Hemorrhoidectomy Specimens: Necessity for Routine Pathologic Evaluation

ABSTRACT

PURPOSE: The aim of this study was to determine the necessity for routine pathologic evaluation of hemorrhoidectomy specimens. METHODS: Between March 1998 and February 2001, 280 patients (185 males, 95 females) underwent a hemorrhoidectomy at Seoul National University Hospital. All patients had grade III~IV hemorrhoids, and the mean age of the patients was 51 years (range 21~74 years). All hemorrhoidectomy specimens were examined with a hematoxylin and eosin stain of one representative section by a pathologist. We performed a retrospective analysis regarding the pathologic results for the hemorrhoidectomy specimens. RESULTS: Two hundred sixty-seven specimens (267, 95.4%) had typical hemorrhoids reported as external and internal hemorrhoids, external hemorrhoids, hemorrhoidal varices, and thrombi. Ten patients (10, 3.2%) had additional benign pathologes such as fibroepithelial polyps (6 cases), a flat condyloma (1 case), hypertrophied papillae with a condyloma, like papillomatosis and keratosis (1 case), dyskeratotic squamous cells with koilocytotic atypia (1 case), and an inflammatory polyp (1 case). Interestingly, three patients (3, 1.1%) had carcinomas in the hemorrhoidectomy specimens. Two patients had squamous- cell carcinomas; one suffered from delayed wound healing after a previous hemorrhoidectomy, and the other had indurated lesions on the hemorrhoids. One patients who had under gone a low anterior resection due to stage-C rectal cancer 7 months before had a adenocarcinoma. CONCLUSIONS: Because of the possibility of unsuspected anal cancer, we recommend pathologic examination of hemorr hoidectomy specimens, especially in cases of suspected indurated lesions within the hemorrhoids, delayed wound healing after a previous hemorrhoidectomy, or previous history of colon cancer.