Endometriosis of the appendix Report
JOHN
of twelve
K.
UOHARA,
THOMAS Honolulu,
cases and review
Y.
B.S.,
KOBARA,
of the literature
M.S. M.D.
Hawaii
Twelve cases of endometriosis of the uermiform appendix are described and reviewed. The incidence of 0.80 per cent is higher than has been preuiousiy reported, None of the patients displayed symptoms of acute appendicitis, however, five (42 per cent) patients had symptoms suggestive of chronic or cyclic appendicitis. Laboratory tests were nondiagnostic of this lesion. There did not appear to be a correlation between the histologic location of the endometriosis and the symptoms of chronic or cyclic appendicitis. All cases of endometriosis of the appendix were discovered as a result of incidental appendectomy.
T w E L V E C A S E s of a relatively uncommon form of endometriosis, endometriosis of the vermiform appendix, were reviewed at Kapiolani Hospital. Endometriosis is defined as the presence of ectopic endometrium-like tissue outside of the mucosal lining of the uterus. Classically, endometriosis has been categorized into two forms: internal and external. The internal or intrauterine form of endometriosis is confined to the uterus proper. In the external form, endometrium-like tissue lies outside the uterus and is generally seen in the lower portion of the abdominal cavity, but its location and extent may vary considerably. While the ovaries are involved in 80 per cent of cases, 23 distant endometrial implants have been described in the lungs, bladder, pleura, and subarachnoid space. Rokitansky first described clinical endometriosis and Russell reported ovarian endometriosis. The first reported incidence of small intestinal involvement was by Meyer in 1908. Cullen reported sigmoidal obstruction from endometriosis, and Sampson”’ proposed a theory of transtubal retrograde From the University of Hawaii, Medicine, and the Department Kapiolani Hospital.
School of of Pathology,
Received
for
16, 1974.
Accepted
June
publication
April
endometrial implantation at the time of menstruation. The following year, Sampson described 12 cases of intestinal endometriosis of which four involved the appendix. Cystic lesions of possible endometrial origin in the appendix were described by Outerbridge. I8 Collins’ reviewed the world literature from 1860 to 1951 and summarized the data from 134 cases. By 1955, the total had risen to 170. Presently there is no record of the total number of cases reported since. Collins’ reported that endometriosis of the appendix was present in 0.054 per cent of the 50,000 specimens examined. Other investigators have reported this lesion as we have noted in Table I. Material
and
methods
All cases of pathologically proved endometriosis of the vermiform appendix were reviewed at Kapiolani Hospital in Honolulu from 1968 to 1973, an arbitrary interval when all cases of endometriosis were accurately coded. Kapiolani Hospital is a maternity and gynecologic specialty hospital with 11,000 admissions and 6,600 (1973) surgical procedures. The medical records of the 12 patients were reviewed and retrospective interviews were conducted to elicit additional information. Microscopic sections of all patients were reviewed; then all cases were further subcategorized with respect to the exact location and extent of endometrioSk.
28, 1974.
Reprint requests: Dr. Thomas Y. Kobara, Department of Pathology, Kapiolani Hospital, 1319 Punahou St., Honolulu, Hawaii 96814. 423
424
Uohara
February 1, 1975 Am. J. Obstet. Gynecol.
and Kobara
Inner
half nn,cosa
--;1;-&:“”
9 (0%)
3 (25%)
JOHN
of twelve
K.
UOHARA,
THOMAS Honolulu,
cases and review
Y.
B.S.,
KOBARA,
of the literature
M.S. M.D.
Hawaii
Twelve cases of endometriosis of the uermiform appendix are described and reviewed. The incidence of 0.80 per cent is higher than has been preuiousiy reported, None of the patients displayed symptoms of acute appendicitis, however, five (42 per cent) patients had symptoms suggestive of chronic or cyclic appendicitis. Laboratory tests were nondiagnostic of this lesion. There did not appear to be a correlation between the histologic location of the endometriosis and the symptoms of chronic or cyclic appendicitis. All cases of endometriosis of the appendix were discovered as a result of incidental appendectomy.
T w E L V E C A S E s of a relatively uncommon form of endometriosis, endometriosis of the vermiform appendix, were reviewed at Kapiolani Hospital. Endometriosis is defined as the presence of ectopic endometrium-like tissue outside of the mucosal lining of the uterus. Classically, endometriosis has been categorized into two forms: internal and external. The internal or intrauterine form of endometriosis is confined to the uterus proper. In the external form, endometrium-like tissue lies outside the uterus and is generally seen in the lower portion of the abdominal cavity, but its location and extent may vary considerably. While the ovaries are involved in 80 per cent of cases, 23 distant endometrial implants have been described in the lungs, bladder, pleura, and subarachnoid space. Rokitansky first described clinical endometriosis and Russell reported ovarian endometriosis. The first reported incidence of small intestinal involvement was by Meyer in 1908. Cullen reported sigmoidal obstruction from endometriosis, and Sampson”’ proposed a theory of transtubal retrograde From the University of Hawaii, Medicine, and the Department Kapiolani Hospital.
School of of Pathology,
Received
for
16, 1974.
Accepted
June
publication
April
endometrial implantation at the time of menstruation. The following year, Sampson described 12 cases of intestinal endometriosis of which four involved the appendix. Cystic lesions of possible endometrial origin in the appendix were described by Outerbridge. I8 Collins’ reviewed the world literature from 1860 to 1951 and summarized the data from 134 cases. By 1955, the total had risen to 170. Presently there is no record of the total number of cases reported since. Collins’ reported that endometriosis of the appendix was present in 0.054 per cent of the 50,000 specimens examined. Other investigators have reported this lesion as we have noted in Table I. Material
and
methods
All cases of pathologically proved endometriosis of the vermiform appendix were reviewed at Kapiolani Hospital in Honolulu from 1968 to 1973, an arbitrary interval when all cases of endometriosis were accurately coded. Kapiolani Hospital is a maternity and gynecologic specialty hospital with 11,000 admissions and 6,600 (1973) surgical procedures. The medical records of the 12 patients were reviewed and retrospective interviews were conducted to elicit additional information. Microscopic sections of all patients were reviewed; then all cases were further subcategorized with respect to the exact location and extent of endometrioSk.
28, 1974.
Reprint requests: Dr. Thomas Y. Kobara, Department of Pathology, Kapiolani Hospital, 1319 Punahou St., Honolulu, Hawaii 96814. 423
424
Uohara
February 1, 1975 Am. J. Obstet. Gynecol.
and Kobara
Inner
half nn,cosa
--;1;-&:“”
9 (0%)
3 (25%)
