Thermal resection-margin artifact mimicking goblet cell adenocarcinoma in appendectomy specimens: clinicopathologic correlation with appendiceal stump technique.
Publication/Presentation Date
5-20-2026
Abstract
BACKGROUND: Goblet cell adenocarcinoma (GCA) of the appendix is a rare but clinically significant neoplasm characterized by infiltrative nests of mucin-rich goblet-like cells that may exhibit minimal cytologic atypia. During routine sign-out, we observed a reproducible alteration of the resection margin in appendectomy specimens that closely mimicked low-grade GCA. Following institutional review board approval, we retrospectively reviewed 33 appendectomy specimens to characterize this finding and assess associated clinicopathologic factors.
METHODS: A goblet cell-like artifact was identified in 12 of 33 cases (36%). The altered areas consisted of optically clear, vacuolated profiles arranged in linear arrays or small clusters within the appendiceal wall, often associated with thermal-type tissue injury. AE1/AE3 immunohistochemistry was performed in all artifact-positive cases, which were negative, supporting a non-epithelial, non-neoplastic interpretation.
RESULTS: The finding was strongly associated with appendiceal base management using endoloop ligation with energy-assisted transection (12/12 artifact cases, 100%), whereas stapler-only transection was observed exclusively in non-artifact cases (p = 0.001). Thermal injury (p < 0.001), mucin depletion (p = 0.009), marked wall edema (p < 0.001), and receipt of an open proximal margin (p = 0.031) were also significantly associated. Clinical follow-up (median 6.2 months in artifact cases) demonstrated no subsequent neoplasms, additional surgery, or oncologic therapy.
CONCLUSION: These findings support a reproducible, procedure-related artifact that can mimic GCA, particularly in specimens managed with endoloop ligation and energy-assisted transection. Awareness of the associated morphologic constellation and operative context may help prevent overinterpretation of this benign alteration as infiltrative neoplasia.
Volume
175
First Page
106157
Last Page
106157
ISSN
1532-8392
Published In/Presented At
Hamed, A., Hoskuldsson, T., Aldaraiseh, B., Alutaibi, M., Karzoun, M. Z., Jamshed, A., Paz, M., Hamed, N., Cartwright, D., Turner, K. O., Khalifa, M. A., Amin, K., & Park, B. U. (2026). Thermal resection-margin artifact mimicking goblet cell adenocarcinoma in appendectomy specimens: clinicopathologic correlation with appendiceal stump technique. Human pathology, 175, 106157. Advance online publication. https://doi.org/10.1016/j.humpath.2026.106157
Disciplines
Medicine and Health Sciences
PubMedID
42167614
Department(s)
Department of Pathology and Laboratory Medicine
Document Type
Article