The aim of this study is to emphasize the importance of rare histopathological findings in appendix specimens of pediatric patients who underwent surgery for the preliminary (underwent appendectomy to treat an initial diagnosis) diagnosis of acute appendicitis. In this study, the demographic and histopathologic data of 1683 patients who underwent surgery for (presumed acute appendicitis) acute appendicitis between 2011 and 2017 were retrospectively evaluated. Appendectomy specimens were classified microscopically as appendix vermiformis, lymphoid hyperplasia, acute appendicitis, phlegmonous appendicitis, gangrenous appendicitis, perforated appendicitis, and unusual histopathological findings. Age, sex, clinical features, surgical reports, and macroscopic and microscopic features of appendix vermiformis were evaluated in patients with unusual histopathological findings. Ages of these 1683 patients ranged between 6 months and 17 years; among them, 1091 were men and 592 were women. Pathology reports included acute appendicitis (n = 827), phlegmonous appendicitis (n = 300), lymphoid hyperplasia (n = 274), perforated appendicitis (n = 181), appendix vermiformis (n = 50), gangrenous appendicitis (n = 3), and abnormal findings (n = 48). Of the 48 patients who were detected to have unusual findings, 32 were women and 16 were men and their ages ranged from 6 to 17 years. The frequency of unusual histopathological findings were as follows: Enterobius vermicularis (n = 37), fibrous obliteration (n = 6), neuroendocrine tumor (n = 2), mucinous neoplasm (n = 1), pseudodivericulitis (n = 1), and foreign body in the lumen (n = 1). No tumor recurrence or distant metastasis developed during the 2-year follow-up in any of the three patients detected to have a tumor. Even if the appendectomy specimen is normal during the surgery, histopathologic evaluation is necessary for the diagnosis of diseases that require treatment and follow-up after surgery.
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Abd A-FM (2017) Importance of histopathological evaluation of appendectomy specimens. Al-Azhar Assıut Med J 15:97–103. https://doi.org/10.4103/azmj.azmj_19-17
Otan E, Akbulut S, Kayaalp C (2013) Amebic acute appendicitis: systematic review of 174 cases. World J Surg 37(9):2061–2073. https://doi.org/10.1007/s00268-013-2079-5
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(6):579–585. https://doi.org/10.1007/s00068-010-0040-y
Akbulut S, Dursun P, Kocbiyik A, Harman A, Sevmis S (2009) Appendiceal endometriosis presenting as perforated appendicitis: report of a case and review of the literature. Arch Gynecol Obstet 280(3):495–497. https://doi.org/10.1007/s00404-008-0922-y
Monajemzadeh M, Hagghi-Ashtiani MT, Montaser-Kouhsari L, Ahmadi H, Zargoosh H, Kalantari M (2011) Pathologic evaluation of appendectomy specimens in children: is routine histopatholgic examination indicated? Iran J Pediatr 21(4):485–490
Yilmaz M, Akbulut S, Kutluturk K, Sahin N, Arabaci E, Ara C, Yilmaz S (2013) Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. World J Gastroenterol 19(25):4015–4022. https://doi.org/10.3748/wjg.v19.i25.4015
Buyukbese Sarsu S, Ucak R, Buyukbese MA, Karakus SC, Deniz H (2015) Unusual histopathological findings in childhood appendectomy specimens. Indıan J Surg 77(Suppl 2):594–599. https://doi.org/10.1007/s12262-013-0934-0
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 17(15):1961–1970. https://doi.org/10.3748/wjg.v17.i15.1961
Yabanoglu H, Caliskan K, Ozgur Aytac H, Turk E, Karagulle E, Kayaselcuk F, Akin TM (2014) Unusual findings in appendectomy specimens of adults: retrospective analyses of 1466 patients and a review of literature. Iran Red Crescent Med J 16(2):e12931. https://doi.org/10.5812/ircmj.12931
Emre A, Akbulut S, Bozdag Z, Yilmaz M, Kanlioz M, Emre R, Sahin N (2013) Routine histopathologic examination of appendectomy specimens: retrospective analysis of 1255 patients. Int Surg 98(4):354–362. https://doi.org/10.9738/INTSURG-D-13-00098.1
Limaiem F, Arfa N, Marsaoui L, Bouraoui S, Lahmar A, Mzabi S (2015) Unexpected histopathological findings in appendectomy specimens: a retrospective study of 1627 cases. Indıan J Surg 77(Suppl 3):1285–1290. https://doi.org/10.1007/s12262-015-1278-8
Jonas L, Bombil I, Mannell A (2017) Unusual histopathologies of the appendix. S Afr J Surg 55(2):55–56
Zakaria OM, Zakaria HM, Daoud MY, Al Wadaani H, Al Buali W, Al-Mohammed H, Al Mulhim AS, Zaki W (2013) Parasitic infestation in pediatric and adolescent appendicitis: a local experience. Oman Medical Journal 28(2):92–96. https://doi.org/10.5001/omj.2013.25
Altun E, Avci V, Azatcam M (2017) Parasitic infestation in appendicitis. A retrospective analysis of 660 patients and brief literature review. Saudı Med J 38(3):314–318. https://doi.org/10.15537/smj.2017.3.18061
Charfi S, Sellami A, Affes A, Yaïch K, Mzali R, Boudawara TS (2014) Histopathological findings in appendectomy specimens: a study of 24,697 cases. Int J Color Dis 29(8):1009–1012. https://doi.org/10.1007/s00384-014-1934-7
Ruiz J, Ríos A, Oviedo MI, Rodríguez JM, Parrilla P (2017) Neurogenic appendicopathy. A report of 8 cases. Rev Esp Enferm Dig 109(3):180–184. https://doi.org/10.17235/reed.2017.4520/2016
Hatzipantelis E, Panagopoulou P, Sidi-Fragandrea V, Fragandrea I, Koliouskas DE (2010) Carcinoid tumors of the appendix in children: experience from a tertiary center in northern Greece. J Pediatr Gastroenterol Nutr 51(5):622–625. https://doi.org/10.1097/MPG.0b013e3181e05358
Lobeck IN, Jeste N, Geller J, Pressey J, von Allmen D (2017) Surgical management and surveillance of pediatric appendiceal carcinoid tumor. J Pediatr Surg 52(6):925–927. https://doi.org/10.1016/j.jpedsurg.2017.03.012
Fallon SC, Hicks MJ, Carpenter JL, Vasudevan SA, Nuchtern JG, Cass DL (2015) Management of appendiceal carcinoid tumors in children. J Surg Res 198(2):384–387. https://doi.org/10.1016/j.jss.2015.03.062
Kulkarni KP, Sergi C (2013) Appendix carcinoids in childhood: long-term experience at a single institution in Western Canada and systematic review. Pediatr Int 55(2):157–162. https://doi.org/10.1111/ped.12047
Rich BS, Roychoudhury S, Williamson AK, Glick RD (2017) Pediatric mucinous neoplasm of the appendix presenting as a mucocele: a case report and review of the literature. J Pediatr Surg Case Rep 17:11e14
Altieri ML, Piozzi GN, Salvatori P, Mirra M, Piccolo G, Olivari N (2017) Appendiceal diverticulitis, a rare relevant pathology: presentation of a case report and review of the literature. International Journal of Surgery Case Reports 33:31–34. https://doi.org/10.1016/j.ijscr.2017.02.027
Yardimci AH, Bektas CT, Pasaoglu E, Kinaci E, Ozer C, Sevinc MM, Mahmutoglu AS, Kilickesmez O (2017) Retrospective study of 24 cases of acute appendiceal diverticulitis: CT findings and pathological correlations. Jpn J Radiol 35(5):225–232. https://doi.org/10.1007/s11604-017-0625-z
Kim JH, Lee DS, Kim KM (2015) Acute appendicitis caused by foreign body ingestion. Ann Surg Treat Res 89(3):158–161. https://doi.org/10.4174/astr.2015.89.3.158
Hazer B, Dandin O, Karakaş DO (2013) A rare cause of acute appendicitis: an ingested foreign body. Ulus Travma Acil Cerrahi Derg 19(6):570–572. https://doi.org/10.5505/tjtes.2013.60329
Klingler PJ, Seelig MH, DeVault KR, Wetscher GJ, Floch NR, Branton SA, Hinder RA (1998) Ingested foreign bodies within the appendix: a 100-year review of the literature. Dıgest Dıs 16(5):308–314
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Öztaş, T., Dursun, A., Söğütçü, N. et al. Unusual Histopathological Findings in Appendectomy Specimens Obtained from 1683 Pediatric Patients with Suspected Acute Appendicitis. Indian J Surg 81, 344–349 (2019). https://doi.org/10.1007/s12262-018-1814-4
- Enterobius vermicularis
- Unusual findings