1
|
Cheng L, Lashmanova N, Reddy SB, Yan L, Gattuso P. Histopathological Findings in Hernia Sacs: A Clinical and Pathological Review. Int J Surg Pathol 2024; 32:310-315. [PMID: 37291883 DOI: 10.1177/10668969231177706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Routine histopathological examination of hernia sac in adults remains a controversial topic. We undertook a retrospective study to assess possible clinical benefits of pathological examination of hernia sac specimens. Our pathology database between 1992 and 2020 was searched for adult specimens submitted as hernia sac. The clinical and pathological data of patients with abnormal histopathological findings were reviewed. There were 5424 hernia sac specimens (3722 inguinal, 1625 umbilical, and 77 femoral), 32/5424 (0.59%) with malignancies (28 epithelial and 4 lymphoid) and 25/32 were located in the umbilical region. Twelve out of twenty-five malignancies (48%) presented as primary clinical manifestations of the diseases (5 GI tract carcinomas, 5 gynecological tract carcinomas, and 2 lymphoid neoplasms); and 13/25 (52%) specimens were involved by previously known tumors (8 gynecological carcinomas, 3 colon carcinomas, 1 breast carcinoma, and 1 lymphoma). Among the 7 inguinal hernia sacs with malignancies, 3 (42.9%) were primary presentations of the tumors (2 prostatic carcinomas, 1 pancreatic carcinoma), and 4 (57.1%) were previously known tumors (2 ovarian carcinomas, 1 colon carcinoma, 1 lymphoid). Benign lesions were 12/5424 (0.22%), including 7 adrenal rests, 4 endometriosis, and 1 inguinal sarcoidosis. The incidence of hernia sacs with malignancies was 32/5424 (0.59%), most commonly from nearby organs in gynecological tract. However distant metastases from breast were also present. Near half of the hernia sac with malignancies (15/32, 47%) presented as the first clinical manifestation. Routine histopathological examination of hernia sac in adults is recommended, since it may provide important clinical information.
Collapse
Affiliation(s)
- Lin Cheng
- Department of Pathology, Rush University Medical Center, Chicago, USA
| | | | - Swathi B Reddy
- Department of Surgery, Rush University Medical Center, Chicago, USA
| | - Lei Yan
- Department of Pathology, Rush University Medical Center, Chicago, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, USA
| |
Collapse
|
2
|
Wang F, Ma B, Ma Q, Liu X. Global, regional, and national burden of inguinal, femoral, and abdominal hernias: a systematic analysis of prevalence, incidence, deaths, and DALYs with projections to 2030. Int J Surg 2024; 110:01279778-990000000-01010. [PMID: 38265437 PMCID: PMC11020045 DOI: 10.1097/js9.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/23/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Hernias, particularly inguinal, femoral, and abdominal, present a global health challenge. While the Global Burden of Disease (GBD) study offers insights, systematic analyses of hernias remain limited. This research utilizes the GBD dataset to explore hernia implications, combining current statistics with 2030 projections and frontier analysis. METHODS We analyzed data from the 2019 GBD Study, focusing on hernia-related metrics: prevalence, incidence, deaths, and disability-adjusted life years (DALYs) across 204 countries, grouped into 21 GBD regions by the SDI (SDI). Data analysis incorporated relative change calculations, Annual Percentage Change (APC), Average Annual Percentage Change (AAPC), and Joinpoint Regression Analysis. The study also employed frontier analysis and the Bayesian Age-Period-Cohort model for trend prediction up to 2030. Analyses utilized R version 4.2.3. RESULTS From 1990 to 2019, global hernia cases surged by 36%, reaching over 32.5 million, even as age-standardized rates declined. A similar pattern was seen in mortality and DALYs, with absolute figures rising but age-standardized rates decreasing. Gender data between 1990 and 2020 showed consistent male dominance in hernia prevalence, even as rates for both genders fell. Regionally, Andean Latin America had the highest prevalence, with Qatar and Bulgaria noting significant increases and decreases, respectively. Frontier analyses across 204 countries linked higher SDIs with reduced hernia prevalence. Yet, some high SDI countries, like Qatar and the UK, deviated unexpectedly. Predictions up to 2030 anticipate increasing hernia prevalence, predominantly in males, while death rates are expected to decline. DALYs, after declining, are stabilizing. CONCLUSIONS Our analysis reveals a complex interplay between socio-demographic factors and hernia trends, emphasizing the need for targeted healthcare interventions. Despite advancements, vigilance and continuous research are essential for optimal hernia management globally.
Collapse
Affiliation(s)
- Fan Wang
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing
| | - Bangzhen Ma
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, People’s Republic of China
| | - Qiuyue Ma
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing
| | - Xiaoli Liu
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Shijingshan District, Beijing
| |
Collapse
|
3
|
Gakuhara A, Fukuda S, Yoshihara T, Fukuda Y, Koga C, Haraguchi N, Hida JI, Wakasa T, Kimura Y. Endometrioid adenocarcinoma arising from inguinal endometriosis during follow-up for gastric cancer surgery: a case report and literature review. Int Cancer Conf J 2024; 13:68-73. [PMID: 38187179 PMCID: PMC10764678 DOI: 10.1007/s13691-023-00639-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/30/2023] [Indexed: 01/09/2024] Open
Abstract
Malignant transformation of inguinal endometriosis is rare. A 56-year-old woman underwent surgery for advanced gastric cancer 5 years ago and received postoperative adjuvant chemotherapy. She had no recurrence since then. However, 5 years after surgery, contrast-enhanced computed tomography (CT) showed a mass in the right inguinal region suspected to be a hydrocele of the canal of Nuck, with a blood test showing a slightly elevated CA19-9 level (63.0 U/mL). Six months later, CT showed an enlarged mass in the right inguinal region and inflammation in the surrounding area. In addition, both inguinal lymph nodes and those in the right iliac artery area were enlarged, suggesting the possibility of malignancy. For diagnostic purposes, a right inguinal mass was excised. Histopathological examination revealed that it was endometrioid adenocarcinoma with ectopic endometriois as the origin. The differential diagnoses for inguinal masses in women include an inguinal hernia, hydrocele of the canal of Nuck, ectopic endometriosis, lymphoma, and metastatic malignancy. The presence of a primary malignancy in the inguinal region is sporadic but must be differentiated. This is the first case of malignant transformation of inguinal endometriosis developed during postoperative follow-up of another cancer.
Collapse
Affiliation(s)
- Atsushi Gakuhara
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Shuichi Fukuda
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Terukazu Yoshihara
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Yasunari Fukuda
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Chikato Koga
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Naotsugu Haraguchi
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Jin-ichi Hida
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Tomoko Wakasa
- Department of Pathology, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara 630-0293 Japan
| | - Yutaka Kimura
- Department of Gastroenterological Surgery, Kindai University Nara Hospital, 1248-1, Otoda-cho, Ikoma, Nara 630-0293 Japan
| |
Collapse
|
4
|
Han Y, Huang L, Tian X, Liu J. Rare form of metastasis: lung cancer metastases to inguinal hernia sac detected by 18F-FDG PET/CT. Jpn J Clin Oncol 2022; 52:1353-1354. [PMID: 36037429 DOI: 10.1093/jjco/hyac130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yuping Han
- Department of Nuclear Medicine, Lanzhou University Second Hospital, Lanzhou, China
| | - Lele Huang
- Department of Nuclear Medicine, Lanzhou University Second Hospital, Lanzhou, China
| | - Xiaoxue Tian
- Department of Nuclear Medicine, Lanzhou University Second Hospital, Lanzhou, China
| | - Jiangyan Liu
- Department of Nuclear Medicine, Lanzhou University Second Hospital, Lanzhou, China
| |
Collapse
|
5
|
Surprise in hernia sacs: Malignant tumor metastasis. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.1031277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
6
|
Topal U, Gok M, Akyuz M, Oz AB, Arikan TB, Solak İ, Deniz K, Sozuer E. Is Histopathological Evaluation of Hernia Sacs Necessary? ARCHIVES OF IRANIAN MEDICINE 2020; 23:403-408. [PMID: 32536178 DOI: 10.34172/aim.2020.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/15/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Our aim was to investigate the pathologies in the hernia sac in adults, and the frequency of malignancy as well as to confirm the necessity of maintaining the current applications in histological examination of the hernia sac. METHODS Patients who were operated for hernia in our clinic from 2013 to 2019 were included in the study. Patient data were evaluated retrospectively. We divided the patients into four groups, according to the type of hernia. We evaluated the demographic characteristics of the patients, the pathologies within the hernia sac, histopathological examination outcomes of the hernia sac and clinical features of malignancy in patients with malignancy. RESULTS A total number of 556 adult patients underwent inguinal, femoral, umbilical or incisional hernia repair in our hospital. Nine patients (0.61%) had malignancy in the hernia sac. Three out of nine patients (33%) had no preoperative diagnosis of malignancy. Six patients (67%) had a known history of malignancy. Two tumors were located in the inguinal (22.0%), six tumors in the incisional (67%), and one in the umbilical (11%) hernia sacs. Among these, 56% were of gastrointestinal, 22% of gynecological, 11% of breast and 11% of epididymis origin. Most of the other pathologies found in the hernia sac were herniated bowel segments, lipomas and omentum. CONCLUSION Since the hernia sac might be the first clue for an underlying cancer, if abnormal pathological findings are detected during surgery, histopathological examination should be performed to exclude malignancy. The purpose of histological examination is to detect a hidden malignancy.
Collapse
Affiliation(s)
- Ugur Topal
- Department of General Surgery, Erciyes University Medical Faculty, Melikgazi, Kayseri, Turkey.,Department of Surgical Oncology, Erciyes University Medical Faculty, Melikgazi, Kayseri, Turkey
| | - Mustafa Gok
- Department of General Surgery, Erciyes University Medical Faculty, Melikgazi, Kayseri, Turkey
| | - Muhammet Akyuz
- Department of General Surgery, Erciyes University Medical Faculty, Melikgazi, Kayseri, Turkey
| | - Abdullah Bahadir Oz
- Department of General Surgery, Erciyes University Medical Faculty, Melikgazi, Kayseri, Turkey
| | - Turkmen Bahadir Arikan
- Department of General Surgery, Erciyes University Medical Faculty, Melikgazi, Kayseri, Turkey
| | - İsmail Solak
- Department of General Surgery, Erciyes University Medical Faculty, Melikgazi, Kayseri, Turkey
| | - Kemal Deniz
- Department of Pathology, Erciyes University Medical Faculty, Melikgazi, Kayseri, Turkey
| | - Erdogan Sozuer
- Department of General Surgery, Erciyes University Medical Faculty, Melikgazi, Kayseri, Turkey.,Department of Surgical Oncology, Erciyes University Medical Faculty, Melikgazi, Kayseri, Turkey
| |
Collapse
|
7
|
Kazerouni A, Nowak KM, Serra S, Vajpeyi R, Chieu K, Chetty R. Review of pathology and cost benefit analysis of hernia sacs processed over a 19-year period. J Clin Pathol 2020; 73:737-740. [PMID: 32220942 DOI: 10.1136/jclinpath-2020-206519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/13/2020] [Accepted: 03/18/2020] [Indexed: 11/04/2022]
Abstract
AIM Hernia sacs with pathological evaluation over a 19-year period were analysed with regards to pathological diagnoses, full costing and the impact on patient management. MATERIALS AND METHODS The database of the Department of Pathology were searched over the study period (2001 to 2019 inclusive) for hernia sacs. The total cost of complete pathology examination was calculated on average numbers and rates of pay that existed over the study period. RESULTS A total of 3619 hernia sacs from the abdominal, hiatus/diaphragmatic, inguinal and femoral hernias were retrieved. Of these 3592 cases (99.25%) had sections taken for histological evaluation. A total of 3437 cases representing 95.7% of all hernia sacs did not show any pathological abnormality. If non-neoplastic clinically insignificant lesions seen in hernia sacs is included, then 3552 of 3592 (98.9%) hernia sacs underwent full pathological evaluation for no patient benefit.On average two blocks or tissue sections per case were processed incurring a technical cost of $53 175.00. The total pathologist cost in reporting the 3592 cases was approximately $39 870.00 and rose to $40 410.00 when interpretation of ancillary tests was factored in. $95 328.90 (average $26.90 per specimen with a yearly average total cost of $5 017.31) was spent over the 19-year period in full pathological examination of 3592 hernia sacs. CONCLUSION Given the low return on investment and the difficult to quantify time savings and reallocation, we do not advocate the routine sampling of hernia sacs. Gross examination will suffice in 99% of the cases. Selective cases may be sampled if clinically indicated.
Collapse
Affiliation(s)
- Arshia Kazerouni
- Department of Pathology, University Health Network Laboratory Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Klaudia M Nowak
- Department of Pathology, University Health Network Laboratory Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Stefano Serra
- Department of Pathology, University Health Network Laboratory Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Rajkumar Vajpeyi
- Department of Pathology, University Health Network Laboratory Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Kenny Chieu
- Department of Pathology, University Health Network Laboratory Medicine Program, University of Toronto, Toronto, Ontario, Canada
| | - Runjan Chetty
- Department of Pathology, University Health Network Laboratory Medicine Program, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
8
|
Val-Bernal JF, Mayorga M, Val D, Garijo MF. Low-grade serous primary peritoneal carcinoma incidentally found in a hernia sac. Pathol Res Pract 2015; 211:550-5. [PMID: 25953339 DOI: 10.1016/j.prp.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 02/23/2015] [Accepted: 04/08/2015] [Indexed: 01/05/2023]
Abstract
Very rarely, a primary peritoneal serous carcinoma can be observed in a hernia sac. We herein describe a low-grade serous primary peritoneal carcinoma incidentally found in a postmenopausal woman following examination of the femoral hernia repair sac. Our case is significant for its unusual presentation. The lesion initially appeared as a 0.3-cm tumor that disseminated in the peritoneum, persisted, and progressed for 75 months. The absence of ovarian disease indicated a primary peritoneal origin. Tumor cells were immunohistochemically positive for PAX8, claudin-4, and VE1, excluding the possibility of being of mesothelial origin. Recognition that a low-grade serous primary peritoneal carcinoma can be incidentally found in a hernia sac should simplify future diagnoses. Immunohistochemistry is helpful in making the correct diagnosis.
Collapse
Affiliation(s)
- José-Fernando Val-Bernal
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IDIVAL, Santander, Spain.
| | - Marta Mayorga
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IDIVAL, Santander, Spain
| | - Daniel Val
- Laboratoire National de Santé, Division d́Anatomie Pathologique, Dudelange, Luxembourg
| | - María-Francisca Garijo
- Anatomical Pathology Department, Marqués de Valdecilla University Hospital, Medical Faculty, University of Cantabria and IDIVAL, Santander, Spain
| |
Collapse
|
9
|
Beecher SM, O'Leary DP, McLaughlin R. Metastatic ovarian carcinoma presenting as an incarcerated femoral hernia. Int J Surg Case Rep 2015; 11:53-55. [PMID: 25931301 PMCID: PMC4446680 DOI: 10.1016/j.ijscr.2015.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/20/2015] [Accepted: 04/20/2015] [Indexed: 11/25/2022] Open
Abstract
Occasionally unusual abdominal structures may be found within the hernia sacs. Abdominal malignancies have the potential to seed any part of the peritoneum. Surgeons should be vigilant where there is a known intra-abdominal malignancy & the presence of an incarcerated hernia.
Introduction Incarcerated femoral hernias usually contain a simple loop of bowel. Occasionally other abdominal structures may be found within the hernial sac. Rarely femoral hernias may contain metastatic tumour deposits. Presentation of case We report the case of an 82 year old lady with a background of ovarian carcinoma, who presented with acute small bowel obstruction and an irreducible right groin mass. CT imaging revealed an incarcerated loop of small bowel within a femoral hernia sac. The patient proceeded to theatre for hernia repair. Upon opening the hernial sac an adherent incarcerated small bowel loop was discovered. Interestingly, the sac itself was lined with metastatic deposits, which were later histologically proven to be ovarian in origin. The sac was reduced and the hernia was repaired. The patient’s post-operative course was uneventful. Discussion As abdominal wall hernias communicate with the abdominal cavity there is the potential for malignant cells to seed the peritoneal lining of the hernia sac. If the sac also contains bowel wall, this may become involved in the tumour mass. This may result in small bowel incarceration & obstruction. Conclusion In cases, where there is a known intra-abdominal malignancy & the presence of an incarcerated hernia, there should be a high index of suspicion for the presence of tumour within the hernial contents.
Collapse
Affiliation(s)
- Suzanne M Beecher
- Department of Surgery, University College Hospital Galway, Galway, Ireland.
| | | | - Ray McLaughlin
- Department of Surgery, University College Hospital Galway, Galway, Ireland
| |
Collapse
|