Pathology service and practice: solo-practice pathologist in a community hospital in Japan: personal experience and a proposal for cost- and time-effective practice

Routine histopathologic examination of "benign" anal lesions: is it necessary?

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.

Value of routine histopathologic examination of three common surgical specimens: appendix, gallbladder, and hemorrhoid

BACKGROUND

The purpose of this study was to assess the need for a routine histopathologic examination of three common surgical specimens (appendix, gallbladder, hemorrhoid) and its impact on the further management of the patients.

METHODS

Histopathologic reports of patients undergoing appendectomy, cholecystectomy, or hemorrhoidectomy performed between 1998 and 2006 in the Faculty of Medicine, Siriraj Hospital were reviewed. The reports were excluded if patients had a clinical diagnosis or suspicion of malignancy. The incidence of unexpected pathologic diagnoses and their impact on postoperative management were evaluated.

RESULTS

Of 4545 appendectomy specimens, 44 (0.97%) revealed incidental unexpected pathological diagnoses, including one adenocarcinoma and one primary appendiceal lymphoma. About one-fifth of such unexpected appendiceal findings had an impact on postoperative treatment. Unexpected pathologic gallbladder findings were found in 88 (2%) of 4317 cholecystectomy specimens. Gallbladder cancer (GBC) was detected in 24 specimens (0.56%). A clinical diagnosis of empyema and patient's age over 60 years were two significant risk factors for an unexpected GBC [odds ratio (OR) 11.0, 95% confidence interval (CI) 4.2-29.2 and OR 6.2, 95% CI 2.1-18.2, respectively]. About one-fourth of patients with unexpected gallbladder findings required further management. Of 914 hemorrhoidectomy specimens, there were 13 (1.4%) histologic abnormalities other than the usually expected lesions in hemorrhoids. None of these altered postoperative management.

CONCLUSIONS

The routine histopathology examination of the appendix and gallbladder, particularly in cases of empyema and patient's age over 60 years, is of value for identifying unsuspected conditions requiring further postoperative management. However, routine histopathologic evaluation of the hemorrhoid seems unnecessary.