The most common lesion is (acute) appendicitis; appendiceal mucocels, mucinous neoplasm, carcinoid tumor are also seen. Appendectomy is also frequently performed during abdominal surgery for other indications.
Key elements to identify: serosal exudate or adhesion, perforation, luminal content (esp., mucoid) and nodules or mass.
Photograph any specimen with: diameter >2.5cm, intraluminal parasites (e.g. pinworm), mucocele or solid tumor.
Measure the appendix (length and greatest diameter) and mesoappendix (three dimensions).
Examine the serosal surface for exudate, perforation, hemorrhage, and other abnormalities.
Ink the proximal resection margin. If the appendix appears abnormal in shape or is obviously involved by tumor, ink the serosal surface as well.
Remove the distal 2 cm and bivalve it longitudinally. Examine for fibrosis and tumor.
Serially section the proximal portion at 5 mm intervals. Examine for fecalith (rock-like fecal material), pus, mucus, and tumor. Measure the wall thickness. If tumor is present, measure its size and distance from the proximal margin, describe it (color, shape/configuration, texture of cut surface, necrosis, ulceration, location in appendix), and examine for invasion into the wall/fat.
If mucinous neoplasm or goblet cell carcinoid is identified microscopically, the entire specimen must be submitted for histological examination.
Distal 2 cm (tip): entirely submit, including attached fat.
If acute appendicitis or incidental appendectomy: two cross sections through abnormal area or representative area. If the specimen is removed for “acute appendicitis” but it appears microscopically normal, submit the entire appendix.
If tumor (including possible mucinous lesion):
Tumor: minimum of five cross sections of tumor, including serosal surface in some sections.
One uninvolved cross section from between the proximal margin and tumor.
Serosal nodules (possible tumor implants in the fat).
Received without fixative/in formalin, labeled _____ and “_____“, is a vermiform appendix (__ cm in length x __ cm in maximum diameter) and attached mesoappendix (__ x __ x __ cm). The serosa is _____ (color, congested, hemorrhagic, covered with fibrinoid exudate) and has no perforation/an area of perforation measuring __ x __ cm located __ cm from the proximal resection margin. The lumen is/is not dilated and filled with pus/serous fluid/mucus/fecalith/soft fecal material. The tip is _____ (fibrotic, patent, involved by tumor). The wall has an average thickness of __ cm. No discrete mass is identified. The peri-appendiceal soft tissue has a yellow fatty cut surface. The specimen is inked _____ (color) at the proximal resection margin. Representative____ (percent) of tissue submitted as follows:
#___ = proximal margin en face (inked) and cross sections
#___ = distal 1/3 and peri-appendiceal soft tissue.