appendectomy. Arch Path Lab Med 125:759–764
Khairy G (2009) Acute appendicitis: is removal of a normal appendix still existing and can we reduce its rate? Saudi J Gastroenterol 15:167–170
Rothrock SG, Green SM, Dobson M (1995) Misdiagnosis of appendicitis in non pregnant women of childbearing age. J Emerg Med 13:1–8
Matthyssens LE, Ziol M, Barrat C, Champault GG (2006) Routine surgical pathology in general surgery. Br J Surg 93:362–368
Bucher P, Mathe Z, Demirag A, Morel P (2004) Appendix tumors in the era of laparoscopic appendectomy. Surg Endosc 18:1063–1066
Ma KW, Chia NH, Yeung HW, Cheung MT (2010) If not appendicitis, then what else can it be? a retrospective review of 1492 appendectomies. Hong Kong Med J 16:12–17
Lyss AP (1988) Appendiceal malignancies. Semin Oncol 15:129–137
In’t Hof KH, van der Wal HC, Kazeimer G, Lange JF (2008) Carcinoid tumour of the appendix: an analysis of 1485 consecutive emergency appendectomies. J Gastrointest Surg 12:1436–1438
Shapiro R, Eldar S, Sadot E, Venturero M, Papa MZ, Zippel DB (2010) The significance of occult carcinoids in the era of laparoscopic appendectomies. Surg Endosc 24:2197–2199
Nielsen GP, Isaksson HJ, Finnbogason H, Gunnlaugsson GH (1991) Adenocarcinoma of the vermiform appendix. a population study. APMIS 99:653–656
Yakan S, Caliskan C, Uguz A, Korkut M, Coker A (2011) A retrospective study on mucocele of the appendix presenting with acute abdomen or acute appendicitis. Hong Kong J Emerg Med 18:144–149
Tucker ON, Healy V, Jeffers M, Keane FB (2003) Granulomatous appendicitis. Surgeon 1:286–289
Akbulut S, Yagmur Y, Bakir S, Sogutcu N, Yilmaz D, Senol A, Bahadir MV (2010) Appendicular tuberculosis: review of 155 published cases and a report of two cases. Eur J Trauma Emerg Surg 36:579–585
Nissotakis C, Sakorafas GH, Koureta T, Revelos K, Kassaras G, Peros G (2008) Actinomycosis of the appendix: diagnostic and therapeutic considerations. Int J Infect Dis 12:562–564
Karatepe O, Adas G, Tukenmez M, Battal M, Altiok M, Karahan S (2009) Parasitic infestation as cause of acute appendicitis. G Chir 30:426–428
Greenberg R, Avital S, Kashtan H (1997) Diverticular disease of the appendix. Harefuah 132:180–182
Medlicott SAC, Urbanski SJ (1998) Acquired diverticulosis of the vermiform appendix: a disease of multiple etiologies. Int J Surg Pathol 6:23–26
Wetzig NR (1986) Diverticulosis of the vermiform appendix. Med J Aust 145:464–465
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Limaiem, F., Arfa, N., Marsaoui, L. et al. Unexpected Histopathological Findings in Appendectomy Specimens: a Retrospective Study of 1627 Cases. Indian J Surg 77 (Suppl 3), 1285–1290 (2015). https://doi.org/10.1007/s12262-015-1278-8
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DOI: https://doi.org/10.1007/s12262-015-1278-8