Unusual histopathological findings of appendectomy specimens

Background: Appendicitis is a very common surgical clinical condition and appendectomy is a frequently performed procedure worldwide. Although obstruction caused by fecoliths or lymphoid aggregation is a common reason for appendicitis, unusual histopathological findings can be a cause too. Unusual findings can range from benign conditions like worm infestation and cysts to malignant conditions like carcinoid tumors and adenocarcinomas. Enterobius vermicularis infection, tuberculosis, ascaris lumbricoides infestation, carcinoid tumors and cystadenomas are some of the commonly appearing unusual findings

Objective: To document the number of rare histopathological findings of appendectomy specimens

Methods: A 7 year retrospective study was conducted at Ziauddin University Hospital from March 2005 to December 2012. From accumulated information for 2157 appendectomies, 138 appendectomy specimens had rare histopathological findings. Incidental and negative appendectomies were excluded from this study

Results: 58% of the patients with unusual histopathological findings were males [n=80] and 42% were females [n=58]. Most common findings included: Enterobius vermicularis48.5% [n=67], Tuberculosis13% [n=18], Carcinoid tumors 9% [n=13] and cystadenomas 8% [n=11]. Other findings include: peri appendicular abscess, adenocarcinoma of colonic origin, necrotizing lymphadenitis, ascaris lumbroides, Meckel's diverticulum, taenia saginata, pheochromocytoma and mucocele

Conclusion: Appendectomy specimens should be routinely sent for histopathological examinations as this practice can help in diagnosing rare tumors and conditions

Carcinoid tumors: an ignored cause of appendicitis

Background: Many conditions related to appendix present as appendicitis. These conditions can range from fecolith obstruction to tumors .Carcinoid tumors are most common tumors to present in appendix. Most of the carcinoid tumors in appendix present as appendicitis. Majority of the cases are diagnosed after histopathological examination, with 90% of the tumors measuring smaller than 1 cm with excellent prognosis after appendectomies. Tumors with the size of 2cm are treated with right hemicolectomy

Objective: To determine the frequency of carcinoid tumors in appendectomies using histopathological data

Methods: This was a retrospective study conducted at Ziauddin University Hospital, Nazimabad for a time period of 7 years from March 2005 to December 2012. 2,157 appendectomies were analyzed, out of which 13 appendectomy specimens were diagnosed as carcinoid tumors. Incidental and negative appendectomies were excluded from this study

Results: 0.60% of the appendectomy specimens were diagnosed as carcinoid tumors [n=13], male to female ratio was [5.5:1], 77% [n=10] of the tumors were up to 1 cm in size and 23% [n=3] of the tumors were of 1.5 cm in size. Majority of the tumors [n=9] had well differentiated cell types. 77% of the tumors were localized to the tip of the appendix, 15% of the tumors spread locally to the distal half of the appendix and 8% spread to the mesentery

Conclusion: Carcinoid tumors of the appendix, mostly present as appendicitis in early stage. While 90% of the cases show excellent prognosis with appendectomy, 10% of the cases might need further management