Value of Routine Histopathologic Examination of Three Common Surgical Specimens: Appendix, Gallbladder, and Hemorrhoid

Lohsiriwat, Varut; Vongjirad, A; Lohsiriwat, Darin

doi:10.1007/s00268-009-0164-6

Cited by 74 publications

(57 citation statements)

References 24 publications

(37 reference statements)

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“…10,11 Other studies advocate routine histological examination of all specimens as the safest approach. 5,12,13 In view of this disagreement in the literature, our study sought to determine the frequency of IGBC in our institution and to establish whether selective histological examination of macroscopically abnormal specimens only would have detected these cancers. Secondary aims were to present the treatment given to patients with IGBC in our institution and to estimate the economic impact of a selective approach to gallbladder histology.…”

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confidence: 99%

Routine versus selective histological examination after cholecystectomy to exclude incidental gallbladder carcinoma

Barrett

Gilliam

et al. 2015

annals

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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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Routine versus selective histological examination after cholecystectomy to exclude incidental gallbladder carcinoma

Barrett

Gilliam

et al. 2015

annals

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“…Akbulut et al, reported unusual histological findings in 54 of 5462 (1%) appendectomy specimens; 37 enterobiasis, 6 carcinoids, 4 mucinous cystadenomas, 2 eosinophilic infiltrations, 2 mucoceles, 2 tuberculosis, and 1 neurogenic hyperplasia [4]. An examination of 4545 appendectomy specimens, performed for acute appendicitis, showed 44 (0.97%) unexpected tumours of appendix including an adenocarcinoma and a primary lymphoma of the appendix [5]. Another series analysed histological reports of 324 appendectomy specimens and reported 8 unexpected lesions [6].…”

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Do We Still Need to Perform Routine Histological Examination of Appendectomy Specimens?

Guraya¹

2015

JCDR

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Appendiceal cancer is exceedingly rare,accounting for 0.5% of all gastrointestinal neoplasms with the age-adjusted incidence of 0.12 case per 1,000,000 people per year [1]. Owing to its vague and bizarre presentations, primary appendiceal cancer cannot be diagnosed preoperatively and is diagnosed in only 0.9%-1.4% of appendectomy specimens. Carcinoid tumours have been reported to be the most frequent primary tumours of appendix, accounting for 32%-85% of all appendiceal tumours, followed by adenocarcinomas that comprise further 4%-6% of tumours [2]. Appendiceal adenocarcinomas are extremely aggressive tumours behaving similar to that of colonic adenocarcinomas, requiring right hemicolectomy for curative intent.A retrospective study showed 10 cases of adenocarcinoma of the appendix from a total of 9323 appendectomies [Table/ Fig-1] (0.1%: 8 men and 2 women with a mean age of 53.1 years) [3]. Akbulut et al., reported unusual histological findings in 54 of 5462 (1%) appendectomy specimens; 37 enterobiasis, 6 carcinoids, 4 mucinous cystadenomas, 2 eosinophilic infiltrations, 2 mucoceles, 2 tuberculosis, and 1 neurogenic hyperplasia [4]. An examination of 4545 appendectomy specimens, performed for acute appendicitis, showed 44 (0.97%) unexpected tumours of appendix including an adenocarcinoma and a primary lymphoma of the appendix [5]. Another series analysed histological reports of 324 appendectomy specimens and reported 8 unexpected lesions [6]. The study concluded that surgeons should bear in mind the possibility of unusual pathologies justifying the need for the routine Surgery SectionDo We Still Need to Perform Routine Histological Examination of Appendectomy Specimens?histopathological examination of appendices. Meticulous attention to the gross operative findings such as abnormally hard part of appendix, grossly visible/palpable lymph nodes in peri-appendiceal region, and the arrangements for frozen-section during surgery can help identify the tumours at an earlier stage.Although fecoliths and lymphoid hyperplasia are the common aetiologies of acute appendicitis, some rare but vitally fatal lesions may also cause appendicitis. On the same note, intraoperative observations alone are not enough to identify the unexpected disease. The most frequent unusual findings in appendectomy specimens are parasites and benign or malignant tumours. Although the routine histological examination of appendectomy specimens poses a burden on the financial and technical resources, current research strongly justifies this practice. There is a need for routine histopathologic examination of the appendectomy specimens. The histologic examination is valuable in identifying unexpected conditions which may require further management depending on the nature of the disease process. Specimens from patients with suspected acute appendicitis may exhibit a myriad of histological variations including cancerous growths [7]. With increasing emphasis on cost-effectiveness in surgery, routine pathological examination of appendectomy specimens, alt...

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“…5,19 Reports on 'selective pathology' based on perioperative visual macroscopic examination of the gallbladder has been documented for several years. In 1998, Taylor and Huang discussed how routine pathological examination of gallbladder is pointless: they proposed selective evaluation according to macroscopic examination.…”

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Incidental findings during routine pathological evaluation of gallbladder specimens: review of 1,747 elective laparoscopic cholecystectomy cases

Başak

Hasbahçeci

Canbak

et al. 2016

annals

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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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Value of Routine Histopathologic Examination of Three Common Surgical Specimens: Appendix, Gallbladder, and Hemorrhoid

Cited by 74 publications

References 24 publications

Routine versus selective histological examination after cholecystectomy to exclude incidental gallbladder carcinoma

Routine versus selective histological examination after cholecystectomy to exclude incidental gallbladder carcinoma

Do We Still Need to Perform Routine Histological Examination of Appendectomy Specimens?

Incidental findings during routine pathological evaluation of gallbladder specimens: review of 1,747 elective laparoscopic cholecystectomy cases

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