Neoplasms of the appendix: a retrospective analysis of 5-year data on histopathology of appendicectomy specimens in a tertiary care hospital

Introduction
Right iliac fossa pain due to appendicular disease is a common clinical presentation to a surgical casualty ward. Neoplasms of the appendix are rare but sometimes they present with acute symptoms similar to acute appendicitis. Studies on neoplasms of appendicectomy are sparse in Sri Lanka. Our objective is to study the epidemiological, demographic characteristics and histopathological data on appendicectomy specimens.

Method
A retrospective descriptive study using the database on appendicectomy specimens in the pathology department of Colombo North teaching hospital, Ragama from January 2015 to December 2019.

Results
Neoplastic lesions were noted in 16[0.82%] among 1939 appendicectomy specimens. All [n=16, 100%] were primary neoplasms and the male to female ratio was 5:11. The percentage of neoplasms was higher in the elderly population compared to the young. Six of the 16 specimens [37.5%] had associated features of acute appendicitis. The commonest neoplasm was neuroendocrine neoplasm [including goblet cell carcinoid tumour] [n=9, 56.25%]. The mean age was 33 years and comprised 0.46% of the population. Mucinous neoplasms were noted in 6 [37.5%] and comprised 0.3% of the population. The median age was 59 years. The resection margin was well away from the tumour in all [n=9] Neuroendocrine neoplasms while the tumour had involved the resection margin in 4 out of 6 [66.6%] of mucinous neoplasms.

Conclusion
Appendicular neoplasms are rare but higher in the elderly population compared to the young. Neuroendocrine neoplasms are the commonest incidental tumours and they are less aggressive at the time of diagnosis. Meticulous dissection is important with a good clearance of the resection margin in suspected mucinous appendiceal neoplasms.