Introduction: Acute appendicitis has traditionally been treated with appendectomy to avoid complications, such as perforation and peritonitis. Non-operative antibiotic management, on the other hand, is gaining popularity as a treatment option for simple conditions. Although surgical appendectomy remains the gold standard, understanding the histopathological findings in appendectomy specimens is critical for making informed treatment decisions. This study aimed to examine the occurrence of various histological abnormalities in appendectomy specimens from a tertiary care hospital in Pakistan over a two-year period. Methodology: A retrospective analysis was conducted on appendectomy specimens collected from January 2022 to December 2023 at a Tertiary Care Hospital in Pakistan. Clinical records, laboratory findings, and surgical details were reviewed. Trained pathologists examined the specimens and categorized the histopathological findings, including acute appendicitis, chronic appendicitis, perforated appendicitis, neoplastic lesions, and other pathologies. Results: Among 1,568 patients with appendicitis, acute appendicitis was the most common finding, accounting for 48.6% of the cases, with no significant gender-based variation. Chronic appendicitis was identified in 13% of the cases, while perforated appendicitis was observed in 34.7% of the cases, more commonly in males (62%). Neoplastic lesions were found in 2.29% of specimens, including carcinoid tumors and adenocarcinomas. Other pathologies, such as parasitic infections and endometriosis, were identified in 1.4% of cases. Perforated appendicitis was associated with a longer hospital stay (mean LOS of 7.5 days) than non-perforated appendicitis (mean LOS of 4 days). Conclusion: This study highlights the varied histopathological findings in appendectomy specimens, including acute, chronic, and perforated appendicitis; neoplastic lesions; and other pathologies. Understanding these findings can aid treatment decisions and contribute to better patient care. Further research is warranted to explore the clinical implications of these histopathological variations in appendicitis.