Beyond the Surface and Exploring the Microscopic Landscape: Histomorphological Findings in Appendicectomy Specimens

Background: A diagnosis of appendicitis is confirmed by histomorphological examination of the specimen. This study aims to assess the incidence of common and incidental findings in the appendix on gross and microscopic examination. Materials and Methods: For each specimen assessed, we recorded a brief clinical history, placed the specimens in 10% buffered formalin for fixation, and performed a thorough gross examination. Later, the tissue bits were processed using the conventional histopathological technique, followed by hematoxylin and eosin staining. The histomorphological findings were correlated with the clinical diagnosis. Results: A total of 156 appendix specimens were studied. The sample was predominantly male (n = 112, 71.8%) with those aged between 11 and 20 years, constituting the largest age group (n = 75, 48.1%). More than half of the cases (n = 102, 65.4%) presented with right iliac fossa pain. Acute appendicitis was the most common diagnosis (n = 58, 37.2%), followed by acute gangrenous appendicitis with perforation (n = 23, 14.7%) and periappendicitis (n = 20, 12.8%). Diagnosis of chronic appendicitis, acute on chronic appendicitis, and eosinophilic appendicitis was made in 20 (12.8%), 19 (12.2%), and 7 (4.5%) cases, respectively. Two cases (1.3%) each of diverticulum, mucocele, and lymphoid hyperplasia were present. Finally, 1 case (0.6%) each of fibrous obliteration, Enterobius vermicularis, mucinous cystadenoma, and carcinoid were reported. Granulomatous appendicitis and normal appendix were seen in 3 (1.9%) cases each. Conclusions: Acute appendicitis, chronic appendicitis, and granulomatous appendicitis are the most common diagnoses following pathological examination of the resected appendix. However, rare findings such as diverticulum, parasitic infestations, and tumors of the appendix were also found. Our findings highlight the importance of histomorphological analysis of the appendix to diagnose incidental findings that may be missed clinically.