Format

Send to

Choose Destination
Mod Pathol. 2019 Feb 14. doi: 10.1038/s41379-019-0216-x. [Epub ahead of print]

Knowledge gaps in the appendix: a multi-institutional study from seven academic centers.

Author information

1
Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Christina.Arnold@OSUMC.edu.
2
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
3
Department of Pathology, Yale School of Medicine, New Haven, CT, USA.
4
Department of Pathology, University of California, San Francisco, San Francisco, CA, USA.
5
Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, USA.
6
Department of Pathology, University of California, Los Angeles, Los Angeles, CA, USA.
7
Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA.

Abstract

Appendix pathology represents uncommonly encountered specimens with unique diagnostic challenges. To delineate common knowledge gaps, extramural consults submitted to seven institutions between 2016-2017 were reviewed. All appendix consults were resections (100%, n = 43), and the majority were directed for consultation by the originating pathologist (95%, n = 41) with no additional studies performed by the consultant (65%, n = 28). This study was dominated by inquiries related to low grade appendiceal mucinous neoplasms (44%, n = 19) and goblet cell carcinoid related neoplasms (19%, n = 8). Of the 43 appendiceal consults, 19 were submitted by the contributing pathologist as low grade appendiceal mucinous neoplasm, but only half of these were diagnosed by the consultant as such (n = 9). Low grade appendiceal mucinous neoplasm-related consultation themes included diverticular disease, criteria for invasion, high grade atypia, extra-appendiceal mucin, and staging. Examples of major disagreements that were downgraded included consults submitted as low grade appendiceal mucinous neoplasm and diagnosed by the consultant as serrated polyp (n = 3), appendicitis (n = 1), and benign appendix (n = 1). Examples of major disagreements-upgraded included cases submitted as low grade appendiceal mucinous neoplasm and diagnosed by the consultant as low grade appendiceal mucinous neoplasm with high-risk features (n = 2) and mucinous adenocarcinoma (n = 2). One case contained both a major disagreement-upgrade (low grade appendiceal mucinous neoplasm changed to high grade appendiceal mucinous neoplasm) and a major disagreement-downgrade (pT3 changed to Tis). Of the 15 cases diagnosed by the consultants as low grade appendiceal mucinous neoplasm, submitted diagnoses included low grade appendiceal mucinous neoplasm (n = 9), adenocarcinoma (n = 5), and one case was submitted without a diagnosis. For goblet cell carcinoid-related consults, the usual inquiry related to distinguishing goblet cell carcinoid from goblet cell carcinoid with adenocarcinoma (adenocarcinoma ex-goblet cell carcinoid). Of the 38 overall consults with a submitted diagnosis, 53% (n = 20) were disagreements, and most of these were major disagreements-downgraded (n = 13).

PMID:
30765881
DOI:
10.1038/s41379-019-0216-x

Supplemental Content

Full text links

Icon for Nature Publishing Group
Loading ...
Support Center