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Intestinal metaplasia of appendiceal endometriosis is not uncommon and may mimic appendiceal mucinous neoplasm
Monika Vyas1, Serena Wong1, Xuchen Zhang1
1Department of Pathology, Yale University School of Medicine, New Haven, CT USA.
Abstract:
Endometriosis of the appendix can be an incidental finding or a cause of appendicitis, intussusception, perforation or retention mucocele. Intestinal metaplasia of appendiceal endometriosis may occur, which can lead to a misdiagnosis of low-grade appendiceal mucinous neoplasm. On a retrospective search of the pathology database from 2001 to 2015, we identified 78 appendiceal endometriosis cases and intestinal metaplasia was present in 10/78 (13%) cases. In most of the cases (90%), the foci of intestinal metaplasia were mainly localized close to the mucosa. Intestinal and endometrial hybrid glands were present in 9/10 (90%) cases. These cases were often associated with marked appendiceal distortion, luminal obliteration and mass formation, causing concern for a mucinous neoplasm clinically and pathologically. Our findings indicate that intestinal metaplasia in appendiceal endometriosis is not an uncommon phenomenon, which can be mistaken for a mucinous neoplasm. Endometriosis should be kept in mind when a diagnosis of appendiceal mucinous neoplasm is made, especially in a young woman with a clinical history of endometriosis.
Insights
Appendiceal endometriosis can mimic mucinous neoplasms due to intestinal metaplasia. This finding, present in 13% of cases, highlights the importance of considering endometriosis in differential diagnoses.
Area of Science:
- Gastroenterology
- Pathology
- Gynecology
Background:
- Appendiceal endometriosis is a rare condition that can present as appendicitis or other complications.
- Intestinal metaplasia within appendiceal endometriosis can mimic neoplastic processes.
- Distinguishing between appendiceal endometriosis with metaplasia and mucinous neoplasms is clinically significant.
Purpose of the Study:
- To investigate the occurrence and characteristics of intestinal metaplasia in appendiceal endometriosis.
- To assess the potential for misdiagnosis of appendiceal mucinous neoplasms.
- To emphasize the importance of considering endometriosis in the differential diagnosis.
Main Methods:
- Retrospective search of a pathology database from 2001 to 2015.
- Identification and analysis of appendiceal endometriosis cases.
- Histopathological examination for intestinal metaplasia and hybrid glands.
Main Results:
- 78 cases of appendiceal endometriosis were identified.
- Intestinal metaplasia was present in 10/78 (13%) cases.
- Intestinal and endometrial hybrid glands were found in 90% of metaplasia cases, often near the mucosa.
- These features caused concern for mucinous neoplasms.
Conclusions:
- Intestinal metaplasia in appendiceal endometriosis is not uncommon and can be mistaken for a mucinous neoplasm.
- Appendiceal endometriosis should be considered in the differential diagnosis of mucinous neoplasms, particularly in young women with a history of endometriosis.
- Accurate pathological assessment is crucial to avoid misdiagnosis.
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