Appendiceal Neoplasms Research Articles

Beyond acute appendicitis: a single-institution experience of unexpected pathology findings after 989 consecutive emergency appendectomy.

Appendiceal neoplasms (ANs) are rare, with an estimated incidence of around 1%: neuroendocrine tumours (NETs) and low-grade appendiceal mucinous neoplasms (LAMNs) comprise most cases. Most tumours are cured by appendectomy alone, although some require right hemicolectomy and intra-operative chemotherapy. The aim of the present study is to evaluate our institution's experience in terms of the prevalence of AN, their histological types, treatment and outcomes in adult patients undergoing emergency appendectomy. Single-centre retrospective cohort analysis of patients treated for acute appendicitis at a large academic medical centre. Patients with a diagnosis of acute appendicitis (AA) where further compared with patients with acute appendicitis and a histologically confirmed diagnosis of appendiceal neoplasm (AN). A diagnosis of acute appendicitis was made in 1200 patients. Of these, 989 patients underwent emergency appendectomy. The overall incidence of appendiceal neoplasm was 9.3% (92 patients). AN rate increased with increasing age. Patients under the age of 30 had a 3.8% (14/367 patients) rate of occult neoplasm, whereas patients between 40 and 89years and older had a 13.0% rate of neoplasm. No difference was found in clinical presentations and type of approach while we found a lower complicated appendicitis rate in the AN group. ANs are less rare with respect to the literature; however, clinically, there are no specific signs of suspicious and simple appendicectomy appears to be curative in most cases. However, age plays an important role; older patients are at higher risk for AN. ANs still challenge the non-operative management concept introduced into the surgical literature.

Bilateral Mucinous Cystic Ovarian Tumours: Beware of an Appendiceal Neoplasm Hiding Behind the Veil

Bilateral Mucinous Cystic Ovarian Tumours: Beware of an Appendiceal Neoplasm Hiding Behind the Veil

The role of advanced endoscopy in appendiceal polyp management and outcomes

BackgroundAppendiceal orifice lesions are often managed operatively with limited or oncologic resections. The aim is to report the management of appendiceal orifice mucosal neoplasms using advanced endoscopic interventions.MethodsPatients with appendiceal orifice mucosal neoplasms who underwent advanced endoscopic resections between 2011 and 2021 with either endoscopic mucosal resection (EMR), endoscopic mucosal dissection (ESD), hybrid ESD, or combined endoscopic laparoscopic surgery (CELS) were included from a prospectively collected dataset. Patient and lesion details and procedure outcomes are reported.ResultsOut of 1005 lesions resected with advanced endoscopic techniques, 41 patients (4%) underwent appendiceal orifice mucosal neoplasm resection, including 39% by hybrid ESD, 34% by ESD, 15% by EMR, and 12% by CELS. The median age was 65, and 54% were male. The median lesion size was 20 mm. The dissection was completed piecemeal in 49% of patients. Post-procedure, one patient had a complication within 30 days and was admitted with post-polypectomy abdominal pain treated with observation for 2 days with no intervention. Pathology revealed 49% sessile-serrated lesions, 24% tubular adenomas, and 15% tubulovillous adenomas. Patients were followed up for a median of 8 (0–48) months. One patient with a sessile-serrated lesion experienced a recurrence after EMR which was re-resected with EMR.ConclusionAdvanced endoscopic interventions for appendiceal orifice mucosal neoplasms can be performed with a low rate of complications and early recurrence. While conventionally lesions at the appendiceal orifice are often treated with surgical resection, advanced endoscopic interventions are an alternative approach with promising results which allow for cecal preservation.

Lymph node metastases are more frequent in paediatric appendiceal NET ≥1.5 cm but without impact on outcome – Data from the German MET studies

BackgroundPaediatric appendiceal neuroendocrine tumours (appNET) are very rare tumours, mostly detected incidentally by histopathological evaluation after appendectomy. Treatment recommendations are based on adult data considering high-risk NET as defined by European Neuroendocrine Tumour Society (ENETS) guidelines for completion right-sided hemicolectomy (RHC). Recent data suggest that less aggressive therapy may be justified. ProcedureAnalysis of children and adolescents with appNET prospectively registered with the German Malignant Endocrine Tumour (MET) studies between 1997 and 2022. ResultsBy December 2022, 662 patients (64.7% females, 35.3% male) had been reported. Median age was 13.3 years [4.5–17.9], median duration of follow-up 2.2 years [0–10.9]. No distant metastases were reported. Tumour size was <1 cm in 63.5%, 1–2 cm in 33.2%, and >2 cm in 3.2% of patients. WHO grade 1 and 2 tumours were diagnosed in 76.9% and 23.1% of patients, respectively. Lymphovascular invasion and lymph node metastases were associated with tumour size ≥1.5 cm. 27.0% of patients presented with high-risk NET according to ENETS criteria. Of those, only 55.9% underwent secondary oncological right hemicolectomy. Neither distant metastases, nor recurrences or disease-related deaths occurred in patients with appendectomy only as well as in patients with completion RHC. Overall and event-free survival were both 100%. ConclusionsInternationally harmonized consensus recommendations on treatment of children and adolescents with appendiceal NET are urgently needed to avoid completion RHC in high-risk patients.

Current Status of Treatment among Patients with Appendiceal Tumors-Old Challenges and New Solutions?

The 5th edition of the World Health Organization (WHO) classification of tumors of the digestive system distinguishes four categories of appendiceal tumors (ATs): serrated lesions and polyps, mucinous neoplasms, adenocarcinomas, and neuroendocrine neoplasms (NENs). The differential diagnosis of ATs can be challenging in medical practice, due to their rarity and lack of data from randomized controlled trials on a large, diverse group of patients. ATs are usually noted in specimens obtained during appendectomies due to clinical acute appendicitis. In the European population, most ATs (65%) occur over the age of 50 and among women (56.8%). According to histological type, 54.6% are neuroendocrine tumors (NETs); 26.8% cystic, mucinous, and serous neoplasms; and 18.6% adenocarcinoma not otherwise specified (NOS). On pathologic analysis, most AT findings are benign lesions or small NENs that do not require further therapeutic measures. The presence of appendiceal mucinous neoplasm (AMN) can lead to pseudomyxoma peritonei (PMP). While the multimodal treatment for abdominal malignancies has evolved over the past several decades, the clinical workup and treatment of ATs remain a challenge. Therefore, this review aims to describe the diagnostic possibilities, molecular-based diagnosis, staging, differences in the treatment process, and prognostic factors associated with ATs.

Can Appendiceal Neoplasms Be Predicted in Patients with Presumed Acute Appendicitis?

Objective: The detection of malignancy in the final pathology report of patients undergoing surgery for acute appendicitis is a nasty surprise for both the patient and the clinician. To improve the management of this situation, we analyzed clues for predicting possible neoplasms. Methods: We analyzed in detail the data of patients operated on in our department with a preliminary diagnosis of acute appendicitis over 42 months. The group whose final pathology was reported as primary appendiceal neoplasm was compared with the acute appendicitis group. Results: Appendiceal neoplasm was detected in 16 patients (1%). Half of these were mucinous epithelial neoplasms. Neuroendocrine tumors (18.7%) were the second most common neoplasm. According to the logistic regression model, low hemoglobin level (p&lt;0.01) and low Alvarado score (p:0.02) were the two most valuable factors in the prediction of primary appendiceal neoplasms. Laboratory findings of high neutrophil/lymphocyte ratio (p&lt;0.01) and plastron formation on imaging (p:0.03) were more common in the neoplasm group. Advanced age, comorbidity, immunosuppression and inflammatory bowel diseases (IBD) were other characteristics of the neoplasm group. Conclusions: Appendiceal neoplasms should always be considered in anemic patients with relatively low Alvarado scores.

Appendiceal neoplasms in Saudi Arabia: prevalence and clinicopathological profile.

The appendix is a small organ with no particular known function. Primary appendiceal neoplasms (ANs) are rare. While the prevalence is increasing worldwide over the past two decades, no apparent increase in the prevalence of ANs has been reported in the Arabian Gulf States. Recently, a significant decline in the age at diagnosis of some types of ANs has been reported worldwide, with a female predominance. Evaluate the prevalence and clinicopathological characteristics of ANs within our institution in Saudi Arabia and compare them to limited existing studies from different regions as well as the Arabian Gulf States. Retrospective cohort. Tertiary care center in Riyadh. All patients who underwent appendectomy and had the appendix submitted for histopathological evaluation between May 2015 and June 2020 were included to allow for a follow-up of 5 years or more at the time of data collection. Demographics, clinical presentations, surgical interventions, histopathological findings, complications, and recurrence rates. 25 AN patients. Of 1110 patients, 25 had ANs (13 female and 12 male participants) with a mean (standard deviation) age of 54.6 (14.1) years. Only 40% presented with acute appendicitis, 64% had comorbidities, and less than 50% underwent laparoscopic appendectomy. Histopathologically, 72% were low-grade appendiceal mucinous neoplasms (LAMNs). Complications were minimal grades (Clavien-Dindo classification), with 80% experiencing none. The mean hospital stay was 9.96 days. Local recurrence occurred in 8% of cases, and distant metastasis was documented in one adenocarcinoma case. However, the 5-year overall and disease-free survival rates were 88% and 80%, respectively. The incidence of ANs is increasing in Saudi Arabia with the higher prevalence of LAMNs. The pathological examination of the resected appendix played a pivotal role in the diagnosis of ANs. Data collected retrospectively, a single institution, and a small population.

PSEUDOMYXOMA PERITONEI SECONDARY TO A VERY RARE OVARIAN CANCER: PRIMARY INFILTRATIVE INTESTINAL TYPE MUCINOUS ADENOCARCINOMA OF THE OVARY WITH INTESTINAL METASTASIS (A CASE REPORT)

Pseudomyxoma peritonei (PMP) syndrome is a disease that typically occurs from ruptured appendiceal mucocele neoplasms. PMP syndrome may arise from malignant transformation of a primary ovarian cancer. In this case study, we present the evaluation and treatment of a 48-year-old patient diagnosed with a left ovarian mass and significant symptomatic abdominopelvic mucinous ascites. Peritoneal cytology indicated paucicellularmucin. The final diagnosis confirmed the presence of diffuse peritoneal adenomucinosis. The treatment approach involved a cytoreductive surgery and chemotherapy. Our findings contribute to the existing body of literature endorsing the use of this intensive treatment approach, typically reserved for advanced abdominal malignancies. We applied this strategy to a patient presenting with a rare clinical entity, further supporting its efficacy in such cases.

Genome-Wide Analysis of DNA Methylation in Pseudomyxoma Peritonei Originated from Appendiceal Neoplasms

Introduction: Pseudomyxoma peritonei (PMP) is a disease characterized by progressive accumulation of intraperitoneal mucinous ascites produced by neoplasms in the abdominal cavity. Since the prognosis of patients with PMP remains unsatisfactory, the development of effective therapeutic drug(s) is a matter of pressing concern. Genetic analyses of PMP have clarified the frequent activation of GNAS and/or KRAS. However, the involvement of global epigenetic alterations in PMPs has not been reported. Methods: To clarify the genetic background of the 15 PMP tumors, we performed genetic analysis using AmpliSeq Cancer HotSpot Panel v2. We further investigated global DNA methylation in the 15 tumors and eight noncancerous colonic epithelial tissues using MethylationEPIC array BeadChip (Infinium 850k) containing a total of 865,918 probes. Results: This is the first report of comprehensive DNA methylation profiles of PMPs in the world. We clarified that the 15 PMPs could be classified into at least two epigenotypes, unique methylation epigenotype (UME) and normal-like methylation epigenotype (NLME), and that genes associated with neuronal development and synaptic signaling may be involved in the development of PMPs. In addition, we identified a set of hypermethylation marker genes such as HOXD1 and TSPYL5 in the 15 PMPs. Conclusions: These findings may help the understanding of the molecular mechanism(s) of PMP and contribute to the development of therapeutic strategies for this life-threatening disease.

Patterns of presentation and delivery of care of appendiceal neoplasms in the largest municipal health care delivery system in the United States.

14 Background: Appendiceal neoplasms (AN) are rare tumors with a broad spectrum of referral and treatment patterns. NYC Health+Hospital (HHC) is the largest municipal health care system in the United States. Here, we study patterns of presentation and management of AN in this safety-net setting. Methods: We identified 92 patients in HHC with AN between 01/01/2017 to 07/01/2023. Statistical analyses were performed in Python. Results: There were 38 (41.3%) mucinous neoplasms, 24 (26.1%) adenocarcinomas, 23 (25.0%) neuroendocrine, and 7 (7.6%) ex-goblet cell adenocarcinomas. 16 cases of pseudomyxoma peritonei were identified. The median age at diagnosis was 55 (IQR: 45-65). 49% were Hispanic, and African Americans were the largest racial block (28%). 50% of cases presented as appendicitis. Appendectomy and a second surgical intervention were more common in this group (p&lt;0.001 and p=0.044, respectively). Other surgical interventions included colon resections and cytoreduction ± Hyperthermic intraperitoneal chemotherapy. Among the patients with mucinous neoplasm or adenocarcinoma, 35 had multidisciplinary tumor board discussion (15 mucinous neoplasm and 20 adenocarcinomas). The median follow-up period was 22.0 months (95% CI: 11.5-30.7 months). Surveillance modalities included CT (75%), CEA (74%), and colonoscopy (35%). 85% remained within HHC during treatment. 16 patients were planned to have chemotherapy, including 9 pseudomyxoma peritonei cases. 5 patients did not follow through, and the other cases had a median of 10 cycles. The following adjuvant chemotherapy regimens were employed: 50% FOLFOX, 20% FOLFIRI, 20% XELODA, and 10% CapeOX and FOLFIRI. There were 2 cancer-related deaths (pseudomyxomas). Excluding pseudomyxomas, none had evidence of disease at the last follow-up. Conclusions: Minorities and immigrants constitute the majority of the population of HHC. 50% of AN presented as appendicitis emphasizing the need for a robust system to identify these cases. Despite challenges encountered in providing long-term oncological care, HHC has treated and provided vigorous follow-up for this underserved population. [Table: see text]

Role of circulating tumor DNA in metastatic appendiceal neoplasms: A systematic review.

757 Background: Circulating tumor DNA (ctDNA), tumor DNA fragments detected in blood sourced from primary malignancy, is an emerging non-invasive tool in oncology for screening, diagnosis, and surveillance. Here, we analyze its utility in patients with metastatic appendiceal neoplasms. Methods: Following PRISMA guidelines, PubMed, Cochrane, and Clinicaltrials.gov were searched for ‘Appendiceal Neoplasms’ AND ‘Circulating Tumor DNA’. Four original studies reporting the role of ctDNA in appendiceal cancer were included after screening 195 articles. Results: A total of 196 patients were included in the review. (Table) The total number of collected samples was 209 and 41% were tested positive for ctDNA. Singh et al. 2023 reported eight stage IV appendiceal cancer patients with the median age of 64.5 (45-75) years. 37.5% were tested positive for ctDNA while 37.5% had undetectable ctDNA despite having residual peritoneal disease and 25% had insufficient DNA from tumor specimen. López-Rojo et al. 2020 reported 50% ctDNA positive rate. All included patients had KRAS mutation and received hyperthermic intraperitoneal chemotherapy (HIPEC). On 36.5 months follow-up all the patients were alive but one out of two ctDNA positive patients had a relapse at 39 months follow-up. Kothary et al. 2022 reported 51% ctDNA positivity and 11% had longitudinal ctDNA measurements available which correlated well with their disease course. Zeineddine et al. 2023 collected 160 blood samples from 147 patients. Of 75% with radiographically metastatic disease, 38% had positive ctDNA while out of 25% with no radiographically metastatic disease, 38% had positive ctDNA. The overall survival and progression free survival for ctDNA positive patients was 46.2 months and 60 months, respectively, versus not reached for ctDNA negative patients. When stratified according to tumor grade, the ctDNA detection rate was 22% for well-differentiated, 39% for moderately differentiated, and 49% for poorly differentiated tumors. Conclusions: The use of ctDNA in metastatic appendiceal tumor is not widespread and detection rates are heterogenous. It was observed more in poorly differentiated appendiceal cancers but further studies are needed to evaluate its utility in clinical practice. [Table: see text]

A case report of appendiceal adenoma - a rare entity

Appendiceal neoplasms are quite uncommon. They are detected in fewer than 0.5 percent of appendectomies and less than 0.5 percent of all gastrointestinal neoplasms. Similar to a colonic adenoma, an appendiceal adenoma is neoplasm with precancerous nature. A rare case of appendiceal adenoma is presented here in a 65-year-old female patient, incidentally discovered at the orifice of the appendix, during the screening analysis. The patient felt well. Abdominal examination and laboratory analysis were regular. Due to the inaccessibility of the lesion by colonoscopy, surgical treatment was recommended. A laparoscopic appendectomy was performed. On pathological examination, diagnosis of tubulovillous adenoma was performed. Endoscopic screening analysis of precancerous appendiceal neoplasm is very important. The method of choice for any appendiceal neoplasm is surgical removal i.e. appendectomy, preferably with a clean caecal margin, which requires stapling of the cecum. Early detection can prevent complications and decrease the risk of consequential appendiceal or colorectal carcinoma.

Peritoneal Microenvironment Promotes Appendiceal Adenocarcinoma Growth: A Multi-omics Approach Using Patient-Derived Xenografts.

The peritoneal microenvironment promotes growth of appendiceal tumors and expression of proliferative pathways in PDXs.

Usefulness of an intraoperative flipped monitor in laparoscopic surgery with situs inversus totalis: a case report of laparoscopic-assisted ileocecal resection

BackgroundSitus inversus totalis (SIT) is a rare congenital condition that involves complete transposition (right to left reversal) of the visceral organs. Laparoscopic surgery can be challenging because of the mirror-image anatomy. We describe a surgical innovation in laparoscopic surgery for SIT.Case presentationA 41-year-old man with SIT was diagnosed with an appendiceal tumor and underwent laparoscopic-assisted ileocecal resection. Preoperatively, we evaluated anatomical variations using 3D-computed tomography and simulated mirror images by watching flipped videos of patients with normal anatomy undergoing similar operations. During the operation, port placement and the surgeons’ standing positions were reversed. Additionally, two monitors were placed at the patient’s head, with one monitor showing original images, and the other showing flipped images that looked the same as the normal anatomy. We checked the range of the mobilized region and important anatomical structures by watching the flipped monitor as needed. The patient’s postoperative course was uneventful.ConclusionsDue to the complexities of laparoscopic surgery for SIT, preoperative preparation and surgical innovation are necessary for safe surgery. Several suggestions have been made to understand anatomical anomalies and improve operability; however, surgeons must focus on the mirror-image anatomy throughout the operation. Therefore, the use of intraoperative flipped monitor will be helpful for surgeons in reducing the risk of anatomical misidentification.

The Quality of Life of Pseudomyxoma Peritonei Patients: A Scoping Review

Background. Pseudomyxoma peritonei (PMP) is a form of peritoneal malignancy. It originates from a perforated appendiceal epithelial tumour. Patients with PMP experience various stressful and traumatic events including diagnosis with a rare disease, treatment with extensive and complex surgery, and long hospital stays. Currently, there is a scarcity of studies that primarily aim to assess the quality of life of patients with PMP, and there is no reviews or comprehensive understanding of the quality of life (QoL) issues faced by these patients. Even fewer studies have consulted with patients themselves. Objective. To review the current literature on the QoL of patients with PMP and answer two main questions: What methods are being used to assess the QoL patients with PMP and what are the main findings?. Methods. For the scoping review, five scientific databases were searched (CINAHL, EMBASE, Pubmed, PsycInfo, and Medline). Publications that were published between 2002 and 2022 and in English were included in this review. Studies were screened by two independent reviewers against the review’s eligibility criteria. Data related to the QoL of patients with PMP in the included studies were extracted to answer two main questions (what were the methods used to assess QoL in this population, and what were the findings?). The extracted data was presented in table form and qualitatively analyzed using content analysis. Findings. Fourteen studies were included in this review. Only five studies out of fourteen assessed the QoL of patients with PMP as a main outcome, and all these studies assessed QoL in relation to surgery. Studies that assessed QoL used different validated measures. There was a consensus among studies that patients’ QoL improved by 12 months posttreatment. The most commonly cited symptom of PMP in this review is abdominal pain. Conclusion. The evidence on the QoL of patients with PMP is limited. Studies that assess the quality of life of these patients independent of surgery are needed. There is no consensus on the measure used to assess QoL in this population.

Appendiceal Neuroendocrine Neoplasms: an Update for 2023.

To summarize the literature from the last 5years on treatment of appendiceal neuroendocrine neoplasms (aNEN). Furthermore, to evaluate the prognostic significance of lymph node metastases, indications for adjuvant treatment, and challenges of the current follow-up regimen. Simple appendectomy is sufficient in tumors < 1cm while extended surgery is indicated in tumors > 2cm. In a multicenter study of aNENs measuring 1-2cm, extended surgery offered no significant prognostic advantage and is now limited to incomplete tumor resection or high-grade G2 or G3 aNEN. Follow-up remains debatable, as the use of imaging and biomarkers lacks validation. While surgical procedure is well established in aNEN tumors < 1cm and > 2cm, the need for extended surgery in aNEN tumors 1-2cm is questionable. Future studies should address the prognostic impact of lymph node metastases and the optimal design and duration of follow-up.

Low-grade Appendiceal Mucinous Neoplasm in a Middle-aged Female: A Case Report

Mucinous Appendiceal Neoplasms (MANs) are rare tumours where more than 50% of the tumour volume is composed of extracellular mucin. Low-grade Appendiceal Mucinous Neoplasm (LAMN) is a rare condition with symptoms that vary depending on clinical manifestations. It can manifest as an unruptured mucin-filled appendix, transmural invasion of the primary tumour, or present with peritoneal metastases post-rupture. The prognosis of LAMN depends on the presence or absence of neoplastic epithelium outside the appendix. Here, the authors describe a case of 35-year-old female who visited the OPD of Emergency Medicine with only complain of pain in abdomen for three days. She exhibited right iliac fossa tenderness with no guarding during the abdominal examination. She underwent an open appendectomy and was diagnosed with LAMN upon histopathological examination. She was advised to follow up after six months post-discharge to monitor for any metastatic spread. Due to its malignant potential, mucinous lesions of the appendix are uncommon yet significant entities. They are more prevalent in women and can range from mucinous adenocarcinomas to straightforward retention cysts. This case illustrates the need for extreme caution when dealing with appendiceal tumours and the importance of selecting the appropriate course of action, be it surgical or medical.

Well Differentiated Appendiceal Neuroendocrine Neoplasm an Incidental Finding Post Subhepatic Appendectomy: A Case Report and Review of the Literature.

Background: Appendiceal neuroendocrine neoplasms (ANENs) are rare tumors often discovered incidentally during procedures like appendectomies. Routine histological evaluation of appendectomy specimens is crucial, as it may reveal unexpected findings such as ANENs. Objective: To present a case of a well-differentiated appendiceal neuroendocrine neoplasm identified incidentally following a subhepatic appendectomy. Case Presentation: A 38-year-old female presented with acute right upper quadrant abdominal pain. A contrast-enhanced computed tomography (CECT) scan of the abdomen and pelvis revealed a slightly dilated appendix (7 mm in diameter) located in the subhepatic area. The scan showed minimal fluid collection around the appendix tip, mild fat stranding, and partial aeration, indicating catarrhal appendicitis. The atypical subhepatic location of the appendix with a partially aerated tip posed a diagnostic challenge. Two weeks after the appendectomy, histopathological analysis of the excised specimen revealed a well-differentiated appendiceal neuroendocrine neoplasm. Conclusion: This case of an appendiceal neuroendocrine neoplasm discovered after a subhepatic appendectomy underscores the importance of routine histopathological examination of the excised appendix to identify unexpected findings.

A Case of Idiopathic Appendiceal Intussusception Difficult to Distinguish from an Appendiceal Tumor

A Case of Idiopathic Appendiceal Intussusception Difficult to Distinguish from an Appendiceal Tumor

Unraveling the Unusual Pathological Findings of Appendiceal Lesions: A Cross-sectional Study from Tertiary Care Centre in Chengalpattu, Tamil Nadu, India

Introduction: The appendix, once considered a vestigial structure, is now recognised as a site of diverse pathologies beyond simple appendicitis through a systematic analysis of published literature and case studies. The diagnosis of appendiceal lesions is still a clinical phenomenon and a constant struggle. The gold standard for diagnosing appendiceal lesions, however, is meticulous histopathological examination. Aim: To determine the histopathological distribution of all the appendiceal lesions and to identify the rare and unusual histopathological findings in appendectomy specimens received at a tertiary care Centre. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at Karpaga Vinayaga Institute of Medical Sciences and Research Centre, Chengalpattu, Tamil Nadu, India for a duration of 10 years, from August 2013 to August 2023. From the histopathological records of 832 appendectomies, 40 specimens with unusual histopathological findings were identified and analysed in this study. Relevant recorded data from all the appendiceal specimens reported during the study period, with special reference to age, sex, and histopathological findings, were retrieved and evaluated retrospectively. Corresponding slides and specimens were reviewed. The data were presented in the form of frequency tables and percentages. The analysis was done using Statistical Package for Social Sciences (SPSS) software version 20.0. Results: Out of 832 appendectomy specimens, there were 485 (58.29%) cases of acute appendicitis, 244 (29.33%) cases of chronic appendicitis, 59 (7.09%) cases of subacute appendicitis, and 4 (0.48%) cases of gangrenous appendicitis. Unusual histopathology findings were noted in 40 cases (4.81%). These include 17 cases of appendiceal neuroma, eight cases of Xanthogranulomatous appendicitis, seven cases of Enterobius vermicularis, three cases of Low-grade Appendiceal Mucinous Neoplasm (LAMN), one case of appendiceal Neuroendocrine Tumour (NET), one case of Goblet Cell Adenocarcinoma (GCA), one case of metastatic squamous cell carcinomatous deposit in the appendix, one case of urothelial rests in the appendix, and one case of appendiceal lipoma. Conclusion: In this study, 4.81% of patients had atypical appendiceal lesions. A complete histopathological examination of appendectomy specimens increases the chances of discovering unusual lesions of the appendix. Ultimately, this comprehensive analysis will contribute to future improvements in clinical management and prognostication, fostering better patient outcomes.