Neuroma of the appendix, a rare cause of appendicitis and an important reason for close follow-up

Appendiceal neuroma presented as acute appendicitis: A rare case report from Syria

Introduction and importance

Appendiceal neuroma, also known as fibrous obliteration, is an exceptional benign lesion discovered in the vermiform appendix removed for indications of acute appendicitis.

Case presentation

We report a case of a 76-year-old woman who presented with signs and symptoms of acute appendicitis. An abdominal ultrasound revealed a mildly distended appendix with a peri-appendiceal fluid collection. Gross examination of the excised appendix showed an obliterated lumen of the distal part on serial cuts. Microscopically, the lumen is replaced by the proliferation of spindle cells into fascicles embedded in fibrous tissue. The diagnosis of appendiceal neuroma was reported and supported by the result of the S-100 immunohistochemical staining.

Clinical discussion

An appendiceal neuroma represents an incidental finding in appendices excised for other reasons. Clinically, there are no specific signs or symptoms, and it is discovered inadvertently. Occasionally, it can mimic acute appendicitis. This lesion is characterized by the proliferation of spindle cells that occlude the lumen of the appendix.

Conclusion

A histopathological evaluation is essential to achieve a definitive diagnosis of an appendiceal neuroma.

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Appendiceal neuroma is an exceptional benign lesion discovered in the appendix removed for appendicitis.

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We report a case of a 76-year-old woman with appendiceal neuroma presented as acute appendicitis.

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Appendiceal neuroma represents an incidental finding in appendices excised for other reasons.

Unusual histopathological findings in appendectomy specimens with clinical diagnosis of acute appendicitis: A retrospective cohort analysis

INTRODUCTION

While appendicitis is considered one of most common acute surgical conditions, several studies have reported abnormal histopathological findings in appendectomy specimens; however, sending all appendices to histopathology is not yet routinely done.Here we report many unusual findings. Those unusual findings played a role not only in confirming acute appendicitis as a cause of the presentation in some cases but also discovering etiologies that mimic it with great impact on its management.

METHODS

Between January 2011 and December 2017, a total of 1510 patients were operated with appendectomy for a primary diagnosis of acute appendicitis. Among them, a total of 72 patients had incidental histopathologic findings in association with acute appendicitis or other pathologies instead of acute appendicitis. A retrospective analysis for those 72 patients was performed with all data being retrieved from the electronic health record system.

RESULTS

Patients ages ranged between 4 and 71 years with a mean age equal to 23.1 years (SD = 14.2). Majority of patients were women (n = 52; 72.2%). Sixty of the seventy-two cases were seen in patients with negative appendectomies (n = 333) with an overall rate of 18% among this group of patients. The remaining 12 patients had additional findings in histopathology specimens beside acute appendicitis (n = 1131) with an overall rate of 1%. The most commonly reported pathologies were serositis, ovarian cysts, and Enterobius vermicularis in descending frequency.

CONCLUSION

Identification of unusual histopathological findings during microscopic examination of resected appendices is more common in female patients and in patients with negative appendectomy. histopathologic assessment of specimens will allow detection of congenital, infectious or malignant pathologies that mimic acute appendicitis clinically even in the absence appendicitis microscopically.