Unexpected Findings in the Routine Histopathological Examinations of Appendectomy Specimens A Retrospective Analysis of 1,970 Patients

Ann Ital Chir. 2017;88:519-525.

Abstract

Introduction: 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.

Methods: The files of 1,970 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 post-operation follow-ups were recorded.

Results: 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.

Conclusion: Although all of the appendectomy samples were normal macroscopically, data from this study suggest that all specimens should be sent for routine investigation.

Key words: Appendicitis, Appendectomy, Carcinoid, Mucocele, Endometriosis.

È molto raro il riscontro di tumori ed altre patologie dell’appendice vermiforme al di fuori dell’appendicite acuta. Ci si è proposti con questo studio di ricercare rari reperti nello studio istopatologico di appendici asportate in caso di appendicite acuta. Sono state studiate retrospettivamente le cartelle cliniche di 1.970 pazienti sottoposti ad appendicectomia per appendicite acuta tra il marzo 2012 e marzo 2016, con il risultato di individuare rari reperti in 59 pazienti, pari al 3%, e questi sono stati studiati in dettaglio, prendendo nota di età, genere, dati patologici e decorso postoperatorio. Sono stati dunque esaminati i reperti istopatologici dei 50 pazienti, di cui 31 donne (52,5%) e 28 uomini (47,5%). L’età media è risultata di 33.1±18.2 anni. I reperti non usuali sono stati i seguenti: 16 obliterazioni fibrose, 11 elmintiasi da Enterobius vermicularis, 2 da Schistosoma, 3 neuromi appendicolari, 2 appendiciti granulomatose, 1 morbo di Crohn, 3 appendiciti croniche, 1 endometriosi, 2 polipi iperplastici, 9 cistadenomi mucinosi con mucocele, 8 Carcinoidi ed 1 Linfoma. Tutti i tumori maligni erano localizzati all’estremità distale dell’appendice, e tutti i pazienti erano stati trattati con appendicectomia. Quelli affetti da patologia parassitaria erano stati sottoposti a trattamento antielmintico, mentre i pazienti affetti da linfoma erano stati sottoposti a chemioterapia. Tutti i pazienti cui era stata diagnosticata una patologia maligna erano vivi al follow up senza particolari pronlemi. Sebbene tutti i reperti anatomopatologici delle appendici asportate apparivano normali macroscopicamente, i dati di questo studio suggeriscono che tutte le appendici asportate debbano essere sottoposte alle indagini di routine.

MeSH terms

  • Adolescent
  • Adult
  • Anthelmintics / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Appendectomy*
  • Appendiceal Neoplasms / complications
  • Appendiceal Neoplasms / diagnosis
  • Appendiceal Neoplasms / pathology
  • Appendiceal Neoplasms / therapy
  • Appendicitis / complications*
  • Appendicitis / surgery
  • Appendix / pathology*
  • Combined Modality Therapy
  • Crohn Disease / complications
  • Crohn Disease / diagnosis
  • Crohn Disease / pathology
  • Endometriosis / complications
  • Endometriosis / diagnosis
  • Endometriosis / pathology
  • Female
  • Follow-Up Studies
  • Humans
  • Incidental Findings
  • Intestinal Diseases, Parasitic / complications
  • Intestinal Diseases, Parasitic / diagnosis
  • Intestinal Diseases, Parasitic / drug therapy
  • Intestinal Diseases, Parasitic / pathology
  • Male
  • Middle Aged
  • Mucocele / complications
  • Mucocele / diagnosis
  • Mucocele / pathology
  • Retrospective Studies
  • Survival Analysis
  • Young Adult

Substances

  • Anthelmintics