Routine histopathologic examination of two common surgical specimens-appendix and gallbladder: is it a waste of expertise and hospital resources?

This study was undertaken to assess whether a routine histopathologic examination of two common surgical specimens (appendix and gallbladder) is needed and whether routine histopathologic examination has an impact on further management of patients. Histopathology reports of patients who had undergone appendicectomy and cholecystectomy, between 2006 and 2010, were analyzed retrospectively in the department of pathology of a tertiary care hospital. The case notes were retrieved in all cases of malignancies. Patients having a clinical diagnosis or suspicion of malignancy were excluded. The incidence and impact of unexpected pathologic diagnosis on postoperative management were noted. The study period included a total of 1,123 and 711 appendicectomy and cholecystectomy specimens, respectively. Fifteen (1.336 %) cases of appendicectomy specimens revealed incidental unexpected pathological diagnoses, which included tubercular appendicitis (n = 2), parasite (n = 8), neuroma (n = 1), carcinoid (n = 2), pseudomyxoma (n = 1), and adenocarcinoma (n = 1). About 88 % of such unexpected appendiceal findings had an impact on postoperative treatment. Unexpected pathologic gallbladder findings were found in 12 (1.68 %) of 711 cholecystectomy specimens. In 6 (0.84 %) cases, gallbladder cancer (GBC) was detected. Additional further management was required in 50 % of patients with unexpected gallbladder findings. Twenty of the total 1,834 specimens (1.090 %) had an impact on patient management or outcome and were not suspected on macroscopic examination at the time of surgery. These would have been missed had the specimens not been examined microscopically. The intraoperative diagnosis of the surgeon is therefore sometimes doubtful in detecting abnormalities of the appendix and gallbladder. This study supports the sending of all appendicectomy and cholecystectomy specimens for routine histopathological examination. Appendix and gallbladder should undergo routine histopathological examination. This is important in patients with advanced age and gallstones. Also, it is of great value in identifying unsuspected conditions which require further postoperative management. Selectively sending specimens for histopathological examination can result in reduced workload on the histopathology department without compromising patient safety.

Mesenchymal chondrosarcoma of the cervical spine: A case report.

Mesenchymal chondrosarcoma (MCS) is a rare tumour accounting for less than 1% of all chondrosarcomas. We report here, the case of a 30-year-old female who presented with neck pain, weakness and tingling and numbness starting on the right side and later involving all four limbs. MRI revealed an ill-defined neoplastic lesion showing specks of calcification and arising from the right half of C2 and C3 cervical vertebrae. Microscopy showed an admixture of well differentiated cartilage showing focal calcification and spindly cell areas having a hemangiopericytomatous pattern.

Anaplastic thyroid carcinoma with osteoclast-like giant cells.

A case of anaplastic thyroid carcinoma with osteoclast-like giant cells is reported. This is an unusual malignant thyroid neoplasm with morphologic resemblance to giant cell tumor of bone. Light microscopy disclosed an undifferentiated carcinoma. Pleomorphic cells and tumour giant cells were accompanied by numerous osteoclast-like multinucleated giant cells.