Incidental Findings in Routine Histopathological Examination of Appendectomy Specimens; Retrospective Analysis of 1970 Patients

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This retrospective analysis of 1970 appendectomy specimens found rare histopathological findings in 3% of patients, including tumors, parasitic infections, and inflammatory conditions, necessitating routine histopathological examination even when macroscopic findings are normal.

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This retrospective study examined 1970 appendectomy specimens from patients operated for a preoperative diagnosis of acute appendicitis (March 2012–March 2016) to characterize rare incidental histopathologic findings. Rare abnormalities were identified in 59 patients (3%), including fibrous obliteration, Enterobius vermicularis, schistosomiasis, appendiceal neuroma, granulomatous appendicitis, Crohn’s disease, endometriosis, chronic appendicitis, hyperplastic polyps, mucinous cystadenoma with mucocele, carcinoid tumors, and lymphoma, with malignancies localized to the distal appendix and all malignant patients alive without reported problems at follow-up; parasitic disease patients received anthelmintic treatment and lymphoma received chemotherapy. A key limitation is that the analysis is confined to appendectomy cases done for suspected acute appendicitis with routine pathology data and follow-up reporting, without a comparator group. Relevance to endometriosis: endometriosis is listed as one of the rare incidental histopathologic findings found in appendectomy specimens, though the paper’s main focus is the overall frequency and spectrum of incidental lesions in routine appendiceal histopathology.

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Abstract

Diseases and tumors of the appendix vermiformis are very rare, except for acute appendicitis. This study aimed to examine rare findings in the histopathologic examinations of specimens of patients undergoing appendectomy due to the diagnosis of acute appendicitis. The files of 1970 patients undergoing appendectomy due to the diagnosis of acute appendicitis between March 2012 and March 2016 were retrospectively investigated. Rare findings were found in 59 (3 %) patients, and these were evaluated in detail. Patients' age, gender, pathology reports, and postoperation follow-ups were recorded. The rare histopathological findings of 59 patients were examined. Of these, 31 were female (52.5 %) and 28 were male (47.5 %). The average age was 33.1 ± 18.2 years. The unusual findings were as follows: 16 fibrous obliteration, 11 Enterobius vermicularis, 2 schistosomiasis, 3 appendiceal neuroma, 2 granulomatous appendicitis, 1 Crohn's disease, 3 chronic appendicitis, 1 endometriosis, 2 hyperplastic polyps, 9 mucinous cystadenoma (+mucocele), 8 carcinoid tumors, and 1 lymphoma. All of the malignant tumors were localized in the distal end of the appendix, and all of the patients were treated with appendectomy. Patients with parasitic diseases also underwent anthelmintic treatment, while chemotherapy was administered to the patient with lymphoma. All of the patients diagnosed with malignancy were alive reported no problems at their follow-ups. Although all of the appendectomy samples were normal macroscopically, data from this study suggest that all specimens should be sent for routine investigation.
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Abstract

Diseases and tumors of the appendix vermiformis are very rare, except for acute appendicitis. This study aimed to examine rare findings in the histopathologic examinations of specimens of patients undergoing appendectomy due to the diagnosis of acute appendicitis. The files of 1970 patients undergoing appendectomy due to the diagnosis of acute appendicitis between March 2012 and March 2016 were retrospectively investigated. Rare findings were found in 59 (3 %) patients, and these were evaluated in detail. Patients’ age, gender, pathology reports, and postoperation follow-ups were recorded. The rare histopathological findings of 59 patients were examined. Of these, 31 were female (52.5 %) and 28 were male (47.5 %). The average age was 33.1 ± 18.2 years. The unusual findings were as follows: 16 fibrous obliteration, 11 Enterobius vermicularis, 2 schistosomiasis, 3 appendiceal neuroma, 2 granulomatous appendicitis, 1 Crohn’s disease, 3 chronic appendicitis, 1 endometriosis, 2 hyperplastic polyps, 9 mucinous cystadenoma (+mucocele), 8 carcinoid tumors, and 1 lymphoma. All of the malignant tumors were localized in the distal end of the appendix, and all of the patients were treated with appendectomy. Patients with parasitic diseases also underwent anthelmintic treatment, while chemotherapy was administered to the patient with lymphoma. All of the patients diagnosed with malignancy were alive reported no problems at their follow-ups. Although all of the appendectomy samples were normal macroscopically, data from this study suggest that all specimens should be sent for routine investigation. Similar content being viewed by others

References

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Incidental Findings in Routine Histopathological Examination of Appendectomy Specimens; Retrospective Analysis of 1970 Patients. Indian J Surg 80, 48–53 (2018). https://doi.org/10.1007/s12262-016-1557-z Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s12262-016-1557-z

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