A. Lahmar

Unexpected Histopathological Findings in Appendectomy Specimens: a Retrospective Study of 1627 Cases

Pathologic evaluation of the appendix after appendectomy is routine and can occasionally identify unexpected findings. The aim of the present study was to determine the incidence and type of pathologic diagnoses found in appendectomy specimens at our institution. The clinicopathological data of 1627 patients who underwent appendectomies for presumed acute appendicitis from January 2008 to October 2014 were reviewed retrospectively. There were 986 men and 641 women (sex ratio M/Fu2009=u20091.5) aged between 16xa0months and 90xa0years (meanu2009=u200930xa0years). All patients underwent appendectomy (either open or laparoscopic). Histological examination of the surgical specimen showed acute inflammation of the appendix in 1455 cases (89.42xa0%), fibrosed appendix in 37 cases (2.27xa0%), and Enterobius vermicularis (nu2009=u200923). In 101 cases (6.2xa0%), the appendix was histologically normal. Incidental unexpected pathological diagnoses were noted in 57 appendectomy specimens. They included pinworm (nu2009=u200923), mucinous neoplasms (nu2009=u200912), neuroendocrine tumors (NET) (nu2009=u20098), adenocarcinoma (nu2009=u20092), granulomatous inflammation (nu2009=u20095), tuberculosis (nu2009=u20092), hyperplastic polyp (nu2009=u20091), tubular adenoma (nu2009=u20091), diverticulitis (nu2009=u20091), endometriosis (nu2009=u20091), and actinomycosis (nu2009=u20091). The routine histopathological examination of the appendix is of value for identifying unsuspected conditions requiring further postoperative management. Gross examination alone does not appear to be a good indicator of an unexpected finding on microscopic exam. It is recommended that in order to avoid misdiagnoses, all appendices should be histopathologically examined.

Pancreatic cystic neoplasms.

Background: Cystic neoplasms of the pancreas are rare and constitute approximately 0.5% of all pancreatic neoplasms. Aims: The study was to describe clinicopathological features of pancreatic cystic tumors. Patients and Methods: In our retrospective study, we reviewed 10 cases of pancreatic cystic neoplasms that were diagnosed at the pathology department of Mongi Slim hospital over a 14-year period (2000-2013). We adopted the latest World Health Organization (WHO) classification (2010) in grouping all tumors. Results: There were one male and nine female patients (sex ratio M/F = 1:9) aged between 21 and 68 years (mean = 37.5 years). The most common clinical presentation was epigastric and abdominal pain (n = 6) followed by vomiting (n = 3). Abdominal computed tomography (CT) scan disclosed a cystic lesion of the pancreas ranging in size between 2 and 10 cm (mean = 6.75 cm). All patients underwent surgical treatment. Histopathological examination of the surgical specimen established the diagnosis of solid pseudopapillary neoplasm (n = 2), serous cystic neoplasm (n = 2), mucinous cystadenoma (n = 4), mucinous cystadenocarcinoma (n = 1), and intraductal papillary mucinous neoplasm with invasive carcinoma (n = 1). Conclusion: Better understanding of pancreatic cystic neoplasms is essential for clinicians to make accurate diagnosis and to provide the best management for patients.

A broad ligament pregnancy successfully managed by laparoscopy

A 32-year-old woman, gravida 2, para 1, was referred for pelvic pain and amenorrhoea of 5weeks. The patient’s obstetric history revealed one full-term, spontaneous and normal vaginal delivery. She had no past medical history or prior surgery. There was neither vaginal bleeding nor pelvic tenderness. Serum quantitative beta hCG levels were 26784 IU/ml. A subsequent ultrasound displayed an empty uterine cavity and an endometrial thickness of 11mm. An ectopic gestational sac and a live extrauterine embryo with a crow-rump length of 12mm were seen beside and right to the uterus. The most likely diagnosis was an ectopic pregnancy. The patient was taken for surgery with a laparoscopic approach. Intraoperatively, the gestational sac was found in the right broad ligament (Figure 1(A)). The uterus, fallopian tube and ovary were normal. Hence, the diagnosis of a broad ligament pregnancy was made. The broad ligament was opened, the sac was excised and products of conception extruded. The patient had an uneventful postoperative course. On histological examination, chorionic villi displayed irregularity in size and shape. A partial hydatiform mole was initially suspected (Figure 1(B)). The patient was closely followed-up with serial monitoring serum beta hCG level. She had a favourable outcome and serum hCG level was <15 IU/ml at day 28.