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SESSILE SERRATED ADENOMA OF APPENDIX: IS FECOLITH A CAUSE?

Sessile serrated adenoma (SSA) originally conceptualized in 1990 shared his to pathological features of both hyper plastic polyps and adenoma. Traditionally sessile serrated adenomas were reported in colon, review of other similar lesions found that serrated adenomas may occur in appendix. The importance of recognizing these underreported proliferations is their link to colon carcinogenesis. The importance of extensive sampling and total processing of the appendectomy specimen, especially in patients greater than 30 years is of utmost importance in diagnosing sessile serrated adenomas. The present study was designed to study the association between acute appendicitis due to fecolith and sessile serrated adenomas. We entirely submitted 246 consecutive appendectomy specimens, with clinical diagnoses of acute appendicitis, at two institutions (Varun Arjun Medical College, (VAMC) and Jawahar Lal Nehru Medical College (JNMC), for a period of one year, from 2018-2019. Statistical analysis was done using Fischer 2 tailed exact test. Fecolith was seen in 142 cases of acute appendicitis and was more prevalent in JNMC (47.9%, 46/96) as compared to VAMC (43%, 65/150). The incidence of SSA in absence of fecolith was 5.8% when compared with presence of fecolith (19.7%). This association was statistically significant (P=.002, two-tailed). The study shows that SSA is strongly associated with fecolith related acute appendicitis, which may be a contributing factor in development of these proliferations. The role of meat rich, fiber lacking diet is a known factor for fecolith formation needs further evaluation in pathogenesis of SSA.