Appendix

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Images hosted on other servers:

Contributed by Mahzad Azimpouran, M.D. and Danielle Hutchings, M.D.

Contributed by Mahzad Azimpouran, M.D. and Danielle Hutchings, M.D.

• Appendix, appendectomy:
  • Inverted appendix
  • No dysplasia or malignancy identified

• Cecal polyp, polypectomy:
  • Polypoid colonic tissue with underlying adipose tissue and muscularis propria consistent with inverted appendix

A 44 year old woman underwent screening colonoscopy. The endoscopist noted a polypoid mass arising in the cecum and performed endoscopic polypectomy. The findings are pictured above. Which of the following is a key microscopic feature of this entity?

1. Absence of ganglion cells
2. Absence of submucosal adipose tissue
3. Ganglion cells embedded in thick smooth muscle bundles
4. Sessile configuration of the lesion

C. Ganglion cells embedded in thick smooth muscle bundles. The presence of thick smooth muscle bundles of muscularis propria containing ganglion cells and nerve fibers is a key microscopic feature. Answer B is incorrect because the presence, rather than absence, of submucosal adipose tissue is a microscopic feature of inverted appendix. Answer A is incorrect because the presence of ganglion cells is a key to the identification of muscularis propria. Answer D is incorrect because the lesion is typically elongated, polypoid or dome shaped rather than sessile.

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Reference: Inverted appendix

A 56 year old woman with a history of cecal mass on imaging underwent partial cecectomy with appendectomy. The gross findings are pictured above. What is true of this diagnosis?

1. It is associated with endometriosis
2. More common in men than women
3. Resection of the lesion is necessary for the diagnosis
4. Resection was inappropriate management for this patient

A. It is associated with endometriosis. The lesion shown is an inverted appendix, which can occur without any underlying abnormality or may be associated with anatomical variations or pathologic conditions, such as endometriosis or appendiceal neoplasm. Answer B is incorrect because inverted appendix is more common in women than men. Answer C is incorrect because though it may be diagnostically challenging in some cases, it is possible to diagnose on radiographic imaging or colonoscopy. Answer D is incorrect because appendectomy with resection of cecal cuff is generally recommended for inverted appendix to avoid recurrence.

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Reference: Inverted appendix