Histopathological Analysis of Unusual Findings in Appendectomy Specimens: A Retrospective Study and Literature Review.

Background-: Acute appendicitis has remained a clinical entity and an ongoing diagnostic challenge. Appendicitis is one of the commonest surgical emergencies. However, histopathological studies are the gold standards for diagnosis of acute appendicitis. Though faecoliths are the usual cause of obstruction, other unusual findings can be the cause too, ranging from inflammatory conditions to malignancies. Aims and Objectives: To document and compare unusual histopathological findings in appendectomy specimens in our center. Methods: The clinicopathological records of resected appendices submitted to histopathology department over the period of 4 years from January 2012 to December 2015 were reviewed retrospectively. From accumulated information from 790 appendectomies, 44 appendectomy specimens had unusual histopathological findings were included in the study. Patient who underwent incidental appendectomy during other surgeries were excluded from the study. Results: Out of 790 appendectomy specimens, acute appendicitis accounted for 302(38.2%) with peak occurrence in the age group 11-20 years (38.9%) and 21-30 years (27.7%) with male predominance (2.34:1). Unusual findings were noted in 44 (5.6%) cases by histopathology. Most common findings included obliterative appendicitis (77.3%), followed by eosinophilic appendicitis (6.8%) and granulomatous appendicitis (4.5%).Other unusual findings include diverticulum, mucocele, carcinoid and signet ring adenocarcinoma of the appendix. Conclusion: The gross examination at the time of surgery cannot detect all the abnormalities of the appendix. Although unusual or co-existing pathologies can be rarely seen during appendectomy, all the appendectomy specimens should be sent for routine histopathological examination to avoid missing of any clinically important and treatable condition.