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Nagra R, Zaman S, Mohamedahmed A, Torrance A. Nasopharyngeal malignant melanoma masquerading in the gallbladder: the importance of histological assessment. Ann R Coll Surg Engl 2023. [PMID: 37983006 DOI: 10.1308/rcsann.2023.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
Metastatic melanoma of the gallbladder is a rare entity that is often diagnosed late, leading to a poor prognosis. The disease may present insidiously as acute cholecystitis or remain asymptomatic. Optimal management remains unclear but surgical resection is considered the mainstay of treatment for this condition. We report the case of a 47-year-old man who suffered a protracted course of generalised abdominal symptoms eventually culminating in a diagnosis of acute cholecystitis. Following an emergency laparoscopic cholecystectomy, the histology revealed a melanoma with an unknown primary. Subsequently this was traced to the nasopharynx. Because of the presence of concurrent liver metastasis, systemic immunotherapy with palliative intent was commenced following a multidisciplinary team discussion. This case highlights the importance of sending clinical specimens for histological analysis. We argue against selectively choosing which specimens to send for histology because radiological and/or intraoperative macroscopic inspection of resected tissue alone can result in a missed diagnosis.
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Affiliation(s)
- R Nagra
- Sandwell and West Birmingham Hospitals NHS Trust, UK
| | - S Zaman
- Sandwell and West Birmingham Hospitals NHS Trust, UK
| | | | - A Torrance
- Sandwell and West Birmingham Hospitals NHS Trust, UK
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2
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Nakai O, Kono F, Miyoshi T, Imashuku S. In situ diffuse large B-cell lymphoma in haemorrhoidectomy tissue. EJHAEM 2022; 3:1050-1051. [PMID: 36051050 PMCID: PMC9421955 DOI: 10.1002/jha2.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Osamu Nakai
- Department of SurgeryUji‐Tokushukai Medical CenterUjiKyotoJapan
| | - Fumihiko Kono
- Division of PathologyUji‐Tokushukai Medical CenterUjiKyotoJapan
| | - Takashi Miyoshi
- Division of HematologyUji‐Tokushukai Medical CenterUjiKyotoJapan
| | - Shinsaku Imashuku
- Division of HematologyUji‐Tokushukai Medical CenterUjiKyotoJapan
- Department of Laboratory MedicineUji‐Tokushukai Medical CenterUjiKyotoJapan
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3
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Routine Histopathology Examination of the Excised Stomach After Sleeve Gastrectomy — Significance and Comparison with Preoperative Endoscopy. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03251-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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4
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Taha-Mehlitz S, Mongelli F, Sykora M, Scheiwiller A, Diebold J, Metzger J, Gass JM. Routine histopathologic examination of the resected specimen after laparoscopic sleeve gastrectomy - what can be expected? Acta Chir Belg 2021; 121:380-385. [PMID: 32644013 DOI: 10.1080/00015458.2020.1794335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Laparoscopic Sleeve Gastrectomy (LSG) is nowadays an established bariatric procedure. Although preoperative gastroscopy is recommended to rule out severe pathologies, there is little evidence about the role of routine histopathologic examination of resected specimens. We sought to identify the prevalence of histopathological relevant findings in patients undergoing LSG and to evaluate their impact in clinical practice. METHODS A retrospective analysis on a prospectively collected dataset on patients undergoing LSG between August 2009 and May 2018 in two bariatric centers was performed. Demographic and clinical data and histopathological results were analyzed. RESULTS Sixhundred-thrirteen patients were identified, mean age was 43.1 years (14-75), average body mass index was 44.8 kg/m2 (34.4-73.9). Histopathology revealed abnormal findings in 47.97% of the patients, most common pathology was chronic non-active or minimally to moderate active gastritis (n = 202;32.95%). Among others, Helicobacter-associated gastritis (n = 33;5.38%), intestinal metaplasia (n = 13;2.12%), micronodular enterochromaffine-like cell hyperplasia (n = 2; 0.33%) and gastrointestinal stromal tumors (n = 6; 0.98%) were present. No malignancies were found. Histopathological results required a change in the postoperative management in 48 patients (7.83%). The costs of histopathological assessment ranged between 0.77% and 2.55% of per-case payment. CONCLUSION A wide range of histopathological findings occur in specimens after LSG, requiring a relevant number of patients additional therapies or surveillance. Therefore, routine histopathological examination after LSG is recommendable.
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Affiliation(s)
| | - Francesco Mongelli
- Department of General Surgery, Cantonal Hospital Lucerne, Spitalstrasse, Switzerland
| | - Martin Sykora
- Department of General Surgery, Cantonal Hospital of Nidwalden, Postfach, Switzerland
| | - Andreas Scheiwiller
- Department of General Surgery, Cantonal Hospital Lucerne, Spitalstrasse, Switzerland
| | - Joachim Diebold
- Department of Pathology, Cantonal Hospital Lucerne, Spitalstrasse, Switzerland
| | - Jürg Metzger
- Department of General Surgery, Cantonal Hospital Lucerne, Spitalstrasse, Switzerland
| | - Jörn-Markus Gass
- Department of General Surgery, Cantonal Hospital Lucerne, Spitalstrasse, Switzerland
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5
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Alabi A, Arvind AD, Pawa N, Karim S, Smith J. Incidental Gallbladder Cancer: Routine versus Selective Histological Examination After Cholecystectomy. Surg J (N Y) 2021; 7:e22-e25. [PMID: 33542953 PMCID: PMC7850885 DOI: 10.1055/s-0040-1722175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 09/16/2020] [Indexed: 01/05/2023] Open
Abstract
Background
Incidental gallbladder cancer is relatively rare, with an incidence ranging between 0.19 and 5.5% of all the cholecystectomies for benign disease, and carries a poor prognosis. Currently, in the literature, there appears to be some controversy about whether all gallbladder specimens should be sent for routine histopathology. The aim of this study was to investigate the need for either routine or selective histopathological evaluation of all gallbladder specimens following cholecystectomy in our institution.
Methods
The records of all patients who underwent a cholecystectomy (laparoscopic and open) for gallstone disease over a 5-year period (between January 2011 and January 2016) were reviewed retrospectively in a single university teaching hospital. Patients with radiological evidence of gallbladder cancer preoperatively were excluded. The notes of patients with incidental gallbladder cancer were reviewed and data were collected for clinical presentation and preoperative investigations including blood tests and radiological imaging.
Results
A total of 1,473 specimens were sent for histopathological evaluation, with two patients being diagnosed with an incidental gallbladder cancer (papillary adenocarcinoma in situ and moderately differentiated invasive adenocarcinoma [stage IIIa]). The incidence rate was 0.14%. All patients with incidental gallbladder cancer had macroscopically abnormal specimens.
Conclusion
Both patients in our study who were diagnosed with incidental gallbladder cancer had macroscopic abnormalities. A selective rather than routine approach to histological evaluation of gallbladder specimens especially in those with macroscopic abnormalities should be employed. This will reduce the burden on the pathology department with potential cost savings.
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Affiliation(s)
- Andrew Alabi
- Department of Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Trust, London, United Kingdom
| | - A D Arvind
- School of Medicine, Imperial College London, United Kingdom
| | - Nikhil Pawa
- Department of Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Trust, London, United Kingdom
| | - Shakir Karim
- Department of Histopathology, West Middlesex University Hospital, Chelsea and Westminster NHS Trust, London, United Kingdom
| | - Jason Smith
- Department of Surgery, West Middlesex University Hospital, Chelsea and Westminster NHS Trust, London, United Kingdom
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6
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Caparelli ML, Batey JC, Tailor A, Braverman T, Barrat C. Internal hemorrhoid harboring adenocarcinoma: A case report. World J Gastrointest Oncol 2021; 13:87-91. [PMID: 33510851 PMCID: PMC7805272 DOI: 10.4251/wjgo.v13.i1.87] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/01/2020] [Accepted: 10/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of carcinoma found within an internal hemorrhoid specimen is exceptionally rare. Further, the presence of primary anal canal adenocarcinoma within internal hemorrhoids is even more infrequent. We describe a case in which anal canal adenocarcinoma was found within an internal hemorrhoidectomy specimen and perform a review of the current literature.
CASE SUMMARY The patient was a 79-year-old male who presented with rectal bleeding and was found to have large thrombosed internal hemorrhoids during screening colonoscopy. The patient subsequently underwent a three-column hemorrhoi-dectomy. Pathologic analysis revealed one of three specimens containing a 1.5 cm moderate-to-poorly differentiated adenocarcinoma of anal origin with superficial submucosal invasion. At three-month follow up, he was taken to the operating theatre for biopsy and re-excision of his non-healing wound, which showed no recurrence. His wound has since healed and he was cancer free at ten-month follow up.
CONCLUSION When faced with primary anal canal adenocarcinoma an interdisciplinary approach to treatment should be considered. Routine pathological analysis of hemorrhoidectomy specimens may be beneficial due to the severity of anal canal carcinomas if left undiagnosed and untreated in a timely manner.
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Affiliation(s)
- Michael L Caparelli
- Department of Surgery, The Jewish Hospital, Cincinnati, OH 45236, United States
| | - Jason C Batey
- Department of Surgery, The Jewish Hospital, Cincinnati, OH 45236, United States
| | - Anisha Tailor
- Department of Surgery, The Jewish Hospital, Cincinnati, OH 45236, United States
| | - Timothy Braverman
- Department of Pathology, The Jewish Hospital, Cincinnati, OH 45236, United States
| | - Cory Barrat
- Department of Surgery, The Jewish Hospital, Cincinnati, OH 45236, United States
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Mishra D, Jain A. A minimalistic approach to benign anorectal pathologies: Retrospective analysis of 100 patients in armed forces. JOURNAL OF MARINE MEDICAL SOCIETY 2021. [DOI: 10.4103/jmms.jmms_9_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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8
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Reply to "Comment on the Correlation between Complete Blood Count Parameters and Appendix Diameter for the Diagnosis of Acute Appendicitis". Healthcare (Basel) 2020; 8:healthcare8040462. [PMID: 33167461 PMCID: PMC7711664 DOI: 10.3390/healthcare8040462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/08/2020] [Accepted: 10/22/2020] [Indexed: 11/21/2022] Open
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9
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Lundgren L, Henriksson M, Andersson B, Sandström P. Cost-effectiveness of gallbladder histopathology after cholecystectomy for benign disease. BJS Open 2020; 4:1125-1136. [PMID: 33136336 PMCID: PMC7709377 DOI: 10.1002/bjs5.50325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background The prevalence of incidental gallbladder cancer is low when performing cholecystectomy for benign disease. The performance of routine or selective histological examination of the gallbladder is still a subject for discussion. The aim of this study was to assess the cost‐effectiveness of these different approaches. Methods Four management strategies were evaluated using decision‐analytical modelling: no histology, current selective histology as practised in Sweden, macroscopic selective histology, and routine histology. Healthcare costs and life‐years were estimated for a lifetime perspective and combined into incremental cost‐effectiveness ratios (ICERs) to assess the additional cost of achieving an additional life‐year for each management strategy. Results In the analysis of the four strategies, current selective histology was ruled out due to a higher ICER compared with macroscopic selective histology, which showed better health outcomes (extended dominance). Comparison of routine histology with macroscopic selective histology resulted in a gain of 12 life‐years and an incremental healthcare cost of approximately €1 000 000 in a cohort of 10 000 patients, yielding an estimated ICER of €76 508. When comparing a macroscopic selective strategy with no
histological assessment, 50 life‐years would be saved and
the ICER was estimated to be €20 708 in a cohort of 10 000
patients undergoing cholecystectomy. Conclusion A macroscopic selective strategy appears to be the most cost‐effective approach.
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Affiliation(s)
- L Lundgren
- Department of Surgery, County Council of Östergötland, Linköping, Sweden.,Department of Biomedicine and Clinical Sciences, Faculty of Health Sciences, Linköping, Sweden
| | - M Henriksson
- Centre for Medical Technology Assessment, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - B Andersson
- Department of Surgery, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Surgery, Lund University, Lund, Sweden
| | - P Sandström
- Department of Surgery, County Council of Östergötland, Linköping, Sweden.,Department of Biomedicine and Clinical Sciences, Faculty of Health Sciences, Linköping, Sweden
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10
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O'Brien SJ, Ellis CT, McDowell J, Galandiuk S, Polk HC. Anal squamous cell carcinoma incidentally found at hemorrhoidectomy. Surgery 2020; 169:610-616. [PMID: 33004218 DOI: 10.1016/j.surg.2020.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/24/2020] [Accepted: 08/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anal squamous cell carcinoma incidence is increasing nationally and, more so, in Kentucky. Squamous cell carcinoma of the anus unexpectedly identified at hemorrhoidectomy pathologic evaluation is not uncommon. We hypothesized this is occurring more frequently and sought to evaluate its impact on outcomes. METHODS The Kentucky Cancer Registry, a premier population database, was queried for all squamous cell carcinoma of the anus cases between 2007 and 2016. Hemorrhoidal squamous cell carcinoma of the anus patients were compared with nonhemorrhoidal squamous cell carcinomas of the anus. Patient demographics, treatments, and outcomes were analyzed. RESULTS Of the 722 squamous cell carcinoma of the anus cases identified, 3.05% (n = 22) were within hemorrhoidectomy specimens. Demographics were similar between hemorrhoidal squamous cell carcinoma of the anus versus nonhemorrhoidal squamous cell carcinoma of the anus. Chemoradiation was the most common treatment strategy among all patients, and there were similar rates of disease, persistence, recurrence, and survival between hemorrhoidal and nonhemorrhoidal squamous cell carcinoma. Stage I disease was more common in the hemorrhoid group compared with the nonhemorrhoid group (63% vs 27%, P < .01). CONCLUSION Hemorrhoidal squamous cell carcinoma of the anus comprised 3.05% of our population-based cohort. Hemorrhoidal squamous cell carcinomas of the anus were more likely to receive chemoradiation compared with local excision, but there were similar oncologic outcomes. We postulate that some individuals may receive overtreatment with chemoradiation owing to imprecise labeling of hemorrhoid specimens. For this reason, we advocate for separate submission of each hemorrhoid specimen.
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Affiliation(s)
- Stephen J O'Brien
- Price Institute of Surgical Research, Department of Surgery, University of Louisville School of Medicine, Louisville, KY
| | - C Tyler Ellis
- Price Institute of Surgical Research, Department of Surgery, University of Louisville School of Medicine, Louisville, KY
| | - Jaclyn McDowell
- Markey Cancer Control Program, Kentucky Cancer Registry, Lexington, KY
| | - Susan Galandiuk
- Price Institute of Surgical Research, Department of Surgery, University of Louisville School of Medicine, Louisville, KY
| | - Hiram C Polk
- Price Institute of Surgical Research, Department of Surgery, University of Louisville School of Medicine, Louisville, KY.
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11
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Malhotra K, Bawa A. Routine Histopathological Evaluation After Appendectomy: Is It Necessary? A Systematic Review. Cureus 2020; 12:e9830. [PMID: 32953339 PMCID: PMC7495960 DOI: 10.7759/cureus.9830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/18/2020] [Indexed: 11/22/2022] Open
Abstract
Acute appendicitis is one of the most common reasons for acute abdominal pain. Fecaliths and lymphoid hyperplasia are the usual etiology of acute appendicitis, however, other unusual causes can also not be neglected which can be parasitic infections, benign or malignant lesions. Due to substantial lab costs and limited resources, the policy of routine histopathological examination (HPE) of appendectomy samples is being questioned. PubMed, PubMed Central (PMC), and Google Scholar were used to look for relevant published studies. The following keywords were used both alone and in combination: "Acute appendicitis" and "routine histopathological examination". Fifteen articles were selected for final review that collectively had 57,524 cases. All these studies included in this systematic review are peer-reviewed. Based on the reviewed articles, it was found that though the probability of unusual findings in a patient of acute appendicitis is less but it is still significant and if found, often results in a change of management plan of the patient. Therefore, it is recommended to perform a routine histopathological examination of all appendectomy specimens to rule out unusual pathologies.
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Affiliation(s)
- Kashish Malhotra
- General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
| | - Ashvind Bawa
- General Surgery, Dayanand Medical College and Hospital, Ludhiana, IND
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12
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Bastiaenen VP, Tuijp JE, van Dieren S, Besselink MG, van Gulik TM, Koens L, Tanis PJ, Bemelman WA. Safe, selective histopathological examination of gallbladder specimens: a systematic review. Br J Surg 2020; 107:1414-1428. [PMID: 32639049 PMCID: PMC7540681 DOI: 10.1002/bjs.11759] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/14/2020] [Accepted: 05/12/2020] [Indexed: 12/13/2022]
Abstract
Background Routine histopathological examination after cholecystectomy is costly, but the prevalence of unsuspected gallbladder cancer (incidental GBC) is low. This study determined whether selective histopathological examination is safe. Methods A comprehensive search of PubMed, Embase, Web of Science and the Cochrane Library was performed. Pooled incidences of incidental and truly incidental GBC (GBC detected during histopathological examination without preoperative or intraoperative suspicion) were estimated using a random‐effects model. The clinical consequences of truly incidental GBC were assessed. Results Seventy‐three studies (232 155 patients) were included. In low‐incidence countries, the pooled incidence was 0·32 (95 per cent c.i. 0·25 to 0·42) per cent for incidental GBC and 0·18 (0·10 to 0·35) per cent for truly incidental GBC. Subgroup analysis of studies in which surgeons systematically examined the gallbladder revealed a pooled incidence of 0·04 (0·01 to 0·14) per cent. In high‐incidence countries, corresponding pooled incidences were 0·83 (0·58 to 1·18), 0·44 (0·21 to 0·91) and 0·08 (0·02 to 0·39) per cent respectively. Clinical consequences were reported for 176 (39·3 per cent) of 448 patients with truly incidental GBC. Thirty‐three patients (18·8 per cent) underwent secondary surgery. Subgroup analysis showed that at least half of GBC not detected during the surgeon's systematic examination of the gallbladder was early stage (T1a status or below) and of no clinical consequence. Conclusion Selective histopathological examination of the gallbladder after initial macroscopic assessment by the surgeon seems safe and could reduce costs.
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Affiliation(s)
- V P Bastiaenen
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - J E Tuijp
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - S van Dieren
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - M G Besselink
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - T M van Gulik
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - L Koens
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - P J Tanis
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - W A Bemelman
- Department of Surgery, Cancer Centre Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
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13
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Bastiaenen VP, Allema WM, Klaver CEL, van Dieren S, Koens L, Tanis PJ, Bemelman WA. Routine histopathologic examination of the appendix after appendectomy for presumed appendicitis: Is it really necessary? A systematic review and meta-analysis. Surgery 2020; 168:305-312. [PMID: 32471653 DOI: 10.1016/j.surg.2020.03.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 03/31/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Owing to substantial costs and increasing interest in the nonoperative management of appendicitis, the necessity of routine histopathologic examination of appendectomy specimens is being questioned. The aim of this study was to determine whether routine histopathologic examination after appendectomy for suspected appendicitis should still be performed. METHODS PubMed, Embase, Web of Science, and the Cochrane Library were searched for studies listing the histopathologic diagnoses after appendectomy for suspected appendicitis. Main outcomes were the incidence of histopathologically proven aberrant findings, the ability of surgeons to recognize unexpected appendiceal pathology intraoperatively, and the percentage of aberrant findings resulting in a change of postoperative management. A meta-analysis was performed using a random-effects model. RESULTS Twenty-five studies with 57,357 patients were included. The pooled percentage of aberrant findings was 2.52% (95% confidence interval 1.81-3.51). Neoplasms were found in 0.71% (95% confidence interval 0.54-0.94). Findings of the intraoperative assessment by the surgeon were reported for 82 of the 2,718 (3.0%) unexpected diagnoses, with great variation between studies. The impact on postoperative management was described for 237 of 2,718 (8.7%) aberrant findings. Of these, 166 (70.0%) resulted in a change of postoperative management. CONCLUSION Based on current evidence, it remains unclear how many of the unexpected appendiceal pathologies with clinical consequences can be identified intraoperatively by the surgeon. Until reliable data on the safety and potential cost savings of a selective policy becomes available, we advise sending appendectomy specimens routinely for histopathologic examination.
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Affiliation(s)
- Vivian P Bastiaenen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Wies M Allema
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Charlotte E L Klaver
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Susan van Dieren
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Lianne Koens
- Department of Pathology, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Pieter J Tanis
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
| | - Willem A Bemelman
- Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands.
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14
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Histopathological Examination of Gallbladder Specimens in Kumaon Region of Uttarakhand. J Gastrointest Cancer 2019; 51:121-129. [PMID: 30847742 DOI: 10.1007/s12029-018-00188-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gall stones are one of the major causes of morbidity and mortality all over the world and common health problems throughout in developing countries. Cholecystectomy is one of the most common surgical practices and postoperative analysis of cholecystectomy specimen has a great value since histopathological reports may document some entities with significant clinical significances. Gallbladder carcinomas in cholecystectomy specimens are received in our histopathology laboratory to analyse their clinicopathological features. This was a descriptive study carried out at the histopathology section of the Department of Pathology at our hospital over a period of two years ranging from November 2016 to October 2018. Both intraoperative and postoperative histological examinations of the excised gallbladder facilitated the diagnosis of gallbladder cancer. Surgery-related variables and surgical approaches were evaluated according to the extent of tumor invasion. Twenty five cholecystectomy specimens of the acute and symptomatic chronic cholecystitis patients were analyzed. Standardization of the reporting were examined. Age, gender, presence of gall stone, cholesterolosis, adenomatous hyperplasia, gastric or intestinal metaplasia, dysplasia, histopathological type of gallbladder carcinoma, cellular differentiation, grading, lympho vascular invision, perineural invasion, lymph node invasion, involvement of cystic duct end margin, liver invasion, omental tissue invasion and T.N.M. staging were investigated. Reported rates of histopathological findings were comparable between patients aged twenty six years to seventy six years. Epithelial hyperplasia and metaplasia were found to be related to age. The correlation between cholesterolosis and gender or metaplasia was noted. We suggest that in India and other nations, high incidences of gallbladder carcinoma, all cholecystectomy specimens must be submitted to routine macroscopic and histopathology examination in the laboratory, as this is the only capability through which malignancies can be detected at an early, potentially curable stage. This incidental finding has altered the management and outcome of this dreadful disease.
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15
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Walędziak M, Różańska-Walędziak A, Janik MR, Paśnik KW, Kowalewski PK. Macroscopic Evaluation of Gastric Specimens After Laparoscopic Sleeve Gastrectomy-an Optimum Screening Test for Incidental Pathologies? Obes Surg 2018; 29:28-31. [PMID: 30187420 PMCID: PMC6320350 DOI: 10.1007/s11695-018-3485-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction Obesity is a serious lifestyle disease with various comorbidities and an augmented risk of cancer. Laparoscopic sleeve gastrectomy (LSG) has recently become the most popular bariatric procedure worldwide. While the cost-effectiveness is a major healthcare providers’ concern, the point of histological exam of each resected tissue may be questioned. Material/Methods We prospectively included patients who underwent LSG. Before the surgery, gastroscopy and abdominal sonography were performed to exclude malignancies. The gastric specimen was cut open after the surgery and inspected macroscopically, then sent for a microscopic examination. Results In 5 cases out of 115, macroscopic evaluation of the resected specimen performed by the surgeon suggested existing pathology, confirmed by a microscopic evaluation in 3 out of 5 cases. In the remaining 2 cases, pathological analysis did not reveal abnormalities. In 110 cases, the gastric specimen was recognized to be unchanged by the surgeon, 109 out of which were confirmed by the pathologist to be normal, in 1 case a hyperplastic polyp was found. The sensitivity of macroscopic evaluation reached 75% (95% CI, 19.4–99.4%, p = 0.625), with specificity of 98.2% (95% CI, 93.6–99.8%, p < 0.0001), and negative predictive value of 99.1% (95% CI, 95–99.9%, p < 0.0001). Conclusions During LSG, a thorough visual inspection of the peritoneal cavity along with a macroscopic surgical evaluation of specimen in patients who had preoperative endoscopy with no findings allows to achieve very good specificity and good sensitivity. Therefore, this procedure may be useful as a screening test for incidental pathologies in bariatric patients and may exclude unnecessary histological examination.
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Affiliation(s)
- Maciej Walędziak
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128 St., Warsaw, 04-141, Poland.
| | | | - Michał R Janik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128 St., Warsaw, 04-141, Poland
| | - Krzysztof W Paśnik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128 St., Warsaw, 04-141, Poland
| | - Piotr K Kowalewski
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Szaserów 128 St., Warsaw, 04-141, Poland
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16
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Charfi S, Gouiaa N, Mnif H, Chtourou L, Tahri N, Abid B, Mzali R, Boudawara TS. Histopathological findings in cholecystectomies specimens: A single institution study of 20 584 cases. Hepatobiliary Pancreat Dis Int 2018; 17:345-348. [PMID: 30173787 DOI: 10.1016/j.hbpd.2018.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The histopathological examination of cholecystectomy specimens has not been standardized with a debate concerning the routine and the selective approach. The aim of this study was to assess the information obtained from routine histopathological examination of cholecystectomy specimens. METHODS All histopathological reports of cholecystectomy specimens between January 2003 and December 2016 were analyzed, including a clinical diagnosis of benign gallstone disease or cholecystitis. RESULTS A total of 20,584 reports were examined. The mean age of patients was 54.2 years. Patients aged more than 60 years represent 37.6% of the study population. Of all patients, 15,973 (77.6%) were females. Incidental gallbladder cancers (GBC) were present in 155 cholecystectomies specimens (0.8%). 67.1% of GBC are at T2 and T3 stage. Granulomatous cholecystitis was diagnosed in only 19 cases (0.1%). GBC were more prevalent in older patients (P < 10-6) and cholesterolosis was more prevalent in young patients (P < 10-6). There was no gender predilection for GBC (P = 0.739). CONCLUSIONS The rate of incidental gallbladder carcinoma in our study is low, yet, we found a higher proportion of T2 and T3 carcinomas stage. Granulomatous cholecystitis may need further investigations and treatments. When a selective approch of histopathological examination of cholecystectomy specimens is used, it is important to take into account that clinical parameters are significantly associated with gallbladder cancer.
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Affiliation(s)
- Slim Charfi
- Department of Pathology, CHU Habib Bourguiba, Sfax 3029, Tunisia; Sfax Medical School, University of Sfax, Sfax 3029, Tunisia.
| | - Naourez Gouiaa
- Department of Pathology, CHU Habib Bourguiba, Sfax 3029, Tunisia; Sfax Medical School, University of Sfax, Sfax 3029, Tunisia
| | - Hela Mnif
- Department of Pathology, CHU Habib Bourguiba, Sfax 3029, Tunisia; Sfax Medical School, University of Sfax, Sfax 3029, Tunisia
| | - Lassaad Chtourou
- Sfax Medical School, University of Sfax, Sfax 3029, Tunisia; Department of Gastroenterology, CHU Habib Bourguiba, Sfax 3029, Tunisia
| | - Nabil Tahri
- Sfax Medical School, University of Sfax, Sfax 3029, Tunisia; Department of Gastroenterology, CHU Habib Bourguiba, Sfax 3029, Tunisia
| | - Bassem Abid
- Sfax Medical School, University of Sfax, Sfax 3029, Tunisia; Department of Surgery, CHU Habib Bourguiba, Sfax 3029, Tunisia
| | - Rafik Mzali
- Sfax Medical School, University of Sfax, Sfax 3029, Tunisia; Department of Surgery, CHU Habib Bourguiba, Sfax 3029, Tunisia
| | - Tahya Sellami Boudawara
- Department of Pathology, CHU Habib Bourguiba, Sfax 3029, Tunisia; Sfax Medical School, University of Sfax, Sfax 3029, Tunisia
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Koppatz H, Nordin A, Scheinin T, Sallinen V. The risk of incidental gallbladder cancer is negligible in macroscopically normal cholecystectomy specimens. HPB (Oxford) 2018; 20:456-461. [PMID: 29248400 DOI: 10.1016/j.hpb.2017.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/11/2017] [Accepted: 11/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cholecystectomy is usually carried out for benign indications. Most perform routine histopathologic examination to detect incidental gallbladder cancer (GBC). METHODS Cholecystectomies performed at four hospitals in the Helsinki Metropolitan Area during 2010-2012 were analyzed retrospectively. Patients with preoperative suspicion of neoplasia, active malignancy, or in whom cholecystectomy was performed as a secondary procedure were excluded. RESULTS A total of 2034 cholecystectomies were included. In ten patients (0.5%), GBC was identified, each with an associated macroscopic finding, including local hardness (n = 1), a thickened wall (n = 5), acute inflammation and necrosis (n = 1), or suspected neoplasia (n = 3). No GBC was found in macroscopically normal gallbladders (n = 1464). Of the ten patients with GBC, five underwent subsequent liver resection, four had metastatic disease, and one had locally advanced inoperable disease. Three of the five patients who underwent liver resection were alive and disease-free at final follow-up (median 48 months). The remaining seven patients with GBC died of the disease, with a median survival of 14 months (range 10-48 months). CONCLUSIONS Routine histopathologic examination of a macroscopically normal gallbladder does not improve diagnosis of GBC. A histopathological examination is, however, mandatory when a macroscopic abnormality is present.
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Affiliation(s)
- Hanna Koppatz
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Arno Nordin
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tom Scheinin
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ville Sallinen
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Unexpected pathological findings after laparoscopic cholecystectomy - analysis of 1131 cases. Wideochir Inne Tech Maloinwazyjne 2017; 13:62-66. [PMID: 29643960 PMCID: PMC5890837 DOI: 10.5114/wiitm.2017.69594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/03/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Gallbladder specimens are routinely sent for histopathological examination after cholecystectomy in order to rule out the presence of unexpected pathological findings. Aim To establish the overall incidence of unexpected pathological findings in patients who underwent laparoscopic cholecystectomy for symptomatic gallbladder disease and determine whether the macroscopic appearance of the gallbladder in ultrasound examination could be a valid method for identifying patients with gallbladder malignancy. Material and methods A retrospective study was conducted between 2013 and 2015. All histological reports (n = 1131) after cholecystectomy were searched for unexpected pathological findings. In cases where unexpected pathological findings were identified the additional analysis of preoperative abdominal ultrasound examination (USG) was done to determine the usefulness of USG in diagnosis of gallbladder malignancy. Results Of the 1131 patients included in the study, 356 (31.47%) were male and 774 (68.43%) were female. Unexpected pathological findings were present in 21 cases. The overall incidence of unexpected pathological findings was 1.86%. Only in 5 patients were suspicious appearances of gallbladder observed in preoperative ultrasound examination. In 16 patients there was no suspicion of malignancy. The positive predictive value of USG was 0.238. Conclusions The incidence of unexpected pathological findings after laparoscopic cholecystectomy was 1.86%. Ultrasonography has low positive predictive value for identifying patients with malignant findings in a gallbladder specimen.
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Histopathological examination of tissue resected during bariatric procedures - to be done or not to be done? Wideochir Inne Tech Maloinwazyjne 2017; 12:135-139. [PMID: 28694898 PMCID: PMC5502342 DOI: 10.5114/wiitm.2017.67807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/12/2017] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Obesity is one of the major lifestyle diseases and provokes various comorbidities, such as hypertension, type 2 diabetes mellitus, obstructive sleep apnea, and even neoplasms. Bariatric surgery is the most effective treatment of obesity. Since cost-effectiveness has become a major concern, there is a tendency to avoid general histological evaluation of surgical specimens during routine procedures. AIM To evaluate the necessity of histopathological investigation of tissue excised during bariatric surgery and to verify whether the operation should be continued in the case of suspicious macroscopic findings. MATERIAL AND METHODS From January 2013 to December 2016, 1252 patients with obesity were qualified for bariatric procedures. The qualification was performed according to the current European recommendations. Every operation started with an inspection of the peritoneal cavity performed once the abdomen was insufflated. If a macroscopic pathology was found, the specimen was secured for histopathological investigation. RESULTS Out of 81 (6.47%) patients from whom histopathological samples were collected, 39% (n = 32) showed negative results, and 61% (n = 49) cases showed abnormalities. CONCLUSIONS As it is impossible to exclude the existence of gastric tumors only in preoperative gastroscopy and ultrasonography, especially as there is a higher risk in obese patients, routine histological examination of tissue excised during bariatric procedures should be considered. Since most of the neoplasms were found to be benign, there is no need to abandon the bariatric procedure if a pathology is found and resected. Bariatric surgeons should always focus on thorough examination of the abdominal and the pelvic cavity, especially in female patients.
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Safaan T, Bashah M, El Ansari W, Karam M. Histopathological Changes in Laparoscopic Sleeve Gastrectomy Specimens: Prevalence, Risk Factors, and Value of Routine Histopathologic Examination. Obes Surg 2017; 27:1741-1749. [PMID: 28063114 PMCID: PMC5489580 DOI: 10.1007/s11695-016-2525-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a common surgical therapeutic option for obese patients, with debate about the value of routine histopathologic examination of LSG specimens. We assessed the following: prevalence of different histopathologic changes in LSG specimens, risk factors associated with premalignant and with frequent histopathologic changes, and whether routine histopathologic examination is warranted for LSG patients with nonsignificant clinical history. METHODS Retrospective review of records of all LSG patients operated upon at Hamad General Hospital, Qatar (February 2011-July 2014, n = 1555), was conducted. Risk factors (age, BMI, gender, and Helicobacter pylori) were assessed in relation to specific abnormal histopathologic changes. RESULTS Mean age and BMI of our sample were 35.5 years and 46.8, respectively. Females comprised 69.7% of the sample. Normal histopathologic specimens comprised 52% of the sample. The most common histopathologic changes were chronic inactive gastritis (33%), chronic active gastritis (6.8%), follicular gastritis (2.7%), and lymphoid aggregates (2.2%). We observed rare histopathology in 3.3% of the sample [e.g., intestinal metaplasia and gastrointestinal stromal tumor (GIST)]. Older age was associated with GIST and intestinal metaplasia (P = 0.001 for both). Females were associated with chronic active gastritis (P = 0.003). H. pylori infection was associated with follicular gastritis, lymphoid aggregates, GIST, intestinal metaplasia, and chronic active gastritis (P < 0.001 for each). CONCLUSION Older age, H. pylori, and female gender are risk factors for several abnormal histopathologic changes. Histopathologic examination of LSG specimens might harbor significant findings; however, routine histopathologic examination of all LSG specimens, particularly in the absence of suggestive clinical symptoms, is questionable. The association between female gender and chronic active gastritis; and the association between H. pylori infection and GIST are both novel findings that have not been previously reported in the published literature.
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Affiliation(s)
- Tamer Safaan
- Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar.
| | - Moataz Bashah
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
| | - Walid El Ansari
- Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
- College of Medicine, Doha, State of Qatar
- School of Health and Education, University of Skövde, Skövde, Sweden
| | - Mohsen Karam
- Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar
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AbdullGaffar B, Raman L, Khamas A, AlBadri F. Should We Abandon Routine Microscopic Examination in Bariatric Sleeve Gastrectomy Specimens? Obes Surg 2016; 26:105-10. [PMID: 25986428 DOI: 10.1007/s11695-015-1726-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a relatively new bariatric surgical procedure to reduce weight in morbidly obese patients, with an overall low rate of complications and thus gaining a worldwide popularity. It provides an opportunity to study the pathology of the stomach in obese patients. Most studies, however, focused on clinical aspects, surgical techniques, and postoperative complications. Few authors studied the histopathologic findings. Whether routine histopathologic examination is warranted in patients with grossly unremarkable LSG specimens and nonsignificant clinical history was not previously studied. METHODS We conducted a prospective study over 8 years to compare the prevalence, the morphologic spectrum and importance of histopathologic findings, and the frequency of incidental neoplasms in LSG specimens with other studies. We also proposed a protocol for the gross handling and sectioning of LSG specimens. RESULTS We found 546 LSG specimens. Five patients developed iatrogenic postoperative complications, two of which pursued a medicolegal case. There was no association between the histopathologic findings and the complications. Less than 1 % of incidental benign lesions were found. No malignancies were identified. All of the patients without postoperative complications had uneventful outcome after 5 months to 6 years follow-up. CONCLUSIONS Routine microscopic examination of all LSG specimens is not necessary. Selective microscopic examination guided by relevant clinical history and macroscopic examination is a better option. This protocol will save money, time, and workload without compromising patient's safety and future management. However, a careful gross description is still necessary in certain cases for potential future medicolegal implications.
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Affiliation(s)
- Badr AbdullGaffar
- Pathology Section, Rashid Hospital, Oud Metha Road, Dubai, United Arab Emirates.
| | - Lakshmiah Raman
- Histopathology Unit, Dubai Hospital, Dubai, United Arab Emirates
| | - Ali Khamas
- Surgery Unit, Rashid Hospital, Dubai, United Arab Emirates
| | - Faisal AlBadri
- Surgery Unit, Rashid Hospital, Dubai, United Arab Emirates
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22
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Kuan EC, Tajudeen BA, Bhuta SM, Palma Diaz MF, Kedeshian PA, Suh JD. Incidental finding of lymphoma after septoplasty. ALLERGY & RHINOLOGY 2016; 7:90-5. [PMID: 27470206 PMCID: PMC5010439 DOI: 10.2500/ar.2016.7.0153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Septoplasty, or surgical correction of the deviated septum, is an elective, routinely performed rhinologic procedure to address nasal airway obstruction. In many cases, resected septal cartilage and bone fragments are sent for pathologic review, although there is no consensus on this practice. We reported two cases of incidentally diagnosed lymphoma after elective septoplasty and discussed clinical presentation, diagnosis, and management. Methods: Retrospective chart review of two patients who underwent septoplasty at a tertiary academic medical center and found to have incidental lymphoma based on histopathology. Results: Two patients who underwent septoplasty had an incidental diagnosis of lymphoma on pathologic analysis. One patient was noted to have an S-shaped septal deviation that produced bilateral nasal obstruction. She underwent a difficult septoplasty, in which the mucoperichondrial flap was firmly adherent to the underlying septum and bone. Final pathology demonstrated diffuse large B-cell lymphoma. She was treated with chemoradiation and remained free of disease at 59 months. The other patient had a history of nasal trauma, which produced left septal deviation. He underwent an uncomplicated septoplasty, with pathology that demonstrated low-grade B-cell lymphoma. Because there was no evidence of active disease, the decision was made to not treat and to observe the patient clinically. Conclusions: This is the first reported series of septal lymphoma incidentally diagnosed on routine septoplasty. Although histopathologic review of specimens from routine nasal and sinus surgery is not routinely performed, this report highlighted the importance of this process, on a case-by-case basis, in detecting unexpected malignancies that otherwise were clinically silent.
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Affiliation(s)
- Edward C Kuan
- Department of Head and Neck Surgery, University of California, Los Angeles (UCLA), Los Angeles, California, USA
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23
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Basak F, Hasbahceci M, Canbak T, Sisik A, Acar A, Yucel M, Bas G, Alimoglu O. Incidental findings during routine pathological evaluation of gallbladder specimens: review of 1,747 elective laparoscopic cholecystectomy cases. Ann R Coll Surg Engl 2016; 98:280-3. [PMID: 26924485 PMCID: PMC5226033 DOI: 10.1308/rcsann.2016.0099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2015] [Indexed: 12/18/2022] Open
Abstract
Introduction Cholecystectomy for benign gallbladder diseases can lead to previously undiagnosed gallbladder cancer during histopathological evaluation. Despite some controversy over its usefulness, histopathological evaluation of all gallbladder specimens is common in most hospitals. We evaluated the results of routine pathology of the gallbladder after cholecystectomy for benign gallbladder diseases with regard to unexpected primary gallbladder cancer (UPGC). Methods Patients undergoing cholecystectomy because of benign gallbladder diseases between 2009 and 2013 were enrolled in this study. All gallbladder specimens were sent to the pathology department, and histopathological reports were examined in detail. The impact of demographic features on pathological diagnoses and prevalence of UPGC assessed. Data on additional interventions and postoperative survival for patients with UPGC were collected. Results We enrolled 1,747 patients (mean age, 48.7±13.6 years). Chronic cholecystitis was the most common diagnosis (96.3%) and was associated significantly with being female (p=0.001). Four patients had UPGC (0.23%); one was stage T3 at the time of surgery, and the remaining three cases were stage T2. Conclusions Routine histopathological examination of the gallbladder is valuable for identification of cancer that requires further postoperative management.
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Affiliation(s)
- F Basak
- Umraniye Education and Research Hospital , Turkey
| | | | - T Canbak
- Umraniye Education and Research Hospital , Turkey
| | - A Sisik
- Umraniye Education and Research Hospital , Turkey
| | - A Acar
- Umraniye Education and Research Hospital , Turkey
| | - M Yucel
- Umraniye Education and Research Hospital , Turkey
| | - G Bas
- Umraniye Education and Research Hospital , Turkey
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25
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Nally C, Singer M. Reoperative surgery for complications of hemorrhoidectomy. SEMINARS IN COLON AND RECTAL SURGERY 2015. [DOI: 10.1053/j.scrs.2015.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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26
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Emmett CD, Barrett P, Gilliam AD, Mitchell AI. Routine versus selective histological examination after cholecystectomy to exclude incidental gallbladder carcinoma. Ann R Coll Surg Engl 2015; 97:526-9. [PMID: 26274738 DOI: 10.1308/rcsann.2015.0013] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Introduction Gallstone disease is treated commonly with cholecystectomy. Malignant disease of the gallbladder may present similarly and has a poor prognosis. It is common for cholecystectomy specimens to be sent for histological examination to exclude malignancy. However, the incidence of incidental gallbladder carcinoma (IGBC) is low and it has therefore been suggested that macroscopic inspection of the gallbladder by the surgeon, followed by selective histological examination of abnormal specimens, may be safe and cost saving. Methods All cholecystectomies performed between 1 May 2003 and 1 September 2009 were identified from clinical coding. Pathology records were used to identify gallbladder malignancies; these were searched manually to identify IGBC. Pathology reports and case notes were cross-referenced to determine whether there were macroscopic abnormalities present. Annual cost savings were estimated by comparing the number of gallbladder specimens over one year (May 2013 - April 2014) with the total number of cholecystectomies performed in that time. Results Of 4,776 cholecystectomies identified, 12 (0.25%) were cases of IGBC. These cases had a higher median age (68 vs 54 years, p<0.001) and a higher proportion were emergency operations (50% vs 12%, p<0.001). All cases had some form of macroscopic abnormality, most commonly wall thickening (n=6, 50%). Only two cases (17%) had a visible tumour present. Conclusions All cases of IGBC in this study had a macroscopically abnormal gallbladder. Our findings suggest it is safe to adopt a selective approach to histological examination. Savings of almost £20,500 per annum have been achieved.
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Affiliation(s)
- C D Emmett
- County Durham and Darlington NHS Foundation Trust , UK
| | - P Barrett
- County Durham and Darlington NHS Foundation Trust , UK
| | - A D Gilliam
- County Durham and Darlington NHS Foundation Trust , UK
| | - A I Mitchell
- County Durham and Darlington NHS Foundation Trust , UK
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Guraya SY. Do We Still Need to Perform Routine Histological Examination of Appendectomy Specimens? J Clin Diagn Res 2015; 9:PL01. [PMID: 26266169 DOI: 10.7860/jcdr/2015/13989.6134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 04/30/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Salman Yousuf Guraya
- Consultant Colorectal Surgeon, Department of Surgery, College of Medicine, Taibah University , Saudi Arabia
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28
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Does everything a surgeon takes out have to be seen by a pathologist? A review of the current pathology practice. Virchows Arch 2015; 468:69-74. [PMID: 26155913 DOI: 10.1007/s00428-015-1801-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/15/2015] [Indexed: 01/13/2023]
Abstract
Histopathologic examination of surgically removed tissues and organs is an important aspect of modern hospital quality health care. Most surgical specimens deserve to be submitted for pathologic examination, which may yield valuable new information relevant for the future treatment of the patient. A small number of specimens, recognized as providing limited or no valuable clinical data during pathologic examination, may be placed on the list of specimens "exempt from submission" or those that are labeled as "for gross examination only." Guidelines written by the committees of the national regulatory organizations provide general orientation on how to deal with various specimens, but the final decision on which type of specimen to eliminate and which ones to include for pathologic examination rests on local governing and advisory bodies of each institution. Particular lists of specimens exempt from pathologic examination are best generated through a consensus agreement of clinical and laboratory physicians. Even though there is general nationwide and even international consensus on which types of specimens deserve pathologic examination and which do not, there are still discussions about the necessity of some pathologic examinations.
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Davies JRL, Smith G, Cornaby AJ, Thomas T, Lamparelli MJ. Delayed recurrence of renal cell carcinoma presenting as a haemorrhoid. J Surg Case Rep 2015; 2015:rjv022. [PMID: 25818654 PMCID: PMC4375114 DOI: 10.1093/jscr/rjv022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Metastatic non-colorectal cancer of the anal canal is a rare entity. To date, only four cases have been described in the literature. We present a 76-year-old man who was referred with an unusual perianal lesion. He had a history of renal cell carcinoma 7 years previously. Histologically, the lesion revealed clear cell carcinoma in keeping with metastasis. To our knowledge, this is only the second time a renal carcinoma metastasis to the anal canal has been identified.
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Affiliation(s)
- James R L Davies
- Department of Colorectal Surgery, Dorset County Hospital, Dorchester, Dorset, UK
| | - Gavin Smith
- Department of Urology, Dorset County Hospital, Dorchester, Dorset, UK
| | - Andrew J Cornaby
- Department of Urology, Dorset County Hospital, Dorchester, Dorset, UK
| | - Teresa Thomas
- Department of Histopathology, Dorset County Hospital, Dorchester, Dorset, UK
| | - Michael J Lamparelli
- Department of Colorectal Surgery, Dorset County Hospital, Dorchester, Dorset, UK
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30
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He X, Huang J, Yao J, Chen Z, Lian L, Li S, Rouniyar S, Chen Y, Wu X, Lan P. Routine histopathologic examination of "benign" anal lesions: is it necessary? Surg Today 2015; 45:416-21. [PMID: 25604139 DOI: 10.1007/s00595-014-1090-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 09/02/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To establish the necessity of routine histopathologic examination of specimens from hemorrhoids and anal fistula that are diagnosed preoperatively. METHODS We reviewed histopathologic reports from hemorrhoidectomy and anal fistula excision operations performed between 2007 and 2011 in the sixth affiliated hospital of Sun Yat-sen University and Guangdong Province Traditional Chinese Medical Hospital. We evaluated the incidence of unexpected pathologic malignancy and its impact on postoperative management. RESULTS Among the 10532 patients recruited, 8308 had undergone hemorrhoidectomy and 2224 had undergone excision of an anal fistula. Unexpected pathologic malignancy was discovered in 17 specimens (0.16 %). Overall and subgroup analysis for risk factors of malignant detection revealed unexpected pathologic malignancy was more likely to be found in people over the age of 60 years (OR = 5.516, P = 0.002 overall and OR = 5.442, P = 0.007 for hemorrhoids). CONCLUSION Routine histopathologic examination of specimens from patients undergoing hemorrhoid or anal fistula surgery is of value for identifying unexpected pathologic malignancy. An age older than 60 years may be a remarkable risk factor.
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Affiliation(s)
- Xiaosheng He
- Department of Colorectal Surgery, The Sixth Affiliated Hospital of Sun Yat-sen University, 26 Yuancun Erheng Rd, Guangzhou, 510655, China
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31
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Sauter JL, Butnor KJ. Pathological findings in spontaneous pneumothorax specimens: does the incidence of unexpected clinically significant findings justify routine histological examination? Histopathology 2014; 66:675-84. [DOI: 10.1111/his.12523] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/07/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Jennifer L Sauter
- Department of Pathology and Laboratory Medicine; University of Vermont/Fletcher Allen Health Care; Burlington VT USA
| | - Kelly J Butnor
- Department of Pathology and Laboratory Medicine; University of Vermont/Fletcher Allen Health Care; Burlington VT USA
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Charfi S, Sellami A, Affes A, Yaïch K, Mzali R, Boudawara TS. Histopathological findings in appendectomy specimens: a study of 24,697 cases. Int J Colorectal Dis 2014; 29:1009-12. [PMID: 24986137 DOI: 10.1007/s00384-014-1934-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/12/2014] [Indexed: 02/04/2023]
Abstract
PURPOSE Appendicitis is by far the commonest major emergency general surgical operation. Histopathological examination of the appendix is routinely performed. METHODS This study is a retrospective analysis of 24,697 appendectomies performed from January 2003 to December 2011. Pathological reports were analyzed for the following parameters: age, gender, and pathological diagnosis. RESULTS Appendectomy specimens represent 17 % of all pathological reports. Acute appendicitis was present in 19,637 (79.5 %) patients. The perforation rate was 6.3 % and was significantly higher in adult patients. The negative appendectomy rate was 15 % and was significantly higher in female and adult patients. The incidence of negative appendectomies had clearly decreased over the 9-year period distribution. Incidental unexpected pathological diagnoses were noted in 226 (0.9 %) appendectomy specimens. Neoplastic lesions were present in 171 cases (0.7 %); they include carcinoid, adenocarcinoma, and mucinous neoplasms. CONCLUSIONS Routine pathological examination of appendectomy specimens is expensive. With advances in technology and imaging modalities, the diagnosis of acute appendicitis has improved, with a subsequent significant reduction in negative appendectomy. There are still a number of unusual diagnoses found in appendicectomy specimens supporting the continued use of routine histology.
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Affiliation(s)
- Slim Charfi
- Department of Pathology, CHU Habib Bourguiba, Sfax, Tunisia,
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Van Wicklin SA. Clinical Issues—July 2014. AORN J 2014. [DOI: 10.1016/j.aorn.2014.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF REVIEW To discuss some key issues involved in the management of gallbladder cancer (GBC). RECENT FINDINGS The decline in incidence and mortality of GBC began decades before the introduction of laparoscopic surgery. In consecutive autopsies and in cases in which cholelithiasis was present, the incidence of gallbladder carcinoma is 3-4%. A number of genetic alterations have been identified in the different stages of GBC and they support the morphological evidence of two pathways by which tumors develop. Some of these genetic changes are associated with particular risk factors. All management of GBC and all comparisons of treatment results from different centers must be based on the stages. SUMMARY Simple cholecystectomy is the adequate treatment for T1a GBC. Lymph node excision improved survival in patients with T2 lesions. Radical en bloc resection of T2 tumors offers greater benefit over conventional cholecystectomy alone in terms of greater long-term survival times. Provided that negative surgical margins are secured, hepatectomy and lymph node resection can, therefore, be withheld in most cases in the surgical treatment of pT2 GBC. With improvements in surgical and anesthetic techniques, aggressive surgery has proven to be performed with safety.
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Affiliation(s)
- Anu Behari
- Department of Surgical Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Raibareli Road, Lucknow 226014, Uttar Pradesh, India
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Swank HA, Mulder IM, Hop WC, van de Vijver MJ, Lange JF, Bemelman WA. Routine histopathology for carcinoma in cholecystectomy specimens not evidence based: a systematic review. Surg Endosc 2013; 27:4439-48. [PMID: 23877761 DOI: 10.1007/s00464-013-3084-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 06/24/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Routine histopathological examination of gallbladder specimens is mainly performed to identify unexpected gallbladder carcinoma (GBC). This systematic review assesses the prevalence and characteristics of GBC in cholecystectomy specimens. METHODS PubMed, EMBASE, Web of Science, and the Cochrane Library were searched for all articles reporting on the finding of GBC in cholecystectomy specimens. RESULTS Of the 30 articles included, 20 were from Europe and the United States, and 10 were of Asian origin. In the Western studies, 276 cases of GBC were found in 61,542 specimens (median prevalence 0.4%, 95% confidence interval [CI] 0.3-0.6). Of these, 65% were expected pre- or intraoperatively. In the Asian studies, 344 cases of GBC were found in 37,365 specimens (median prevalence 1.2%, 95% CI 0.8-1.7). Of these, 45% were expected pre- or intraoperatively. In a subgroup analysis, identification of previously unexpected GBC affected treatment in only a minority of patients. In total, 72% of the patients received no further treatment and 32 patients (22%) received secondary surgery, of whom 15 patients survived at least 1 year. CONCLUSIONS The histopathological finding of GBC after cholecystectomy appears to be a rare event. The prevalence of unexpected GBC was higher in Asian studies than in Western studies. The pre- and intraoperative sensitivity for this carcinoma is low. Moreover, the diagnosis of GBC at the time of histopathology is usually inconsequential. The results of this systematic review do not support routine histopathology of cholecystectomy specimens in clinical practice.
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Affiliation(s)
- Hilko A Swank
- Department of Surgery, Academic Medical Centre, University of Amsterdam, Postbox 22660, 1100 DD, Amsterdam, The Netherlands,
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Jayasundara JASB, de Silva WMM. Histological assessment of cholecystectomy specimens performed for symptomatic cholelithiasis: routine or selective? Ann R Coll Surg Engl 2013; 95:317-22. [PMID: 23838492 PMCID: PMC4165132 DOI: 10.1308/003588413x13629960046471] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 12/21/2022] Open
Abstract
Traditionally, all cholecystectomy specimens resected for symptomatic cholelithiasis were sent for histological evaluation. The objectives of such evaluation are to confirm the clinicoradiological diagnosis, identification of unsuspected findings including incidental gallbladder malignancy, audit and research purposes, and quality control issues. Currently, there is a developing trend to consider selective histological evaluation of surgical specimens removed for clinically benign disease. This article discusses the need for routine or selective histopathological evaluation of gallbladder specimens following cholecystectomy. Although several retrospective studies have suggested selective histological evaluation of cholecystectomy specimens performed for symptomatic cholelithiasis, the evidence is not adequate at present to recommend selective histological evaluation globally. However, it may be appropriate to consider selective histological evaluation on a regional basis in areas of extremely low incidence of gallbladder cancer only after unanimous agreement between the governing bodies of surgical and histopathological expertise.
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Affiliation(s)
- J A S B Jayasundara
- General Surgical Unit (Ward 19), National Hospital of Sri Lanka, Colombo 10, Sri Lanka.
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Abstract
Neoplasms are an uncommon finding after appendectomy, with malignant tumors occurring in less than 1% of the surgical specimens, and carcinoid being the most frequent malignancy. A negative or inconclusive ultrasound is not adequate to rule out appendicitis and should be followed by CT scan. For pregnant patients, MRI is a reasonable alternative to CT scan. Nonoperative treatment with antibiotics is safe as an initial treatment of uncomplicated appendicitis, with a significant decrease in complications but a high failure rate. Open and laparoscopic appendectomies for appendicitis provide similar results overall, although the laparoscopic technique may be advantageous for obese and elderly patients but may be associated with a higher incidence of intraabdominal abscess. Preoperative diagnostic accuracy is of utmost importance during pregnancy because a negative appendectomy is associated with a significant incidence of fetal loss. The increased morbidity associated with appendectomy delay suggests that prompt surgical intervention remains the safest approach. Routine incidental appendectomy should not be performed except in selected cases. Interval appendectomy is not indicated because of considerable risks of complications and lack of any clinical benefit. Patients older than 40 years with an appendiceal mass or abscess treated nonoperatively should routinely have a colonoscopy as part of their follow-up to rule out cancer or alternative diagnosis.
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Affiliation(s)
- Pedro G R Teixeira
- Division of Trauma and Acute Care Surgery, LAC and USC Medical Center, University of Southern California, 2051 Marengo Street, IPT, Room C5L 100, Los Angeles, CA 90033-4525, USA
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Andrén-Sandberg A. Diagnosis and management of gallbladder cancer. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 4:293-9. [PMID: 22866265 PMCID: PMC3409652 DOI: 10.4103/1947-2714.98586] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gallbladder cancer (GBC) is a rather uncommon disease, but at the time when it gives symptoms it has usually reached no longer curable stage. Therefore, all attempts must be made to make the diagnosis earlier to have better opportunity for cure. The author searched PubMed, and reviewed literatures on diagnoses and treatment of GBC.
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Affiliation(s)
- Ake Andrén-Sandberg
- Department of Surgery, Karolinska Institute at Karolinska University Hospital, Huddinge, Stockholm, Sweden
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Lohsiriwat V. Hemorrhoids: From basic pathophysiology to clinical management. World J Gastroenterol 2012; 18:2009-17. [PMID: 22563187 PMCID: PMC3342598 DOI: 10.3748/wjg.v18.i17.2009] [Citation(s) in RCA: 231] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 01/10/2012] [Accepted: 02/08/2012] [Indexed: 02/06/2023] Open
Abstract
This review discusses the pathophysiology, epidemiology, risk factors, classification, clinical evaluation, and current non-operative and operative treatment of hemorrhoids. Hemorrhoids are defined as the symptomatic enlargement and distal displacement of the normal anal cushions. The most common symptom of hemorrhoids is rectal bleeding associated with bowel movement. The abnormal dilatation and distortion of the vascular channel, together with destructive changes in the supporting connective tissue within the anal cushion, is a paramount finding of hemorrhoids. It appears that the dysregulation of the vascular tone and vascular hyperplasia might play an important role in hemorrhoidal development, and could be a potential target for medical treatment. In most instances, hemorrhoids are treated conservatively, using many methods such as lifestyle modification, fiber supplement, suppository-delivered anti-inflammatory drugs, and administration of venotonic drugs. Non-operative approaches include sclerotherapy and, preferably, rubber band ligation. An operation is indicated when non-operative approaches have failed or complications have occurred. Several surgical approaches for treating hemorrhoids have been introduced including hemorrhoidectomy and stapled hemorrhoidopexy, but postoperative pain is invariable. Some of the surgical treatments potentially cause appreciable morbidity such as anal stricture and incontinence. The applications and outcomes of each treatment are thoroughly discussed.
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Agarwal AK, Kalayarasan R, Singh S, Javed A, Sakhuja P. All cholecystectomy specimens must be sent for histopathology to detect inapparent gallbladder cancer. HPB (Oxford) 2012; 14:269-73. [PMID: 22404266 PMCID: PMC3371214 DOI: 10.1111/j.1477-2574.2012.00443.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Traditionally, a gallbladder removed for presumed benign disease has been sent for histopathological examination (HPE), but this practice has been the subject of controversy. This study was undertaken to compare patients in whom gallbladder cancer (GBC) was diagnosed after cholecystectomy on HPE with GBC patients in whom the gallbladder was not sent for HPE and who therefore presented late with symptoms. METHODS A retrospective analysis of prospectively collected data for 170 GBC patients diagnosed after cholecystectomy was conducted. All patients presented to one centre during 2000-2011. These patients were divided into two groups based on the availability of histopathology reports: Group A included patients who presented early with HPE reports (n = 93), and Group B comprised patients who presented late with symptoms and without HPE reports (n = 77). RESULTS The median time to presentation in Group A was significantly lower than in Group B (29 days vs. 152 days; P < 0.001). Signs or symptoms suggestive of recurrence (pain, jaundice or gastric outlet obstruction) were present in four (4.3%) patients in Group A and all (100%) patients in Group B (P < 0.001). Patients deemed operable on preoperative evaluation included all (100%) patients in Group A and 38 (49.4%) patients in Group B (P < 0.0001). The overall resectability rate (69.9% vs. 7.8%) and median survival (54 months vs. 10 months) were significantly higher in Group A compared with Group B (P < 0.0001). CONCLUSIONS Patients in whom a cholecystectomy specimen was sent for HPE presented early, had a better R0 resection rate and longer overall survival. Hence, routine HPE of all cholecystectomy specimens should be performed.
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Affiliation(s)
- Anil K Agarwal
- Department of Gastrointestinal Surgery and Pathology, G. B. Pant Hospital and Maulana Azad Medical College, Delhi University, New Delhi, India.
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Khan RA, Ghani I, Chana RS. Routine histopathological examination of appendectomy specimens in children: is there any rationale? Pediatr Surg Int 2011; 27:1313-5. [PMID: 21614465 DOI: 10.1007/s00383-011-2926-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Primary carcinoma of the bowel is a rare malignancy in pediatric age group. The aim of the study was to assess the incidence of appendicular malignancies in children and the possibility of reducing the need for routine histopathological examination of appendix. MATERIALS AND METHODS In last 15 years, all the cases of appendectomies in children were analyzed. Retrospective analysis of the data was done to document the clinical presentation, diagnosis, outcome and histopathology reports of the specimen. The case files and operation notes were studied thoroughly in cases where HPR was positive for malignancy. RESULTS From July 1995 to June 2010, 595 appendectomies were done in children. Three cases of carcinoid tumor were detected. All were less than 1 cm and were on the tip of the appendix. There was no preoperative or intraoperative suspicion. CONCLUSION Routine histopathological analysis did not help in the management of any of the cases. Therefore, selective utilization of the already burdened histopathology section of the hospital would be more cost effective without affecting the patient outcome.
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Affiliation(s)
- Rizwan A Khan
- Unit of Pediatric Surgery, Department of Surgery, J. N. Medical College, AMU, Aligarh, India.
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Swank HA, Eshuis EJ, Ubbink DT, Bemelman WA. Is routine histopathological examination of appendectomy specimens useful? A systematic review of the literature. Colorectal Dis 2011; 13:1214-21. [PMID: 20958910 DOI: 10.1111/j.1463-1318.2010.02457.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AIM Histopathological examination of the appendix after appendectomy is routinely performed. The object of this systematic review is to determine whether routine histopathological examination of the appendix is justified. METHOD PubMed, EMBASE, Web of Science and the Cochrane library were searched without language restriction up to 1 October 2009. All articles that reported on the incidence of histopathologically proven aberrant appendiceal pathology were included. RESULTS Nineteen case series reported the incidence of a benign neoplasm [0.5%, weighted mean (WM)], malignant neoplasm (0.2%, WM) and other pathology (0-14%). Nine articles reported the sensitivity of the intra-operative findings to detect aberrant diagnoses. Parasitic infection was detected in 0-19%, endometriosis in 0% and granulomatosis in 0-11% of cases. Five articles addressed the consequences of aberrant pathology. Most patients with parasite infection, granulomatosis and malignant neoplasms underwent additional investigation or treatment, in contrast to patients with a benign neoplasm. CONCLUSION The incidence of unexpected findings in appendectomy specimens is low and the intra-operative diagnosis alone appears insufficient for identifying unexpected disease. The benefit of histopathology is studied inadequately. From the present available evidence, routine histopathology cannot be judged as useless.
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Affiliation(s)
- H A Swank
- Department of Surgery, Academic Medical Centre, Amsterdam, the Netherlands
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