Is Histopathological Evaluation of Hernia Sacs Necessary?

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

Presentación de emergencia de las hernias de la pared abdominal: factores que afectan las resecciones y las complicaciones del sitio quirúrgico en escenarios agudos complejos

“…There are plenty of surgical repair modalities, whether laparoscopic or open technique of AWH [17][18][19][20] . The hernia sac may contain different tissues varying from any abdominal tissue to metastasis of any malignant tissue 21,22 . The literature mentions that an inguinal hernia's incarceration probability is 4.5% for 2 years after diagnosis.…”

Rectal Metastases of Breast Carcinoma: A Case Report

“…Researchers found the histopathological study of excised hernia sacs giving first clues for extra-abdominal cancer with GI metastasis, like the breast lobular adenocarcinoma. 13 Exceedingly rarely, metastatic breast cancer gives origin to carcinomatous peritonitis. 5 If one considers the analysis of hernia sacs allowing the investigation of peritoneal seeding or invasion, microscopic study of all abdominal wall hernia seems beneficial.…”

“…5 If one considers the analysis of hernia sacs allowing the investigation of peritoneal seeding or invasion, microscopic study of all abdominal wall hernia seems beneficial. 13 MRI images contribute to distinguishing primary rectal carcinoma from GI metastasis. Concentric mural thickening with involvement of the submucosa and muscularis propria and sparing of the rectal mucosa are not usually found in primary rectal cancer.…”

Surprise in hernia sacs: Malignant tumor metastasis

“…Malignant tumor in the hernia sac may occur as a metastasis or the secondary involvement of another cancer. Most metastatic tumors are malignant epithelial tumors, and colorectal carcinoma metastasis is most frequently observed in the hernia sac [1][2][3][4][5][6]. Metastases originating from ovarian, prostate, pancreatic, appendix, peritoneum, endometrium, and stomach cancers have also been reported [1][2][3][4][7][8][9][10][11][12][13][14].…”

“…Most metastatic tumors are malignant epithelial tumors, and colorectal carcinoma metastasis is most frequently observed in the hernia sac [1][2][3][4][5][6]. Metastases originating from ovarian, prostate, pancreatic, appendix, peritoneum, endometrium, and stomach cancers have also been reported [1][2][3][4][7][8][9][10][11][12][13][14]. Rarely, the hernia sac may be the first presentation of an unknown malignancy.…”