Auto Text: “Insert Appendix”
Triage
The appropriate sections to take depend on the indication for appendectomy (see below). Standard sections include the base (which is a common site for adenocarcinoma), the tip (which is a common site for carcinoids), and the middle (to document appendicitis).
The specimen should be examined carefully for an occult carcinoid tumor, which grossly appears as a firm tan-yellow mass. If such a lesion is identified, it is critical that a cross section of the proximal resection margin is placed in a separate cassette.
If it is an appendectomy for a mass lesion, allow the appendix to fix well before sectioning.
Gross
- Incidental: Submit standard sections: an inked cross section from the base (proximal margin, en face), a cross section from the middle, and the tip, bisected longitudinally.
- Appendicitis: If appendicitis is grossly apparent, submit an inked cross section from the base (proximal margin, en face), a cross section from the middle, and the tip, bisected longitudinally. If grossly normal, submit the entire appendix.
- Appendicitis over the age of 50 years: There is a significant chance that an occult malignancy is also present, so careful inspection is critical. A cross section of the proximal margin (en face) should be submitted in a separate cassette. Several sections should be submitted.
- Mass lesion: Ink the serosal surface. Submit a cross section of the proximal margin (en face) in a separate cassette. Submit representative cross sections of the mass lesion. Submit any lymph nodes.
- Mucinous neoplasm: The appendix may grossly appear dilated. The specimen should be fixed overnight, without sectioning, in 37% formaldehyde. 37% formaldehyde is stored in the yellow fire cabinet in the gross room. After fixing overnight, the appendix should be entirely submitted to document the presence or absence of mucin and neoplastic epithelium on the outer / serosal surface of the appendix.
- Ovarian tumor:https://voices.uchicago.edu/grosspathology/gyne/ovary-borderline-malignant/
