Impact of histopathological examination of appendix in context to clinical management of patients
Keywords:
appendicitis, unusual findings, value
Abstract
Background: Acute appendicitis is one of the common conditions requiring emergency surgery. In routine practice , appendix is sent for histolopathological examination only when the operative findings are inconclusive. In view of this trend in clinical practice this study was carried out to assess the value of routine histopathological examination of surgically resected appendices, to review spectrum of histopathological diagnosis of appendectomy done at our institute over a 22 months period, some of which would further have effect on patient management and prognosis.Methods: A retrospective study was done including appendicectomy specimens received at histopathology section of Department of Pathology at Tertiary care centre in South Gujarat during January 2015 till October 2016 .Result: Total 400 cases were reviewed . Out of these, clinically suspected appendicitis was found in 365 (91.3 %) cases including spectrum of appendicitis (acute, subacute, chronic, ulcerative, suppurative, necrotizing, gangrenous, acute with periappendicits,acute on chronic) . Unusual unexpected findings were found in 20 (5 %) cases[tuberculosis, amoebiasis, faecolith, congestion with sickle RBCs, mucocele and neoplastic lesions including carcinoid, adenocarcinoma, mucinous cystadenoma(low grade appendiceal mucinous neoplasm)].Conclusion: Though majority of cases had the usual features, 20 of these 400 specimen (5 %) had an impact on patient management or outcome. They were not suspected on macroscopic examination at the time of surgery and would have been missed had the specimens not been examined microscopically. Intraoperative diagnosis of surgeon is therefore unreliable in detecting abnormalities of appendix. This study supports the sending of all appendicectomy specimens for routine histopathological examination.References
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2) 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.
3) Matthyssens LE, Ziol M, Barrat C, Champault GG: Routine Surgical Pathology in General Surgery. Br J Surg 2006; 93:362-368
4). Chan W, Fu KH: Value of Routine Histopathological examination of appendices in Hong Kong. J Clin Pathol 1987; 40:429-433.
5). Duzgun AP, Moran M, Uzun S, Ozmen M, Ozer VM, Seckin S, Coskun F: Unusual findings in appendicectomy specimens: Evaluation of 2458 cases and review of the literature. Indian J Surg 2004; 66(4):221-226.
6). Nemeth L, Reen DJ, O'Briain D, McDermott M, Pui P: Evidence of an Inflammatory Pathologic Condition in "Normal" Appendices following Emergency Appendectomy. Arch Path Lab Med 2001; 125(6):759-764.
7) Jones AE, Phillips AW, Jarvis JR, Sargen K. The value of routine histopathological examination of appendicectomy specimens, Bio Medical Central surgery 2007;7:17
8) 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
9) Chawda HK, Miskin AT, Dombale VD. Spectrum of histopathological lesion in surgically removed appendix , Journal of Drug Discovery and Therapeutics Available. 2015:3;53-56
10) Edino ST, Mohammed AZ, Ochicha O, Anumah M. Appendicitis in Kano, Nigeria: A 5 year review of pattern, morbidity and mortality, Ann Afr Med 2004;3:38-41..
11) Gaffar AB. Granulomatous diseases and granulomas of the appendix. Int J Surg Pathol2010; 18: 14-2
12) Tucker ON, Healy V, Jeffers M, Keane FB. Granulomatous appendicitis. Surgeon2003;1(5):286–289
13) Cortina R, McCormick J, Kolm P, Perry RR. Management and prognosis of adenocarcinoma of the appendix. Dis Colon Rectum 1995; 38: 848-52
14) Sieren LM, Collins JN, Weireter LJ, Britt RC, Reed SF, Novosel TJ, Britt LD. The incidence of benign and malignant neoplasia presenting as acute appendicitis. Am Surg 2010; 76: 808-811
2) 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.
3) Matthyssens LE, Ziol M, Barrat C, Champault GG: Routine Surgical Pathology in General Surgery. Br J Surg 2006; 93:362-368
4). Chan W, Fu KH: Value of Routine Histopathological examination of appendices in Hong Kong. J Clin Pathol 1987; 40:429-433.
5). Duzgun AP, Moran M, Uzun S, Ozmen M, Ozer VM, Seckin S, Coskun F: Unusual findings in appendicectomy specimens: Evaluation of 2458 cases and review of the literature. Indian J Surg 2004; 66(4):221-226.
6). Nemeth L, Reen DJ, O'Briain D, McDermott M, Pui P: Evidence of an Inflammatory Pathologic Condition in "Normal" Appendices following Emergency Appendectomy. Arch Path Lab Med 2001; 125(6):759-764.
7) Jones AE, Phillips AW, Jarvis JR, Sargen K. The value of routine histopathological examination of appendicectomy specimens, Bio Medical Central surgery 2007;7:17
8) 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
9) Chawda HK, Miskin AT, Dombale VD. Spectrum of histopathological lesion in surgically removed appendix , Journal of Drug Discovery and Therapeutics Available. 2015:3;53-56
10) Edino ST, Mohammed AZ, Ochicha O, Anumah M. Appendicitis in Kano, Nigeria: A 5 year review of pattern, morbidity and mortality, Ann Afr Med 2004;3:38-41..
11) Gaffar AB. Granulomatous diseases and granulomas of the appendix. Int J Surg Pathol2010; 18: 14-2
12) Tucker ON, Healy V, Jeffers M, Keane FB. Granulomatous appendicitis. Surgeon2003;1(5):286–289
13) Cortina R, McCormick J, Kolm P, Perry RR. Management and prognosis of adenocarcinoma of the appendix. Dis Colon Rectum 1995; 38: 848-52
14) Sieren LM, Collins JN, Weireter LJ, Britt RC, Reed SF, Novosel TJ, Britt LD. The incidence of benign and malignant neoplasia presenting as acute appendicitis. Am Surg 2010; 76: 808-811
Published
2017-12-19
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