Is Submucosal Lipomatosis of the Appendix Vermiformis Really a Rare Entity?

Year 2024, , 42 - 48, 29.04.2024

Gizem Ay Haldız

https://doi.org/10.35440/hutfd.1383433

Abstract

Background: Acute appendicitis (AA) is the most common surgical emergency in patients who visit the emergency department with abdominal pain. In some of the patients who were operated with a prediagnosis of AA, lymphoid hyperplasia, fecalitis, enterobius vermicularis, carcinoid tumor, or adenoma are determined without transmural inflammation in microscopic examination of the appendix. 'Submucosal lipomatosis' is also another entity that has been rarely reported in appendix localization. In this study, we aimed to determine the frequency and severity of submucosal fatty tissue (SFT) in appendectomy specimens and identify risk factors.
Materials and Methods: 293 appendectomy specimens were evaluated retrospectively. The amounts of SFT (A0: None, A1: Isolated adipocytes (Mild), A2: Small adipocyte groups (Moderate), A3: Prominent adipocyte groups (Marked), A4: Severe adipocyte groups that narrow the lumen (Severe)) and the groups that were created according to the amounts of SFT (Group 1: Cases with A1,2,3,4, group 2: Cases with A2,3,4, group 3: Cases with A3,4) were determined in hematoxylin-eosin sections.
Results:
91.47% of the cases had any amount of SFT. Amounts of SFT were mild in 23.89%, moderate in 46.76%, marked in 18.09%, and severe in 2.73%. All of the cases without SFT were in pediatric age. When the amount of SFT increased, the mean age and adult rate increased regularly (p<0.05). As 68% of the cases without SFT were female, male predominance was observed in cases with SFT. When the amount of SFT increased, male rate increased regularly (p<0.05). AA wasn’t determined in 26,28% of the cases. The AA rate in the group without SFT (20%) was marked lower than group 1 (78,73%), group 2 (82,32%), and group 3 (83,87%) (p<0.05). The most prominent increase in AA rate was between the group without SFT and group 1 which was the most sensitive group to the amount of SFT. When group 1,2,3 were compared, no significant increase in the AA ratio was found.
Conclusions: The presence of SFT in the appendix is a common condition. Age increase and male gender are risk factors for the accumulation of SFT. Due to SFT accumulation increases the risk of AA, it would be logical to classify it as mild/moderate/marked/severe, and accept it as 'Submucosal lipomatosis'.

Keywords

Appendicitis, appendix, lipomatosis.

Ethical Statement

Ethics committee approval has been obtained. The document is attached.

Thanks

I would like to thank Gökhan Dağlı for his help only at the statistical analysis stage.

Apendiks Vermiformisin Submukozal Lipomatozisi Gerçekten Nadir Bir Antite Mi?

Abstract

Amaç: Akut apandisit (AA) karın ağrısı ile acil servise başvuran hastalarda en sık saptanan cerrahi acildir. AA ön tanısı ile opere edilen hastaların bir kısmında apendiksin mikroskobik incelemesinde transmural inflamasyon eşlik etmeksizin lenfoid hiperplazi, fekalit, enterobius vermikularis, karsionid tümör veya adenom saptanır. ‘Submukozal lipomatozis’te apendikste nadiren bildirilen bir diğer antitedir. Bu çalışmada apendektomi spesmenlerinde submukozal yağlı doku (SYD) varlığının sıklığını ve şiddetini belirlemeyi, risk faktörlerini tanımlamayı amaçladık.
Materyal ve Metod: 293 apendektomi spesmeni retrospektif olarak incelenmiştir. Hematoksilen-eozin kesitlerde SYD miktarları (M0: Yok, M1: İzole adipositler (Hafif), M2: Küçük adiposit grupları (Orta), M3: Belirgin adiposit grupları (Belirgin), M4: Lümeni daraltan adiposit grupları (Şiddetli)) ve SYD miktarlarına göre oluşturulan gruplar (Grup 1: M1,2,3,4 olan olgular, grup 2: M2,3,4 olan olgular, grup 3: M3,4 olan olgular) belirlenmiştir.
Bulgular: Olguların %91,47’sinde değişik miktarlarda SYD mevcuttur. SYD miktarları olguların %23,89’unda hafif, %46,76’sında orta, %18,09’unda belirgin, %2,73’ünde şiddetlidir. SYD içermeyen olguların tamamı pediatrik yaş grubundadır. SYD miktarı arttıkça yaş ortalamaları ve yetişkin oranları düzenli olarak artmıştır (p<0,05). SYD içermeyen olguların %68’i kadınken, SYD içeren olgularda erkek hakimiyeti görülmüştür. SYD miktarı arttıkça erkek oranları düzenli olarak artmıştır (p<0,05). Olguların %26,28’inde AA saptanmamıştır. AA oranları SYD içermeyen grupta (%20), grup 1 (%78,73), grup 2 (%82,32) ve grup 3‘e (%83,87) göre belirgin düşüktür (p<0.05). AA oranında en belirgin artış SYD içermeyen grup ile SYD miktarına en hassas olan grup 1 arasındadır. Grup 1,2,3 karşılaştırıldığında AA oranlarında anlamlı artış belirlenememiştir.
Sonuç: Apendikste SYD varlığı sık görülen bir durumdur. Yaş artışı ve erkek cinsiyet SYD birikimi için risk faktörüdür. SYD birikiminin AA riskini arttırması sebebiyle hafif/orta/belirgin/şiddetli olarak sınıflandırılarak ‘Submukozal lipomatozis’ kabul edilmesi mantıklı olacaktır.

Keywords

Apandisit, apendiks, lipomatozis.

Ethical Statement

Etik kurul onayı alınmıştır. Belge ektedir.

Thanks

Yalnızca istatistiksel analiz aşamasında destek olan Gökhan Dağlı‘ya yardımlarından dolayı teşekkür ederim.

References

• 1. Adler DG, Farraye FA, Crawford JM. Gastrointestinal Tract Endoscopic and Tissue Processing Techniques and Normal Histology. In: Odze RD, Goldblum JR, eds. Odze and Goldblum Surgical Pathology of the GI Tract, Liver, Biliary Tract, and Pancreas. 3rd ed. Philadelphia, 2015: 4-33.
• 2. Cervellin G, Mora R, Ticinesi A, Meschi T, Comelli I, Cate-na F, et al. Epidemiology and outcomes of acute abdomi-nal pain in a large urban Emergency Department: retros-pective analysis of 5,340 cases. Ann Transl Med. 2016;4(19):362.
• 3. Saverio SD, Podda M, Simone BD, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendici-tis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2020;15(1):27.
• 4. Allaway MGR., Eslick GD, Cox MR. The Unacceptable Morbidity of Negative Laparoscopic Appendectomy. World J Emerg Surg. 2019;43:405-414.
• 5. Bhangu A, Soreide K, Saverio SD, Assarsson JH, DrakeFT. Acute appendicitis: modern understanding pathogenesis, diagnosis, and management. Lancet. 2015;86(10000):1278-1287.
• 6. Sanlı S, Sasani H, Darıcı E, Bakır B. Isolated submucosal lipomatosis of appendix mimicking acute appendicitis: computed tomography findings. Acta Med Anatol. 2015; 3(2):76-77.
• 7. Glick Y. Isolated submucosal lipomatosis of the appendix. Case study, Radiopaedia.org. (Case published 2021) (Ava-ible from: https://radiopaedia.org/cases/89448)
• 8. Sanches LP, Junior AR, Falsarella PM, Carvalho VO, Valle LGM, Neto MJF, et al. Caecal appendix lipomatosis in a pregnant patient mimicking acute appendicitis. Einstein (São Paulo). 2020;18:1-4.
• 9. Shanmugarajah I, Sundrehagen HB, Warberg EA, Kazaryan AM. Lipomatosis of appendix in a teenager. Clin Case Rep. 2021;9:e04595.
• 10. Hornick JL, Odze RD. Polyps of the Large Intestine. In: Odze RD, Goldblum JR, eds. Odze and Goldblum Surgical Pathology of the GI Tract, Liver, Biliary Tract, and Panc-reas. 3rd ed. Philadelphia, 2015: 607-655.
• 11. Dajti G, Vagliasindi A, Bosi S, Guerra E, Zanti F, Raulli GD. An unusual clinical presentation of colonic lipomatosis: A case report. Int J Surg Case Rep. 2020;75:273–275.
• 12. Atsinelos P, Paroutoglou G, Jouvaras G, Beltsis A, Mimidis K, Papaziogas B. Lipohyperplasia of the ileocecal valve as a cause of intussusception. Acta Gastroenterol Belg. 2005;68(2):280-282.
• 13. BorekciI H, Serin HI, Bas H, Borekci E. Relationship between appendicitis and diameter of ileocecal lipomato-sis and also ileocecal angle. Surg Radiol Anat. 2020;42:437-441.