• 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.

• Proximal resection margin:  en face.
• Distal 2 cm (tip):  entirely submit, including attached fat.
• Proximal portion:
• 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.

__ blocks, __ H&E