Histopathological Analysis of Unusual Findings in Appendectomy Specimens: A Retrospective Study and Literature Review.
Keywords:
Appendicitis, unusual findings, carcinoid tumor, histopathological analysis.
Abstract
Background-: Acute appendicitis has remained a clinical entity and an ongoing diagnostic challenge. Appendicitis is one of the commonest surgical emergencies. However, histopathological studies are the gold standards for diagnosis of acute appendicitis. Though faecoliths are the usual cause of obstruction, other unusual findings can be the cause too, ranging from inflammatory conditions to malignancies.Aims and Objectives: To document and compare unusual histopathological findings in appendectomy specimens in our center.Methods: The clinicopathological records of resected appendices submitted to histopathology department over the period of 4 years from January 2012 to December 2015 were reviewed retrospectively. From accumulated information from 790 appendectomies, 44 appendectomy specimens had unusual histopathological findings were included in the study. Patient who underwent incidental appendectomy during other surgeries were excluded from the study.Results: Out of 790 appendectomy specimens, acute appendicitis accounted for 302(38.2%) with peak occurrence in the age group 11-20 years (38.9%) and 21-30 years (27.7%) with male predominance (2.34:1). Unusual findings were noted in 44 (5.6%) cases by histopathology. Most common findings included obliterative appendicitis (77.3%), followed by eosinophilic appendicitis (6.8%) and granulomatous appendicitis (4.5%).Other unusual findings include diverticulum, mucocele, carcinoid and signet ring adenocarcinoma of the appendix.Conclusion: The gross examination at the time of surgery cannot detect all the abnormalities of the appendix. Although unusual or co-existing pathologies can be rarely seen during appendectomy, all the appendectomy specimens should be sent for routine histopathological examination to avoid missing of any clinically important and treatable condition.References
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2. Oguntola AS, Adeoti ML, Oyemolade TA. Appendicitis: Trends in incidence, age, sex, and seasonal variations in South-Western Nigeria. Ann Afr Med 2010;9:213-7.
3. Agarwala N, Liu CY. Laparoscopic appendectomy. J Am As-soc Gynecol Laparosc 2003; 10: 166-168
4. Ojo OS, Udeh SC, Odesanmi WO. Review of the histopathologi-cal findings in appendices removed for acute appendicitis in Ni-gerians. J R Coll Surg Edinb 1991;36:245-8.
5. Ross E, Ruiz ME. Pathology of the cecal appendix in our country. An analysis of 936 surgical specimens of appendectomy. GEN 1995;49:140-4.
6. Blair NP, Bugis SP, Turner LJ, MacLeod MM. Review of the pathologic diagnoses of 2,216 appendectomy specimens. Am J Surg 1993;165:618-20
7. Royes CA, DuQuesnay DR, Coard K, Fletcher PR. Appendicec-tomy at the University Hospital of the West Indies (1984-1988). A retrospective review. West Indian Med J 1991;40:159-62.
8. Butler C. Surgical pathology of acute appendicitis. Hum Pathol 1981;12:870-8.
9. Shrestha R, Ranabhat SR, Tiwari MHistopathologic analysis of appendectomy specimens. Journal of Pathology of Nepal (2012) Vol. 2, 215 - 219
10. Duzgun AP, Moran M, Uzun S, Ozmen MM, Ozer VM, Seckin S et al. Unusual findings in appendicectomy specimens: Evaluation of 2458 cases and review of the litera-ture. Indian J Surg 2004; 66: 221-226
11. Abdulrahman Saleh Al-Mulhim.Unusual findings in appendicectomy specimens: Local experience in Al-Ahsa region of Saudi Arabia. Journal of Clinical Pathology and Forensic Medicine.2011; 2(1): 40-41.
12. Akbulut S, Tas M, Sogutcu N, Arikanoglu Z, Basbug M, Ulku A. Unusual histopathological findings in appendectomy specimens: a retrospective analysis and literature review. World J Gastroenterol. 2011;17(15):1961–1970
13. 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 Oct-Dec; 98(4): 354–362
14. Memon I, Moorpani K, Rehman S. Unusual histopathological findings of appendectomy specifimens. Pak J Med Dent 2014; 3(3):3-7.
15. Kanthikar SN, Nikumbh DB, Desale SS. Primary Eosinophilic Obliterative Appendicitis. Online J Health Allied Scs. 2014;13(1):6.
16. Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR. Eosinophilic gastroenteritis: A clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. Gut.1990;31:54-8.
17. Manzanares-Campillo Mdel C, Pardo-García R, Martín-Fernández J. Appendicular pseudodiverticula and acute appendicitis. Our 12-year experience. Rev Esp Enferm Dig. 2011;103(11):582–585
18. Coulier B, Pierard F, Malbecq S. Appendicular diverticulitis in an Amyand's hernia. JBR-BTR. 2010;93(2):114.
19. Sunil V Jagtap, Dhiraj B Nikumbh, Ashok Y Kshirsagar, Sujata R Kanetkar, Ashish Bohra. Eosinophilic appendicitis presented as mucocele: a rare clinical entity . IJHSR. 2012;2(2):99-103.
20. Shapiro R, Eldar S, Sadot E, Venturero M, Papa MZ, Zippel DB. The significance of occult carcinoids in the era of laparoscopic appendectomies. Surg Endosc 2010; 24: 2197-2199
2. Oguntola AS, Adeoti ML, Oyemolade TA. Appendicitis: Trends in incidence, age, sex, and seasonal variations in South-Western Nigeria. Ann Afr Med 2010;9:213-7.
3. Agarwala N, Liu CY. Laparoscopic appendectomy. J Am As-soc Gynecol Laparosc 2003; 10: 166-168
4. Ojo OS, Udeh SC, Odesanmi WO. Review of the histopathologi-cal findings in appendices removed for acute appendicitis in Ni-gerians. J R Coll Surg Edinb 1991;36:245-8.
5. Ross E, Ruiz ME. Pathology of the cecal appendix in our country. An analysis of 936 surgical specimens of appendectomy. GEN 1995;49:140-4.
6. Blair NP, Bugis SP, Turner LJ, MacLeod MM. Review of the pathologic diagnoses of 2,216 appendectomy specimens. Am J Surg 1993;165:618-20
7. Royes CA, DuQuesnay DR, Coard K, Fletcher PR. Appendicec-tomy at the University Hospital of the West Indies (1984-1988). A retrospective review. West Indian Med J 1991;40:159-62.
8. Butler C. Surgical pathology of acute appendicitis. Hum Pathol 1981;12:870-8.
9. Shrestha R, Ranabhat SR, Tiwari MHistopathologic analysis of appendectomy specimens. Journal of Pathology of Nepal (2012) Vol. 2, 215 - 219
10. Duzgun AP, Moran M, Uzun S, Ozmen MM, Ozer VM, Seckin S et al. Unusual findings in appendicectomy specimens: Evaluation of 2458 cases and review of the litera-ture. Indian J Surg 2004; 66: 221-226
11. Abdulrahman Saleh Al-Mulhim.Unusual findings in appendicectomy specimens: Local experience in Al-Ahsa region of Saudi Arabia. Journal of Clinical Pathology and Forensic Medicine.2011; 2(1): 40-41.
12. Akbulut S, Tas M, Sogutcu N, Arikanoglu Z, Basbug M, Ulku A. Unusual histopathological findings in appendectomy specimens: a retrospective analysis and literature review. World J Gastroenterol. 2011;17(15):1961–1970
13. 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 Oct-Dec; 98(4): 354–362
14. Memon I, Moorpani K, Rehman S. Unusual histopathological findings of appendectomy specifimens. Pak J Med Dent 2014; 3(3):3-7.
15. Kanthikar SN, Nikumbh DB, Desale SS. Primary Eosinophilic Obliterative Appendicitis. Online J Health Allied Scs. 2014;13(1):6.
16. Talley NJ, Shorter RG, Phillips SF, Zinsmeister AR. Eosinophilic gastroenteritis: A clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. Gut.1990;31:54-8.
17. Manzanares-Campillo Mdel C, Pardo-García R, Martín-Fernández J. Appendicular pseudodiverticula and acute appendicitis. Our 12-year experience. Rev Esp Enferm Dig. 2011;103(11):582–585
18. Coulier B, Pierard F, Malbecq S. Appendicular diverticulitis in an Amyand's hernia. JBR-BTR. 2010;93(2):114.
19. Sunil V Jagtap, Dhiraj B Nikumbh, Ashok Y Kshirsagar, Sujata R Kanetkar, Ashish Bohra. Eosinophilic appendicitis presented as mucocele: a rare clinical entity . IJHSR. 2012;2(2):99-103.
20. Shapiro R, Eldar S, Sadot E, Venturero M, Papa MZ, Zippel DB. The significance of occult carcinoids in the era of laparoscopic appendectomies. Surg Endosc 2010; 24: 2197-2199
Published
"21-08-2016"
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