The Utility of Routine Histopathological Examination of the Appendectomy Specimens
Keywords:
Appendicitis, Appendectomy, Histopathology
Abstract
Background: Appendectomy is the most commonly performed surgical procedure worldwide to manage appendicitis. The practice of sending all appendices specimens for routine histopathology examination depends on the concerned clinician. This study was performed to reveal the importance of routine histopathology examination of the appendectomy specimens with recording of the occurrence and distribution of unusual pathologic findings Methods: This was a retrospective record based comparative study performed in a single Hospital in Saudi Arabia, where the medical files of 766 patients were recruited. The appendectomy specimens were obtained either from our hospital or referred from any other hospital for histopathology examination. All the unusual diagnoses were reviewed by the histopathology author and blindly re-evaluated by other pathology consultant. Statistic analysis was performed manually. Result: 700 cases were within the usual histopathology scope. Unusual histopathological findings were observed in 66 cases (8.6%): four cases of mucinous neoplasms, 20 cases of fibrous obliteration or appendiceal neuroma, 18 cases showed parasitic infestation, and 24 cases were periappendicitis without appendicular acute inflammation. Conclusion: Routine histopathology examination of the appendix not only confirms the clinical diagnosis of acute appendicitis, but also leads to the incidental diagnosis of much unusual pathologies which could have been missed by the surgeon, and these pathologies include parasitic infestation, peri-appendicitis, neuromas and appendiceal mucinous neoplasms.References
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2. Kozar RA, Roslyn JJ. The appendix. In: Schwartz SI. Schwartz’s Principles of surgery. 7th ed. New York, NY: McGraw-Hill; 1999.
3. Al-Omran M, Mamdani MM, Mcleod RS. Epidemiologic features of acute appendicitis in Ontario, Canada. Can J Surg. 2003; 46:263–268.
4. Dincel O, Göksu M, Türk BA, Pehlivanoğlu B, İşler S. Incidental Findings in Routine Histopathological Examination of Appendectomy Specimens; Retrospective Analysis of 1970 Patients. Indian J Surg. 2018; 80(1):48–53. doi:10.1007/s12262-016-1557-z
5. Steinmann P, Keiser J, Boss R, Tanner M, Utzinger J. Schistosomiasis and water resources development: systemic review, meta-analysis and estimates of people at risk. Lancet Infect Dis. 2006; 6(7):411–425.
6. Tirumani SH, Fraser-Hill M, Auer R, Shabana W, Walsh C, Lee F, Ryan JG. Mucinous neoplasms of the appendix: a current comprehensive clinicopathologic and imaging review. Cancer Imaging. 2013; 13:14-25.
7. Odze RD, Goldblum JR. Surgical Pathology of the GI Tract, Liver, Biliary Tractand Pancreas. 3rded. Philadelphia, PA: Elsevier; 2015. pp. 779–802.
8. Shaib WL, Assi R, Shamseddine A, et al. Appendiceal Mucinous Neoplasms: Diagnosis and Management [published correction appears in Oncologist. 2018 Jan;23 (1):137]. Oncologist. 2017; 22(9):1107–1116. doi:10.1634/theoncologist.2017-0081.
9. Patel MM, Shah RJ. Impact of Histopathological Examination of Appendix in Context to Clinical Management of Patients. Annals of Pathology and Laboratory Medicine. 2017; 4(6): 699-704.
10. Rabindranath D, Khan AA, Ansari H, Senthil P. Unusual incidental findings of routine histopathological examination of appendectomy specimens- a 2-year retrospective analysis with review of the literature. Int J of Allied Med Sci and Clin Res. 2016; 4(1):90-98.
11. Matthyssens LE, Ziol M, Barrat C, Champault GG: Routine Surgical Pathology in General Surgery. Br J Surg. 2006; 93:362-368
12. Rehman S, Khan AI, Ansari HA, Alam F, Vasenwala SM, Alam K, Khan M A. Retrospective analysis of appendicectomy specimens: A tertiary care center-based study. Saudi Surg J. 2017;5:71-5
13. Sharma S, Mahajan D, Mohsin-ul-Rasool, Bashir S, Hafiz A, Wajahat M. Histopathology of Appendicectomy Specimen: A 5 Year Study. Scholars Journal of Applied Medical Sciences. 2014; 2(1B):176-180.
14. Yilmaz M, Akbulut S, Kutluturk K, et al. Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. World J Gastroenterol. 2013; 19(25):4015–4022. doi:10.3748/wjg.v19.i25.4015
15. Emre A, Akbulut S, Bozdag Z, Yilmaz M, Kanlioz M, Emre R, et al. Routine histopathologic examination of appendectomy specimens: retrospective analysis of 1255 patients. Int Surg. 2013; 98: 354-62.
16. Matariswa S. Need of Histopathological Evaluation in Routine Appendectomy Specimens. IJPRP. 2019; 8 (6): 733-738.
17. Chawda HK, Miskin AT, Dombale VD. Spectrum of histopathological lesion in surgically removed appendix. Journal of Drug Discovery and Therapeutics. 2015; 3:53-56.
18. Shreshtha R, Ranabhat SR, Tiwari M. Histopathological analysis of appendectomy specimens. J Pathol Nepal. 2012; 2: 215-9
19. Elfaedy O, Benkhadoura M, Elshaikhy A, Elgazwi K. Impact of routine histopathological examination of appendectomy specimens on patient management: a study of 4012 appendectomy specimens. Turk J Surg. 2019; 35 (3): 196-201.
20. Gupta K, Solanki A,Vasishta RK. Appendiceal neuroma: report of an elusive neuroma. Trop Gastroenterol. 2020; 32:332–3.
21. Mukherjee A, Schlenker E, LaMasters T, Johnson M, Brunz J, Thomas E. Periappendicitis: Is It a Clinical Entity?. Am Surg. 2002; 68 (10), 913-6
22. Odze RD, Goldblum JR. Odze and Goldblum Surgical Pathology of the GI Tract, Liver, Biliary Tract and Pancreas, 3rd ed. Philadelphia, PA: Saunders (ELSEVIER imprint); 2014.
23. Arca MJ, Gates RL, Groner JI, Hammond S, Caniano DA. Clinical manifestations of appendiceal pinworms in children: an institutional experience and a review of the literature. Pediatr Surg Int. 2004; 20:372– 375.
24. Ramezani MA, Dehghani MR. Relationship between Enterobius vermicularis and the incidence of acute appendicitis. Southeast Asian J Trop Med Public Health. 2007; 38:20–23.
25. Bilgin N. Appendicitis. In: Sayek İ, editor. Basic Surgery Handbook. 3rd ed. Ankara: Güneş Kitabevi; 2004. Pp.1191–1197. [Original language: Turkish.]
26. Engin O, Calik S,Calik B, Yildirim M, Coskun G. Parasitic appendicitis from past to present in Turkey. Iranian J Parasitol. 2010; 5:57–63.
27. Wiebe BM. Appendicitis and Enterobius vermicularis. Scand J Gastroenterol. 1991; 26:336–338.
28. Helmy A H, Abou Shousha T, Magdi M, Sabri T. Appendicitis:Appendectomy and the value of endemic parasitic infestation. Egyp J Surg. 2000; 19:87–91.
29. Jada S K, Jayakumar K, Sahu P S, Vinorth R. Faecolith examination for spectrum of parasitic association in appendicitis. J Clin Diagn Res. 2014; 8:16–18.
30. Sah SP, Bhadani PP. Enterobius vermicularis causing symptoms of appendicitis in Nepal. Trop Doct. 2006; 36:160–162.
31. Molina GA, Torres MA, Montenegro MS, Sánchez GD, Arcia AC, Enríquez JJ, Ayala AV, Orejuela ME. Neuroma of the appendix, a rare cause of appendicitis and an important reason for close follow-up. Journal of Surgical Case Reports. 2020; 3: 1–3.
32. Jagtap S, Boral S, Jagtap S, Ajagekar P. Appendiceal neuroma: an uncommon entity. Surgery. 2019; 6:2631.
33. Stanley MW, Cherwitz D, Hagen K, Snover DC. Neuromas of the appendix: a light-microscopic, immunohistochemical and electron-microscopic study of 20 cases. Am J Surg Pathol. 1986; 10:801–815.
34. Hatch QM, Gilbert EW. Appendiceal Neoplasms. Clinics in Colon and Rectal Surgery. 2018; 31(5): 278-287.
35. Carr NJ, Cecil TD, Mohamed F, et al. A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: The Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process. Am J Surg Pathol. 2016; 40(1):14–26. doi:10.1097/PAS.0000000000000535
36. Kehagias I, Zygomalas A, Markopoulos G, et al. Diagnosis and treatment of mucinous appendiceal neoplasm presented as acute appendicitis. Case Rep Oncol Med. 2016; 2016:2161952.
37. Gündoğar Ö, Kımıloğlu E, Komut N, et al. Evaluation of appendiceal mucinous neoplasms with a new classification system and literature review. Turk J Gastroenterol. 2018; 29(5):533–542. doi:10.5152/tjg.2018.17605.
2. Kozar RA, Roslyn JJ. The appendix. In: Schwartz SI. Schwartz’s Principles of surgery. 7th ed. New York, NY: McGraw-Hill; 1999.
3. Al-Omran M, Mamdani MM, Mcleod RS. Epidemiologic features of acute appendicitis in Ontario, Canada. Can J Surg. 2003; 46:263–268.
4. Dincel O, Göksu M, Türk BA, Pehlivanoğlu B, İşler S. Incidental Findings in Routine Histopathological Examination of Appendectomy Specimens; Retrospective Analysis of 1970 Patients. Indian J Surg. 2018; 80(1):48–53. doi:10.1007/s12262-016-1557-z
5. Steinmann P, Keiser J, Boss R, Tanner M, Utzinger J. Schistosomiasis and water resources development: systemic review, meta-analysis and estimates of people at risk. Lancet Infect Dis. 2006; 6(7):411–425.
6. Tirumani SH, Fraser-Hill M, Auer R, Shabana W, Walsh C, Lee F, Ryan JG. Mucinous neoplasms of the appendix: a current comprehensive clinicopathologic and imaging review. Cancer Imaging. 2013; 13:14-25.
7. Odze RD, Goldblum JR. Surgical Pathology of the GI Tract, Liver, Biliary Tractand Pancreas. 3rded. Philadelphia, PA: Elsevier; 2015. pp. 779–802.
8. Shaib WL, Assi R, Shamseddine A, et al. Appendiceal Mucinous Neoplasms: Diagnosis and Management [published correction appears in Oncologist. 2018 Jan;23 (1):137]. Oncologist. 2017; 22(9):1107–1116. doi:10.1634/theoncologist.2017-0081.
9. Patel MM, Shah RJ. Impact of Histopathological Examination of Appendix in Context to Clinical Management of Patients. Annals of Pathology and Laboratory Medicine. 2017; 4(6): 699-704.
10. Rabindranath D, Khan AA, Ansari H, Senthil P. Unusual incidental findings of routine histopathological examination of appendectomy specimens- a 2-year retrospective analysis with review of the literature. Int J of Allied Med Sci and Clin Res. 2016; 4(1):90-98.
11. Matthyssens LE, Ziol M, Barrat C, Champault GG: Routine Surgical Pathology in General Surgery. Br J Surg. 2006; 93:362-368
12. Rehman S, Khan AI, Ansari HA, Alam F, Vasenwala SM, Alam K, Khan M A. Retrospective analysis of appendicectomy specimens: A tertiary care center-based study. Saudi Surg J. 2017;5:71-5
13. Sharma S, Mahajan D, Mohsin-ul-Rasool, Bashir S, Hafiz A, Wajahat M. Histopathology of Appendicectomy Specimen: A 5 Year Study. Scholars Journal of Applied Medical Sciences. 2014; 2(1B):176-180.
14. Yilmaz M, Akbulut S, Kutluturk K, et al. Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. World J Gastroenterol. 2013; 19(25):4015–4022. doi:10.3748/wjg.v19.i25.4015
15. Emre A, Akbulut S, Bozdag Z, Yilmaz M, Kanlioz M, Emre R, et al. Routine histopathologic examination of appendectomy specimens: retrospective analysis of 1255 patients. Int Surg. 2013; 98: 354-62.
16. Matariswa S. Need of Histopathological Evaluation in Routine Appendectomy Specimens. IJPRP. 2019; 8 (6): 733-738.
17. Chawda HK, Miskin AT, Dombale VD. Spectrum of histopathological lesion in surgically removed appendix. Journal of Drug Discovery and Therapeutics. 2015; 3:53-56.
18. Shreshtha R, Ranabhat SR, Tiwari M. Histopathological analysis of appendectomy specimens. J Pathol Nepal. 2012; 2: 215-9
19. Elfaedy O, Benkhadoura M, Elshaikhy A, Elgazwi K. Impact of routine histopathological examination of appendectomy specimens on patient management: a study of 4012 appendectomy specimens. Turk J Surg. 2019; 35 (3): 196-201.
20. Gupta K, Solanki A,Vasishta RK. Appendiceal neuroma: report of an elusive neuroma. Trop Gastroenterol. 2020; 32:332–3.
21. Mukherjee A, Schlenker E, LaMasters T, Johnson M, Brunz J, Thomas E. Periappendicitis: Is It a Clinical Entity?. Am Surg. 2002; 68 (10), 913-6
22. Odze RD, Goldblum JR. Odze and Goldblum Surgical Pathology of the GI Tract, Liver, Biliary Tract and Pancreas, 3rd ed. Philadelphia, PA: Saunders (ELSEVIER imprint); 2014.
23. Arca MJ, Gates RL, Groner JI, Hammond S, Caniano DA. Clinical manifestations of appendiceal pinworms in children: an institutional experience and a review of the literature. Pediatr Surg Int. 2004; 20:372– 375.
24. Ramezani MA, Dehghani MR. Relationship between Enterobius vermicularis and the incidence of acute appendicitis. Southeast Asian J Trop Med Public Health. 2007; 38:20–23.
25. Bilgin N. Appendicitis. In: Sayek İ, editor. Basic Surgery Handbook. 3rd ed. Ankara: Güneş Kitabevi; 2004. Pp.1191–1197. [Original language: Turkish.]
26. Engin O, Calik S,Calik B, Yildirim M, Coskun G. Parasitic appendicitis from past to present in Turkey. Iranian J Parasitol. 2010; 5:57–63.
27. Wiebe BM. Appendicitis and Enterobius vermicularis. Scand J Gastroenterol. 1991; 26:336–338.
28. Helmy A H, Abou Shousha T, Magdi M, Sabri T. Appendicitis:Appendectomy and the value of endemic parasitic infestation. Egyp J Surg. 2000; 19:87–91.
29. Jada S K, Jayakumar K, Sahu P S, Vinorth R. Faecolith examination for spectrum of parasitic association in appendicitis. J Clin Diagn Res. 2014; 8:16–18.
30. Sah SP, Bhadani PP. Enterobius vermicularis causing symptoms of appendicitis in Nepal. Trop Doct. 2006; 36:160–162.
31. Molina GA, Torres MA, Montenegro MS, Sánchez GD, Arcia AC, Enríquez JJ, Ayala AV, Orejuela ME. Neuroma of the appendix, a rare cause of appendicitis and an important reason for close follow-up. Journal of Surgical Case Reports. 2020; 3: 1–3.
32. Jagtap S, Boral S, Jagtap S, Ajagekar P. Appendiceal neuroma: an uncommon entity. Surgery. 2019; 6:2631.
33. Stanley MW, Cherwitz D, Hagen K, Snover DC. Neuromas of the appendix: a light-microscopic, immunohistochemical and electron-microscopic study of 20 cases. Am J Surg Pathol. 1986; 10:801–815.
34. Hatch QM, Gilbert EW. Appendiceal Neoplasms. Clinics in Colon and Rectal Surgery. 2018; 31(5): 278-287.
35. Carr NJ, Cecil TD, Mohamed F, et al. A Consensus for Classification and Pathologic Reporting of Pseudomyxoma Peritonei and Associated Appendiceal Neoplasia: The Results of the Peritoneal Surface Oncology Group International (PSOGI) Modified Delphi Process. Am J Surg Pathol. 2016; 40(1):14–26. doi:10.1097/PAS.0000000000000535
36. Kehagias I, Zygomalas A, Markopoulos G, et al. Diagnosis and treatment of mucinous appendiceal neoplasm presented as acute appendicitis. Case Rep Oncol Med. 2016; 2016:2161952.
37. Gündoğar Ö, Kımıloğlu E, Komut N, et al. Evaluation of appendiceal mucinous neoplasms with a new classification system and literature review. Turk J Gastroenterol. 2018; 29(5):533–542. doi:10.5152/tjg.2018.17605.
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27-07-2020
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