Incidental Findings of Appendiceal Diverticulitis Presenting as Acute Appendicitis

Diverticulosis of the appendix (DA) is a rare pathological finding that clinically imitates acute appendicitis and is most commonly found in adult males with chronic abdominal pain. It has a higher rate of perforation compared to acute appendicitis (84% vs 12%, P<0.01), and is consequently associated with a higher rate of mortality. Appendiceal diverticulitis has been found to have a significant association with incidental appendiceal neoplasms, therefore elective prophylactic appendectomy is recommended to prevent the risk of complications and to rule out the possibility of a coexisting neoplasm. Meticulous gross examination in addition to thorough histological examination of the entire appendectomy specimen by pathologists is essential in order to identify diverticula. We present two female patients with signs and symptoms consistent with acute appendicitis, they were found to have appendiceal diverticulitis on pathologic evaluation.

Retrospective analysis of the appendiceal neoplasms: sampling technique may influence neoplasm detection

Background and aimsAppendiceal neoplasms are uncommon entities that are usually determined incidentally during the histopathological examination. Different techniques used for the macroscopic sampling of appendectomy material may affect the determinating neoplasms.Materials and methodsH&E-stained slides of 1280 cases who underwent appendectomy between 2013 and 2018 were reviewed retrospectively for histopathological features.ResultsNeoplasms were determined in 28 cases (3.09%); 1 lesion was observed in the proximal part of the appendix, 1 covering the entire length from proximal to distal and 26 in the distal part. In the 26 cases that observed in the distal part, the lesion was seen on both sides of the longitudinal section of the distal appendix in 20 cases, while it was seen on only one distal longitudinal section in the remaining 6 cases.ConclusionThe vast majority of appendiceal neoplasms are seen in the distal part of the appendix, and, in some cases, neoplasms might be seen on only one side of the distal section. Sampling only one-half of the distal part of the appendix, where tumours are most often observed, could result in some neoplasms being missed. Therefore, sampling the whole distal part would be more beneficial to determine small diameter tumours that do not create macroscopic findings.

TP9.2.22A six year retrospective study of appendicular neoplasms and review of literature

Aims The aim of this study was to evaluate the incidence of appendiceal neoplasm, identify possible association of pre and intra-operative factors associated with it, and to determine its clinical significance. Methods Using pathological reports from surgical specimens of appendix from January 2015 to September 2020, a single centre retrospective analysis was performed. Medical records of patients, pre-operative investigations, intra operative findings, histological reports and post operative management were evaluated. Results The incidence of appendiceal neoplasms was 2.33% (65/2791). They consisted of Neuroendocrine tumor (NET) in 35(53.85%), followed by Low grade mucinous neoplasm (LAMN) in 23(35.38%), Goblet cell carcinoid in three (4.62%), mucinous cystadenoma 2(3.08%), one (1.54%) adenocarcinoma and one (1.54%) metastasis. Appendicitis was the most common indication for surgery. 46(70.77%) patients had emergency surgery. 89.13% emergency surgeries was appendicectomy, NET being the most common tumor in 60.87%. 19(29.23%) patients had elective surgery, all had pre operative radiological investigation, LAMN being most common. Only five (7.69%) patients had intra operative suspicion of tumor. Ten patients required second procedure in the form of right hemicolectomy in nine, and cytoreducetive surgery in one. All patients were followed up as per national guidelines. Conclusions The incidence of appendiceal neoplasms though low, has been steadily rising. Its diagnosis is rarely evident on pre operative radiological investigations. Surgeons should be aware of these neoplasms and its frequent association with emergency appendicectomies done for suspected acute appendicitis.

Appendiceal Neoplasms: Diagnosis, Management and Follow-up

Appendicectomy is one of the most performed surgical procedures. Neoplasms of the appendix are identified in approximately 1% of appendiceal specimens, and the incidence seems to be rising. The aim of this review was to summarize the current data on these neoplasms, focusing on the recent classification, clinical manifestations, management, and follow-up of such patients, which remain under debate. A literature search was performed using the database PubMed. The keywords used were related to appendiceal neoplasms, mucocele, pseudomyxoma peritonei and treatment. Records without abstracts, case reports, opinion articles and experimental studies were excluded. The appendix tumors can be classified between epithelial or nonepithelial. The epithelial variant is composed by mucinous neoplasms, nonmucinous adenocarcinoma, and signet ring cell tumors; instead, neuroendocrine tumors, lymphoma, and sarcoma are included in nonepithelial neoplasia. Goblet cell carcinoids share characteristics of both epithelial and nonepithelial tumors. The clinical presentation can be variable and the algorithm for evaluation and treatment is complex. Treatment is based on stage and histology. Our intention is to clarify some questions and help the surgeon in operative decisions, treatment strategies, and patient counseling. Doi: 10.28991/SciMedJ-2021-0303-9 Full Text: PDF