Abstract
Purpose: Sessile serrated adenoma of the appendix is rarely seen as a cause of acute appendicitis. These premalignant lesions of the appendix, which cannot be detected by preoperative imaging and tests, can be definitively diagnosed by histopathological examination. This study aims to evaluate the diagnosis and management of sessile serrated adenoma.
Methods: The patients underwent surgey due to the diagnosis of acute appendicitis between December 2014 and December 2018 were evaluated retrospectively. Seven patients' postoperative histopathological reports were compatible with sessile serrated adenoma of the appendix. Each patient's presenting symptoms, laboratory tests, imaging methods, type of surgical procedure, length of hospital stay, postoperative mortality and morbidities, postoperative colonoscopy reports were recorded.
Results: The patient's median age was 48 (29-72) years. Three of the patients were male, and four were female. All the patients were diagnosed as acute appendicitis and operated with an open technique under general anesthesia. Postoperative mortality and morbidity weren't seen in patients. All appendectomy specimens which were compatible with sessile serrated adenoma were evaluated carefully for invasion and carcinoma. Two months after the surgery, colonoscopy was performed to all patients. Although four patient's colonoscopies were unremarkable, three of the patient's colonoscopies were reported as tubular adenoma with low-grade dysplasia in descending and sigmoid colon.
Conclusion: The diagnosis, treatment and postoperative follow-up require more careful evaluation for sessile serrated adenoma of the appendix. Postoperative colonoscopy recommended due to the possibility of a high risk of sessile serrated adenoma or carcinoma in the rest of the colon.
Keywords
Thanks
I would like to express my gratitude to Professor Cengiz Aydın and Associate Professor Mustafa Emiroğlu for advices drafting the study and Gülen Gül, MD from University of Health Sciences Tepecik Training and Research Hospital, Department of Pathology who helped for preparation the histopathological images. We thank our colleagues from University of Health Sciences Tepecik Training and Research Hospital, Department of General Surgery who provided insight and expertise that greatly assisted the research. Thanks to all the peer reviewers and editors for their opinions and suggestions.
References
- 1. C A Rubio, Serrated adenomas of the appendix, J Clin Pathol 2004;57:946–949. doi: 10.1136/jcp.2004.018317
- 2. Snover DC, Jass JR., Fenoglio-Preiser C, et al. Serrated polyps of the large intestine: a morphologic and molecular review of an evolving concept. American Journal of Clinical Pathology. 2005;124(3):380–391
- 3. Martinez CA, Cutovoi J, Rossi DH, et al., Intramucosal Carcinoma of the Appendix Arising from Traditional Serrated Adenoma, Case Reports in Surgery Volume 2015, Article ID 297450
- 4.Karabulut YY, Savaş B, Kurşun N, et al. Serrated lesions of the appendix: Do they differ from their colorectal counterparts?,Turk J Gastroenterol 2014; 25: 29-34
- 5. Ma XM, Bourke MJ, Sessile Serrated Adenomas: How to Detect, Characterize and Resect, Gut Liver. 2017 Nov; 11(6): 747–760.
- 6. Renshaw AA, Kish R, Gould EW, Sessile Serrated Adenoma Is Associated With Acute Appendicitis in Patients 30 Years or Older,Am J Clin Pathol 2006;126:875-877
- 7. Hu CC, Chang JJ, Chen TC, et al, Colonoscopic feature of primary adenocarcinoma of the appendix. Internal Medicine. 2008;47(4):255–257
- 8. Bettington M, Brown IS, Rosty C., Serrated lesions of the appendix in serrated polyposis patients. Pathology. 2016 Jan;48(1):30-4.
- 9. Liu C, Walker NI, Leggett BA ,et al., Sessile serrated adenomas with dysplasia: morphological patterns and correlations with MLH1 immunohistochemistry, Mod Pathol. 2017 Dec;30(12):1728-1738.
Abstract
Amaç: Apendiksin sesil serrated adenomu (SSA) nadiren akut apandisit nedeni olarak görülür. Preoperatif görüntüleme ve testlerle tespit edilemeyen apendiksin bu premalign lezyonları histopatolojik inceleme ile kesin olarak teşhis edilebilir. Bu çalışma, apendiksin SSA tanı ve tedavisini değerlendirmeyi amaçlamaktadır.
Yöntem-Gereç: Aralık 2014-2018 arasında akut apandisit tanısı ile opere edilen çalışmalar retrospektif olarak değerlendirildi. 7 hastanın postoperatif histopatolojik incelemesi apendiks SSA ile uyumlu raporlandı. Her hastanın başvuru semptomları, labaratuvar testleri, görüntüleme yöntemleri, cerrahi operasyon süresi, hastanede kalış süresi, postoperatif gelişen mortalite ve morbidite, postoperatif kolonoskopi raporları kaydedildi.
Bulgular: Hastaların ortalama yaşı 48 (29-72) olup, 3ü erkek ve 4ü kadındı. Tüm hastalar akut apandisit tanısı ile genel anestezi altında açık yöntemle opere edildi. Postoperatif mortalite ve morbidite hiçbir hastada gözlenmedi. Apendektomi spesimen incelemesi SSA ile uyumlu olan preparatlar invazyon ve karsinom açısından dikkatlice değerlendirildi. Operasyondan iki ay sonra tüm hastalara kolonoskopi yapıldı. 4 hastanın kolonoskopisinde patolojik bir bulgu saptanmazken, 3 hastanın kolonoskopisinde inen ve sigmoid kolonda düşük dereceli displazi içeren tubuler adenom saptandı.
Tartışma ve Sonuç: Apendiksin sesil serrated adenomu tanı, tedavi ve postoperatif takip açısından dikkatli bir değerlendirmeyi gerektirir. Kolonun geri kalan kısmında yüksek dereceli SSA veya karsinom riski olasılığı nedeniyle postoperatif kolonoskopi yapılması önerilir.
Keywords
References
- 1. C A Rubio, Serrated adenomas of the appendix, J Clin Pathol 2004;57:946–949. doi: 10.1136/jcp.2004.018317
- 2. Snover DC, Jass JR., Fenoglio-Preiser C, et al. Serrated polyps of the large intestine: a morphologic and molecular review of an evolving concept. American Journal of Clinical Pathology. 2005;124(3):380–391
- 3. Martinez CA, Cutovoi J, Rossi DH, et al., Intramucosal Carcinoma of the Appendix Arising from Traditional Serrated Adenoma, Case Reports in Surgery Volume 2015, Article ID 297450
- 4.Karabulut YY, Savaş B, Kurşun N, et al. Serrated lesions of the appendix: Do they differ from their colorectal counterparts?,Turk J Gastroenterol 2014; 25: 29-34
- 5. Ma XM, Bourke MJ, Sessile Serrated Adenomas: How to Detect, Characterize and Resect, Gut Liver. 2017 Nov; 11(6): 747–760.
- 6. Renshaw AA, Kish R, Gould EW, Sessile Serrated Adenoma Is Associated With Acute Appendicitis in Patients 30 Years or Older,Am J Clin Pathol 2006;126:875-877
- 7. Hu CC, Chang JJ, Chen TC, et al, Colonoscopic feature of primary adenocarcinoma of the appendix. Internal Medicine. 2008;47(4):255–257
- 8. Bettington M, Brown IS, Rosty C., Serrated lesions of the appendix in serrated polyposis patients. Pathology. 2016 Jan;48(1):30-4.
- 9. Liu C, Walker NI, Leggett BA ,et al., Sessile serrated adenomas with dysplasia: morphological patterns and correlations with MLH1 immunohistochemistry, Mod Pathol. 2017 Dec;30(12):1728-1738.
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Original Investigation |
| Authors | |
| Publication Date | December 9, 2021 |
| Acceptance Date | April 19, 2021 |
| Published in Issue | Year 2021 Volume: 4 Issue: 3 |
