Unexpected Histopathological Diagnoses in Acute Appendicitis Specimens: A Retrospective Analysis of 2076 Patients

Abstract

Aim:Acute appendicitis is the most common cause of emergency abdominal surgery in the world. Although the etiology of appendicitis is still not fully known, possible causes include lumen obstruction. Fecaloid and lymphoid hyperplasia are the most common causes of lumen obstruction. However, some rare conditions may cause acute appendicitis by causing lumen obstruction. Here, we aimed to present the pathology results of 2076 patients operated due to acute appendicitis in our hospital and the unexpected histopathological findings in the light of the literature.Method:Patients who were emergently operated with diagnosis of appendicitis between January 2016 and February 2020 in Gaziantep Dr. Ersin Arslan Training and Research Hospital were retrospectively screened. Incidental appendectomies were excluded. Data of 2076 patients were reached. Gender, age, and pathology results of the patients were analyzed. Pathology preparations were reassessed by two pathologists. Pathology results were analyzed under two categories as general findings and unexpected findings. Fisher’s chi-square test was used for statistical analysis.Results:A total of 2076 patients were included in the study and analyzed. Of the patients, 1368 (66%) were man, 708 (34%) were woman, and the mean age was 33±12.9 years. Acute appendicitis was found in 1309 (63.1%) patients, gangrenous-perforated appendicitis in 305 (14.7%) patients, negative appendectomy in 105 (5.1%) patients, phlegmonous appendicitis in 32 (1.5%) patients, and unexpected pathological findings in 62 (3%) patients. Among the unexpected pathological findings were fibrous obliteration in 31 (50%) patients, mucosal hyperplasia in 8 (13%) patients, appendicular diverticulitis in 7 (11.3%) patients, retention cyst in 5 (8.1%) patients, mucinous cystadenoma in 3 (4.8%) patients, well-differentiated neuroendocrine tumor in 2 (3.2%) patients, eosinophilic infiltration in 2 (3.2%) patients, foreign body reaction in 2 (3.2%) patients, granulomatous appendicitis in 1 (1.6%) patient, and parasitic infestation was detected in 1 (1.6%) patient.Conclusion:Unexpected histopathological findings are rare in appendectomy specimens and these diagnoses help guide the patient’s treatment.

Keywords

• appendicitis
• neuroendocrine neoplasm
• mucocele
• adenocarcinoma
• carcinoid