Importance of routine histopathological examination in appendectomy specimens
Abstract
Background: Acute appendicitis is the most common abdominal emergency. It is a clinical entity with an ongoing diagnostic challenge. Histopathological examinations are the gold standard for the final diagnosis, which has revealed much unusual, unexpected serious underlying pathology. This study is to analyze the histopathological patterns in appendectomy specimens and to establish the role and importance of histopathological examination in diagnosing various serious incidental pathologies.
Materials and Methods: This is a retrospective study comprising of 181 patients, carried out at VMKVMCH, Department of Pathology, over a period of 2 years from September 2017 to August 2019. Clinical data of patients were collected for all the appendectomy specimens received at the pathology department and histopathology slides were reviewed.
Results: A total of 181 cases were analyzed. Patients’ age ranged from 3 to 77 years. The predominant appendectomy finding was acute appendicitis 86 cases (47.51%) followed by chronic appendicitis 58 cases (32.04%). Among the unusual findings, eosinophilic appendicitis was the commonest 4 cases (2.20%), mucocele, carcinoid and parasite 1 case (0.55%) each respectively.
Conclusion: Although most of the cases were diagnosed as acute appendicitis, a few of the essential incidental pathologies were missed out pre-operatively and intra-operatively. Hence these serious incidental diagnoses undeniably support the fact that all appendectomy specimens should be sent routinely for histopathological examination, which is not followed in many hospitals in India.
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Myageri A, Agnihotri AD, Chauhan LDS. Clinicopathologic Study of Appendix Specimens- A Two Year Retrospective Study at a Tertiary Care Center. National J Lab Med. 2019;8(2):5-10. doi: 10.7860/NJLM/2019/40985:2345
Al-Omran M, Mamdani MM, McLeod RS. Epidemiologic features of acute appendicitis in Ontario,Canada. Can J Surg 2003;46(4):263-268.
Oguntola AS, Adeoti ML, Oyemolade TA. Appendicitis: Trends in incidence, age, sex, and seasonal variations in South-Western Nigeria. Ann Afr Med. 2010;9(4):213-217. doi: 10.4103/1596-3519.70956.
Vijayasree V, Sunil CSPV, Noel S, Rao TS. Histopathological spectrum of appendicular lesions and correlation with age and sex incidence: A retrospective study. Med Pulse Int J Pathol. 2017;4(1):16-20. doi: https://doi.org/10.26611/105414.
Zulfikar I, Khanzada T. W, SushelC, Samad A. Review of the Pathologic Diagnoses of Appendectomy Specimens. Annals. 2009;15(4):168-170. doi: https://doi.org/10.21649/akemu.v15i4.61.
Shaik S, Jayakumar NM, Manikyam UK, Naidu R. Should every appendectomy specimen be subjected to histopathological examination? A retrospective study of histological findings in appendectomy specimens. J Evid Med. 2017; 4(94):5772-5775. doi: 10.18410/jebmh/2017/1162.
R Sujatha, Anushree CN, Neha Singh. Histopathologicla spectrum of appendicectomy specimens – A prospective study. Indian J Pathol Oncol. 2017;4(4):638-642. doi: 10.18231/2394-6792.2017.0136.
Kulkarni MP, Sulhyan KRS, Barodawala SM, Yadav DH. Histopathological study of lesions of the appendix. Int J Health Sci Res. 2017;7(4);90-95.
Lee JAH. The incidence of sex and age on appendicitis in children and young adults. Gut. 1962;3:80-84.
Lohar HP, Calcuttawala MAA, Nirhale DS, Athavale VS, Malhotra M, Priyadarshi N. Epidemiological aspect of appendicitis in a rural setup. Med J Dr. D. Y. Patil University. 2014;7(6):753-757. doi: 10.4103/0975-2870.144867.
Omotoso AJ, Nnoli MA, Bassey IE, Akintomide AO, Ngim OE, Ekanem IA. Histopathological analysis of appendectomy specimens in Calabar, South – Southern Nigeria. IOSR J VLSI Signal Proces. 2013:2;42-46.
Rathi N, Riddell L, Worsley A. Food consumption patterns of adolescents aged 14-16 years in Kolkata, India. Nutritional J. 2017;16:50. doi 10.1186/s12937-017-0272-3.
Chawda HK, Miskin AT, Dombale VD. Spectrum of histopathological lesions in surgically removed appendix. J Drug Dis Therapeut. 2015;3(28):53-56.
Robert E. Petras, Terry L. Gramlich. Nonneoplastic Intestinal Diseases.In: Mills, Stacey E (Eds) Sternberg's Diagnostic Surgical Pathology, 5th Edition, Baltimore. Lippincott Williams & Wilkins; 2010. P.1355-1356
Liamaiem F, Arfa N, Marsaoui L, Bouraoui S, Lahmar A, Mzabi S. Unexpected histopathological findings in appendectomy specimens: a retrospective study of 1627 cases. Indian J Surg. 2015;77(3):1285-1290. doi 10.1007/s12262-015-1278-8
Sharma S, Mahajan D, Rasool M, Bashir S, Hafiz A, Wajahat M. Histopathology of appendicectomy specimen: A 5-year study. Scholar J App Med Sci. 2014;2:176-180.
Chan W, Fu KH. Value of routine histopathological examination of appendices in Hong Kong. J Clin Pathol. 1987;40(4):429-433. doi: 10.1136/jcp.40.4.429.