Endometriosis of the appendix mimicking appendicitis: Histomorphology and case report

Ari Sudewa Ida Bagus, Dewi Rahayu Luh, Caka Gunantara Ida Bagus, Sagita Dewi Ni Luh Gde
In: Intisari Sains Medis · 2023 · vol. 14(2) , pp. 883–885 · doi:10.15562/ism.v14i2.1766 · W4388814638
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⚙ AI-generated summary by claude@2026-06, 2026-06-21 ⓘ

This report describes a rare case of appendiceal endometriosis mimicking appendicitis, confirmed by the histological identification of endometrial glands and stroma in the appendix.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-21 · read from full text ⓘ

This paper reports a 42-year-old woman with severe right lower abdominal pain in whom an appendectomy was performed for presumed appendicitis, followed by microscopic tissue analysis. Histopathology showed endometrial glands and stroma located in the muscularis propria and serosa of the appendix, establishing appendiceal endometriosis. The authors note that appendiceal endometriosis is rare, can mimic appendicitis, and is difficult to detect preoperatively, with diagnosis relying on histomorphology. This paper is centrally about endometriosis — specifically endometriosis of the appendix presenting as appendicitis-like pain.

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Abstract

Introduction: Even though endometriosis is relatively common among women of reproductive age, endometriosis of the appendix is rare. It has various clinical presentations and sometimes mimics appendicitis. Diagnosis is made from microscopic examination. Case Description: Here, we report a case of a 42-year-old woman with severe right lower abdominal pain. An appendectomy was performed, and the tissue specimen was analyzed. Endometrial glands and stroma were found in the muscularis propria and serosa. The diagnosis of appendiceal endometriosis was established histologically. Conclusion: Endometriosis of the appendix is a rare case. It can mimic appendicitis and is hard to detect preoperatively. A histopathology examination was recommended to confirm the diagnosis.
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Introduction

Even though endometriosis is relatively common among women of reproductive age, endometriosis of the appendix is rare. It has various clinical presentations and sometimes mimics appendicitis. Diagnosis is made from microscopic examination. Case Description: Here, we report a case of a 42-year-old woman with severe right lower abdominal pain. An appendectomy was performed, and the tissue specimen was analyzed. Endometrial glands and stroma were found in the muscularis propria and serosa. The diagnosis of appendiceal endometriosis was established histologically.

Conclusion

Endometriosis of the appendix is a rare case. It can mimic appendicitis and is hard to detect preoperatively. A histopathology examination was recommended to confirm the diagnosis. - Sabo CM, Grad S, and Dumitrascu DL. Chronic Abdominal Pain in General Practice. Dig Dis. 2021;39(6):606–614. - Cartwright SL and Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician.2008;77(7):971-978. - Parasar P, Ozcan P, and Terry KL. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep. 2017;6(1):34–41. - Reyna-Villasmil E, Torres-Cepeda D, and Labarca-Acosta M. Endometriosis of the appendix. Gastroentrol Hepatol. 2016;39(7):463-465. - Liang H-H, Huang M-T, Wei P-L, et al. Endometriosis-induced appendiceal intussusception. Am J Surg. 2009;197:e66-e68. - Oulaqi NSA, Hefny AF, Joshi S, et al. Endometriosis of the appendix. Afr Health Sci. 2008;8(3):196–198. - Eroschenko VP. Di Fiore's atlas of histology with functional correlations. 12th ed. Lippincott Williams & Wilkins. 2013. - Jaschinski T, Mosch C, Eikermann M, et al. Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomized controlled trials. BMC Gastroenterol. 2015;15:48. - Coleman JJ, Carr BW, Rogers T, et al. The Alvarado score should be used to reduce emergency department length of stay and radiation exposure in select patients with abdominal pain. J Trauma Acute Care Surg. 2018;84(6):946-950. - Ohle R, O'Reilly F, O'Brien, et al. The Alvarado score for predicting acute appendicitis: a systematic review. BMC Med. 2011;9:139. - Kumar V, Abbas AK, and Aster JC. Robbins & Cotran Pathologic Basis of Disease. 10th ed. Elsevier. 2021. - Walls M, Buckley H, and Fox H. Gynaecological and Obstetric Pathology for the MRCOG and Beyond. 2nd ed. Cambridge University Press. 2014. - McCluggage WG. Endometriosis-related pathology: a discussion of selected uncommon benign, premalignant and malignant lesions. Histopathol. 2020;76:76-92. - Agarwal N and Subramanian A. Endometriosis – Morphology, clinical presentations and molecular pathology. J Lab Physicians. 2010;2(1):1–9. - Lewin D and Lewin KJ. Small Intestine. In: Weidner N, Cote RJ, Suster S, et al, editors. Modern Surgical Pathology. 2nd ed. Elsevier. 2009;719–754. - Machida T, Takahashi T, Itoh T, et al. Reactive lymphoid hyperplasia of the liver: A case report and review of literature. World J Gastroenterol. 2007;13(40):5403–5407. - El-Agwany AS. Endosalpingiosis (A Rare Pathology that Mimic Others): Could it be a Precursor of Cancer? Indian J Gynecol Oncolog. 2016;14:47. - Almatrafi MH, Alhazmi AM, and Almosaieed BN. Mullerianosis of the urinary bladder. Urol Case Rep. 2020;33:101333. - Lee SH, Park J-W, and Rha SH. Diagnostic dilemma in cervical endocervicosis. Obstet Gynecol Sci. 2017;60(4):396–400. - Dawson A, Fernandez ML, Anglesio M, et al. Endometriosis and endometriosis-associated cancers: new insights into the molecular mechanisms of ovarian cancer development. Ecancermedicalscience. 2018;12:803. - Sourial S, Tempest N, and Hapangama DK. Theories on the pathogenesis of endometriosis. Int J Reprod Med. 2014;2014:179515. - Parasar P, Ozcan P, and Terry K. Endometriosis: epidemiology, diagnosis and clinical management. Curr Obstet Gynecol Rep. 2017;6(1):34-41. Ida Bagus, A. S., Luh, D. R., Ida Bagus, C. G., & Ni Luh Gde , S. D. (2023). Endometriosis of the appendix mimicking appendicitis: Histomorphology and case report: Histomorphology and case report. Intisari Sains Medis, 14(2), 883–885. https://doi.org/10.15562/ism.v14i2.1766

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