Histopathological Study in Appendectomy Specimens

Abstract

Background: Acute appendicitis is the commonest abdominal condition requiring emergency surgical intervention. Objective: To determine the spectrum and frequency of various histopathological findings in appendectomy specimens of patients presenting with acute appendicitis at Central Park Medical College/Central Park Teaching Hospital, Lahore. Method: It was cross-sectional study commencing from 15th April 2016 to 15th April 2021 conducted at the Pathology Department of Central Park Medical College, Lahore. Relevant record from previous histopathology reports were retrieved. Data were compiled using SPSS version 21. Frequency and percentages were calculated for age, gender, and histopathological findings. Test of significance (Chi square) was used to observe the relation of age and gender with morphology. Results: A total of 429 appendectomy specimens were included in the study. These included 243 cases (56.6%) from males and 186 cases (43.4%) from females. Patients ranged in age from 1 to 75 years with a maximum of 158 cases (36.8%) in the age range of 11 to 20 years. On histopathology the commonest diagnosis was acute appendicitis in 125 cases (29.13%) with associated findings of peri appendicitis in 77 cases (18%), acute suppurative appendicitis in 61 cases (14.2%), perforated appendices in 11 cases (2.6%), fibrosed lumina in 7 cases (1.63%) and gangrenous appendix in 1 case (0.23%). Lymphoid hyperplasia constituted the second most frequent diagnosis in 114 cases (26.6%). Other significant unsuspected findings were pinworm infestation in 5 cases (1.16%), granulomatous inflammation in 2 cases (0.5%) and endometriosis in 2 cases (0.5%). Incidental tumors included 3 cases (0.7%) of neuroendocrine tumors (carcinoid) and 1 case (0.23%) of Low Grade Appendiceal Mucinous Neoplasm (LAMN). Normal appendectomies were reported in 4 cases (0.93%). Chi-square test of association was used to observe the statistically significant relation of age and gender with histopathological findings. Conclusion: Histopathological examination of appendectomy specimens is the “gold standard” for accurate diagnosis and confirmation of the clinical diagnosis of “acute appendicitis”. Certain coexistent, unexpected incidental findings may also be detected.