Vacuoles in the Breast: A Histologic Clue for an Unusual Presentation of an Atypical Organism.

Infections with nontuberculous mycobacteria (NTM) are increasing in prevalence worldwide, and this group of organisms is emerging as significant clinical pathogens. We present a case of a 58-year-old female with persistent furuncles of the breast who was found to have an NTM infection. This case is unique for the lack of risk factors for NTM in the patient's history, the location of the infection in the breast, and the close cooperation needed across disciplines to arrive at the diagnosis. This multi-disciplinary discussion considers the classic clinical presentation of NTM, it is a characteristic morphological appearance on histopathology, the differential diagnosis, treatment, and the ultimate outcome of the case. This case report and discussion will assist both clinicians and pathologists in the diagnosis of this important infectious disease.

A case of mitochondrial myopathy and chronic progressive external ophthalmoplegia. / çº¿ç²’ä½“è‚Œç— åˆå¹¶æ ¢æ€§è¿›è¡Œæ€§çœ¼å¤–è‚Œéº»ç—¹1例（英文）.

Mitochondrial myopathy is a group of multi-system diseases in which mitochondrial DNA (mtDNA) or nuclear DNA (nDNA) defects lead to structural and functional dysfunction of mitochondria. The clinical manifestations of mitochondrial myopathy are complex and varied, and the testing for mtDNA and nDNA is not widely available, so misdiagnosis or missed diagnosis is common. Chronic progressive external ophthalmoplegia (CPEO) is a common type of mitochondrial myopathy, which is characterized by blepharoptosis. Here we report a 38-year-old female with mitochondrial myopathy presented with chronic numbness and weakness of the limbs, accompanied by blepharoptosis that was recently noticed. Laboratory and head magnetic resonance imaging (MRI) examinations showed no obvious abnormalities. Muscle and nerve biopsies showed characteristic ragged red fibers (RRFs) and large aggregates of denatured mitochondria. Testing for mtDNA and nDNA showed a known mutation c.2857C>T (p.R953C) and a novel variant c.2391G>C (p.M797I) in the polymerase gamma (POLG)gene, so the patient was diagnosed as mitochondrial myopathy. Clinicians should pay more attention to long-term unexplained skeletal muscle diseases with recent onset blepharoptosis. Histopathologic examination and genetic testing are of great value in the early diagnosis and therapeutic intervention.

Radiohistologic Comparison Study of Temporal Bone Specimens After Cochlear Implant Electrode Array Insertion: Is Cone-Beam CT Superior to MDCT?

OBJECTIVE. The purpose of this article is to evaluate subjective image quality and diagnostic accuracy to determine cochlear implant (CI) electrode position in a temporal bone (TB) specimen on cone-beam CT (CBCT) versus MDCT. MATERIALS AND METHODS. In this retrospective study, two radiologists independently reviewed CBCT (96-kV and 120-kV settings) and MDCT images of 20 TB specimens after electrode implantation. Qualitative evaluation of bone structures of the otic capsule, inner and outer cochlear wall, osseous spiral lamina, electrode position relative to the osseous spiral lamina, visualization of single electrode contacts on the array, metal artifacts, and overall image quality was performed using a five-point scale. Intracochlear electrode position was subsequently correlated with histologic examination. RESULTS. Radiologic assessment of bone structures of the otic capsule, the cochlear wall (except the outer part), osseous spiral lamina, electrode position, visualization of single electrode contacts on the array, metal artifacts, and overall image quality were significantly higher in CBCT compared with MDCT (maximum p = .04). No significant differences were found between CBCT at 96 kV and 120 kV (minimum p = .21). The intracochlear electrode position with histologic correlation was correctly diagnosed in 100% and 97.5% of specimens on 120-kV and 96-kV CBCT, respectively, whereas 77.5% were correctly assessed using MDCT. CONCLUSION. The data suggest that CBCT shows a higher diagnostic accuracy in TB specimen imaging after CI compared with MDCT, in particular to determine the intracochlear localization of the implant.

Method for adequate macroscopic gallbladder examination after cholecystectomy.

BACKGROUND AND AIMS: There is no clear guideline nor protocol for macroscopic examination of the gallbladder, leaving surgeons extemporaneous in regard of gallbladder examination in selective histopathologic policy. The purpose of this article is to describe a surgical approach for adequate macroscopic inspection of the gallbladder. MATERIALS AND METHODS: The described practical method was developed in collaboration between surgeons and pathologists. This method was introduced in 2011 and implemented in 2012. We retrospectively reviewed the number of cholecystectomies and number of histopathologic examinations between 2006 and 2017, using our own patient database. We used the Netherlands Cancer Registry (NCR) to examine the incidence of gallbladder cancer patients before and after implementation of the selective policy in our hospital. In addition to the method, we depict several frequent macroscopic abnormalities in order to provide some examples for surgical colleagues. RESULTS: Since implementation of the selective policy, 2271 surgical macroscopic gallbladder examinations were performed. As a result, we observed a significant decrease from 83% in 2012 to 38% in 2017, in histopathologic examination of the gallbladder following cholecystectomy. We observed a stable trend of gallbladder carcinoma in the same period (0.17%, n = 4 during 2006-2011 and 0.26%, n = 6 during 2012-2017). CONCLUSION: A simple, valid and easy method is described for future macroscopic analysis by the surgeon following a cholecystectomy.

Gastric Histopathologic Findings in South Italian Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: Is Histopathologic Examination of All Resected Gastric Specimens Necessary?

BACKGROUND: The value of the routine histopathologic examination of resected gastric remnants following laparoscopic sleeve gastrectomy (LSG) remains to be controversial. This study aimed to determine whether the routine histopathologic examination of gastric specimens is necessary for all patients undergoing LSG if upper gastrointestinal endoscopy (UGIE) plus multiple biopsies are performed routinely during the preoperative work-up. MATERIALS AND METHODS: Clinicopathologic data of 474 patients who underwent LSG were analysed. Types of histopathologic findings in LSG specimens and the prevalence of these and Helicobacter pylori (HP) infection were estimated. Comparisons were conducted to assess the association of risk factors with the most frequent abnormal and premalignant histopathologic findings. RESULTS: Chronic gastritis was the most common gastric pathology (63.5%) and premalignant lesions were present in 7.8% of the specimens. The prevalence of HP infection was 36.9%. A statistically significant association was observed between HP infection and chronic gastritis (P = .000), and premalignant lesions (P = .000). Similarly, a statistically significant association was noted between age and premalignant gastric lesions (P = .000). CONCLUSION: Histopathologic examination of LSG specimens may not be routinely needed and can be performed on selected patients. While we recommend routine preoperative UGIE in all LSG-treated patients, we suggest that histopathologic assessment of the LSG specimens should be mandatory when UGIE biopsies demonstrate HP infection and/or premalignant lesions, in all patients older than 42 years, and in cases of intraoperative detection of incidental tumours or suspicious lesions.

Histological examination of the gallbladder following routine cholecystectomy? A selective analysis is justified.

BACKGROUND: It was hitherto common practice to analyse each removed gallbladder for the presence of gall bladder cancer (GBC) although this approach may be questioned. The aim of this study was to determine whether a policy of selective histopathological analysis (Sel-HPA) is oncologically safe and cost effective. METHODS: This retrospective study was conducted in a single Dutch teaching hospital. Immediately following cholecystectomy, the surgeon decided on the basis of inspection and palpation whether histological examination was indicated. The Dutch Comprehensive Cancer Organisation (IKNL) registry was used to identify the number of GBC during this time period. RESULTS: Of 2271 patients who underwent a cholecystectomy in our institution between January 2012 and December 2017, 1083 (47.7%) were deemed indicated for histopathological analysis. Sixteen pathological gallbladders (1.5%) were identified in that period (intestinal metaplasia, n = 3; low grade dysplasia n = 7; carcinoma n = 6). During follow-up, no patient was found to have GBC recurrence in the population whose gallbladder was not sent for pathology (52.3%, n = 1188, median 49 months of follow up). The percentage of gallbladders that were analysed decreased over the six years of observation from 83% to 38%. Our policy of Sel-HP saved over €65 000. CONCLUSIONS: A policy of selective histopathology after cholecystectomy is oncologically safe and reduces costs.

Prevalence of HPV-16/18 genotypes and immediate histopathologic correlation results in a Chinese population with negative cytology and positive high-risk HPV testing.

BACKGROUND: The objective of this study was to examine the prevalence of human papillomavirus 16/18 (HPV-16/18) genotypes and immediate histopathologic correlations in a Chinese population with negative cytology and positive high-risk human papillomavirus (hrHPV) testing. METHODS: Patients who had documented negative cytology with immediate follow-up (within the 6 months after negative for intraepithelial lesion or malignancy Papanicolaou [Pap] testing), including a histopathologic examination and/or hrHPV testing, between 2011 and 2018 were included, and the data were analyzed. RESULTS: Among 1,424,182 Pap tests, 1,333,453 (93.6%) were interpreted as negative cytology. Although conventional Pap smears had the highest reporting rate, cervical intraepithelial neoplasia 2 and higher (CIN-2+) lesions were detected significantly more with liquid-based cytology preparations (2.1%) than the conventional method (1.4%; P < .01). The overall hrHPV-positive rate was 14.9% (25,507 of 171,273) in the women with negative cytology. Among the 18,423 cytology-negative, HPV-positive cases tested with the Cobas assay, the overall HPV-16/18 prevalence was 24.7%, with 17.9% being HPV-16-positive, 6.2% being HPV-18-positive, and 0.6% being positive for both HPV-16 and HPV-18. The immediate histopathologic examination was documented for 21,796 women with cotesting results, including 8915 HPV-positive cases and 12,881 HPV-negative cases. CIN-2+ lesions were diagnosed in 15.2% of the HPV-16-positive cases; this rate was significantly higher than the rates seen in the HPV-18-positive cases (4.8%) and the cases positive for 1 of the other 12 types of HPV (3.0%). CONCLUSIONS: This is by far the largest routine clinical practice report of HPV-16/18 genotyping and histopathologic examination in negative-cytology women and the first report of such an investigation in the Chinese population. This study indicates enhanced risk stratification with HPV-16/18 genotype testing in HPV-positive, cytology-negative women in the Chinese population.

Granular cell tumor presenting as an intraocular mass: a case report.

BACKGROUND: Granular cell tumor (GCT) can arise in any location in the body and present as a solitary, slow-growing, painless mass. However, GCT rarely affects the orbit. We report a Chinese girl who presented with an intraocular mass, and in whom a biopsy led to a diagnosis of GCT. CASE PRESENTATION: A 5-year-old Chinese girl exhibited exotropia in her right eye for 2 years and had been losing her vision for 6 months. The visual acuity in the right eye revealed no light perception. A fundus examination showed a large, yellowish-white, elevated, subretinal mass lesion in front of and inferior to the disc, with hemi-inferior-quadrant retinal detachment. The retina was greyish-yellow with scattered yellow spots. A vitrectomy with neoplasm resection was performed. A histopathologic examination revealed a GCT. The tumor cells were positive for CD68, NSE, S-100, and CD163 expression but negative for GFAP, Syn, and CD123 expression. The Ki-67 index was 1%. The right eye remained stable with visual acuity of no light perception at a 2-years follow-up. CONCLUSION: Intraocular GCT can present as a yellow-white solid mass with no calcification. Although intraocular GCT is very rare, it can lead to devastating visual loss. Intraocular GCT should be kept in mind and considered in clinical practice.

Outcome of Surgical Inspection of the Gallbladder in Relation to Final Pathology.

INTRODUCTION: Routine histopathologic gallbladder examination after cholecystectomy has been a point of discussion. The aim of this study was to evaluate the macroscopic examination by the surgeon in relation to the final histology. METHODS: A prospective study was conducted to investigate the practice of macroscopic gallbladder examination by a surgeon compared to routine histopathology by a pathologist. All consecutive cholecystectomies were included between November 2009 and February 2011. RESULTS: A total of 319 consecutive cholecystectomies were performed. Of all macroscopic examinations, the surgeon identified 62 gallbladders with macroscopic abnormalities, ranging from polyps to wall thickening or ulcers. In 55 (17.2%) cases, the surgeon judged that further examination of the specimen by the pathologist could possibly lead to additional and relevant findings. There was a strong agreement between the surgeon and the pathologist concerning the macroscopic examination (κappa = 0.822). The surgeon and the pathologist had disagreement on the macroscopic examination of 18 gallbladders, without clinical consequences for the patient. DISCUSSION: The present prospective study shows that the surgeon should be able to select those gallbladders needing a microscopic gallbladder examination. Potentially, about 80% of this kind of routine histology can be reduced.

Characteristics of cervical disease among symptomatic women with histopathological sample at Hawassa University referral hospital, Southern Ethiopia.

BACKGROUND: Cervical cancer is one of the most common cancers of women in developing countries. It is also eminent cause of mortality and morbidity in women worldwide. Symptoms usually develop when the cancer has become invasive and invade nearby tissue. This has significant effect on treatment of cases in area where there is limited awareness. The aim of this study is to describe cervical disease among symptomatic women with a histhological sample at Hawassa University referral hospital, southern Ethiopia. METHODS: Five years retrospective histopathological characteristics of symptomatic cervical cases were studied from January, 2010 to January, 2015 at Hawassa University referral hospital pathology laboratory. Clinical diagnosis of patients, patient's age, biopsy sample size and type, and microscopic finding of the cases were collected for this study. The data were entered by Epi-Info statistical software version 7 and later exported to SPSS version 20 for analysis. Descriptive analyses such as frequency, mean, and standard deviation were computed. RESULTS: A total of 513 patients with cervical lesion were examined histopathologically in the study period. The age ranges of the patients were from 17 to 85 years with mean and standard deviation of 42 ± 11 years. Of these symptomatic examined cases, 253 (49.3%) of them were cancerous lesion while non cancerous and precancerous cases account 166 (32.4%) and 51 (9.9%) respectively. Cervical squamous cell carcinoma was the predominant type cancer which accounts 211(83.4%) of all cancerous cervical cases. The proportion of cervical cancer was higher in age group older than 60. The magnitude of cervical cancer and precancerous cases were steadily increasing throughout study periods whereas non cancerous cases were fluctuating. CONCLUSIONS: Cervical cases were associated with wide range of disorders. Cervical cancer was the predominant cervical disease in symptomatic southern Ethiopian women. The high proportion of cervical cancer was observed in post-menopausal age when compared with other cervical cases. Effective uses of low-tech and inexpensive screening tools that already exist and giving awareness about the disease in combination with vaccine could reduce this high magnitude of cervical cancer in study area.

Surgical Margins: The Perspective of Pathology.

Neoplasms of the head and neck constitute a broad spectrum of benign and malignant entities. When treatment involves resection, assessment of the surgical margins represents an important component of the pathologic examination. Margin status is an important indicator of a complete surgical resection. The ability to generalize conclusions such as 'safe distance' measurements from work performed mSCCa or cutaneous malignancy to other types of neoplasms in the head and neck region seems limited. This article reviews conditions and considerations for reliable margin assessment and interpretation.

Histopathological Changes in Laparoscopic Sleeve Gastrectomy Specimens: Prevalence, Risk Factors, and Value of Routine Histopathologic Examination.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is a common surgical therapeutic option for obese patients, with debate about the value of routine histopathologic examination of LSG specimens. We assessed the following: prevalence of different histopathologic changes in LSG specimens, risk factors associated with premalignant and with frequent histopathologic changes, and whether routine histopathologic examination is warranted for LSG patients with nonsignificant clinical history. METHODS: Retrospective review of records of all LSG patients operated upon at Hamad General Hospital, Qatar (February 2011-July 2014, n = 1555), was conducted. Risk factors (age, BMI, gender, and Helicobacter pylori) were assessed in relation to specific abnormal histopathologic changes. RESULTS: Mean age and BMI of our sample were 35.5 years and 46.8, respectively. Females comprised 69.7% of the sample. Normal histopathologic specimens comprised 52% of the sample. The most common histopathologic changes were chronic inactive gastritis (33%), chronic active gastritis (6.8%), follicular gastritis (2.7%), and lymphoid aggregates (2.2%). We observed rare histopathology in 3.3% of the sample [e.g., intestinal metaplasia and gastrointestinal stromal tumor (GIST)]. Older age was associated with GIST and intestinal metaplasia (P = 0.001 for both). Females were associated with chronic active gastritis (P = 0.003). H. pylori infection was associated with follicular gastritis, lymphoid aggregates, GIST, intestinal metaplasia, and chronic active gastritis (P < 0.001 for each). CONCLUSION: Older age, H. pylori, and female gender are risk factors for several abnormal histopathologic changes. Histopathologic examination of LSG specimens might harbor significant findings; however, routine histopathologic examination of all LSG specimens, particularly in the absence of suggestive clinical symptoms, is questionable. The association between female gender and chronic active gastritis; and the association between H. pylori infection and GIST are both novel findings that have not been previously reported in the published literature.

Unsuspected Malignancies in Routine Femoral Head Histopathologic Examination During Primary Total Hip Arthroplasty: Cost-Effectiveness Analysis.

BACKGROUND: Routine femoral head histopathology during primary total hip arthroplasty (THA) has been recently reported as a potentially useful screening tool for bone- and bone marrow-associated malignancies. However, cost-effectiveness of routine histopathology during THA remains unclear due to low prevalence of significant medical findings which alter patient management. The aim of this study was to evaluate the cost-effectiveness of routine histopathology in diagnosing unsuspected malignancy in patients undergoing primary THA. METHODS: From 1993 to 2011, we retrospectively analyzed routine histopathologic findings of 3200 femoral head specimens from 2725 patients that underwent primary THA. Preoperative and postoperative diagnoses were classified into concordant (clinical diagnosis concurred with pathologic diagnosis), discrepant (differing diagnosis with no resultant impact on patient management), and discordant (differing diagnosis with subsequent change in patient management). Cost-effectiveness analysis was performed using the incremental cost-utility ratio. RESULTS: A total of 3055 of 3200 pathologic samples were concordant with the preoperative diagnosis (95.4%), 140 of 3200 were discrepant (4.4%), and 5 of 3200 were discordant (0.2%). Routine histopathology revealed 1 unsuspected malignancy out of 640 (5 of 3200) femoral heads. The total cost of histopathologic screening was $614,664.80. The average cost to identify a discrepant case was $4390.46, and the cost to identify a discordant case was $122,932.96. The incremental cost-utility ratio was $49,569.74 per quality-adjusted life year (QALY) gained. CONCLUSION: Our study indicates routine femoral head histopathology may be cost-effective in diagnosing unsuspected malignancy at $49,569.74/QALY gained (less than World Health Organization recommended threshold $159,000/QALY gained), providing useful clinical information for surgeons considering the value of routine femoral head histopathology in patients undergoing THA.

A rare case of right ventricular myxoma causing recurrent stroke.

We present a 62-year-old lady admitted in our hospital with two episodes of acute ischemic stroke about 2 weeks apart. She was evaluated for acute ischemic stroke and was thrombolysed for recent stroke in right MCA territory first time. On further evaluation, she was found to have a RVOT mass. A transthoracic and transesophageal echocardiogram revealed a PFO and a large, 5.1cm×2.3cm, ovoid, well circumscribed, echogenic mass in the right ventricle outflow tract attached by small pedicle to the ventricular side of anterior tricuspid leaflet, partly obstructing the right ventricular outflow tract and protruding through the pulmonic valve during systole. She was scheduled for surgery (right ventricular mass excision and PFO closure) after 3 weeks due to the risk of secondary hemorrhage in the infarcted area following thrombolysis and anticoagulation and so was discharged with medications after full neurologic recovery after about a week of hospital stay. She was readmitted 7 days after discharge, before the scheduled date of surgery with history of weakness of right upper limb, slurred speech and mild breathing difficulty lasting for about 20min following which she improved slowly (transient ischemic attack). The tumor was completely removed with the stalk using cardiopulmonary bypass support. The histopathological findings confirmed the diagnosis of myxoma.

Histopathologic examination of the genital tract in rabbits treated once or twice with a slow-release deslorelin implant for reversible suppression of ovarian function.

A total of 13 rabbits were treated with a subcutaneous deslorelin long-term release implant (4.7 mg) to study the effect on ovarian function and histologic features of the uterus. Seven rabbits (group 1) were implanted with a slow-release deslorelin implant before onset of puberty for 273 days as a part of a previous study. After resumption of ovarian function had been confirmed, they were implanted again at the age of 430 days. Six adult rabbits (>177 days old; group 2) were implanted with a slow-release deslorelin implant for 273 days. Ovarian function before, during, and after treatment with the implant was assessed by measuring serum progesterone levels 10 days after a challenge injection of a short-acting GnRH (0.8 µg buserelin intramuscularly) on progesterone levels in peripheral blood. Values more than 4 ng/mL progesterone were considered to verify ovarian function. Animals in group 1 underwent ovariohysterectomy during the second treatment with the implant and the uteri, and ovaries were subjected to histopathologic examination. Endometrial hyperplasia and endometritis were observed in 5 of 7 animals. Nonatretic and atretic follicles at different developmental stages, but no active corpora lutea, were present in the ovaries. Ovariohysterectomy of group 2 animals was performed 2 to 12 months after implant removal. The histopathologic examination of the uterus and ovary of four animals neutered during induced pseudopregnancy showed no signs of uterine disorders. In two animals undergoing ovariohysterectomy 12 months after implant removal, endometritis was present. Their ovaries contained follicles at different developmental stages and corpora albicantia. Reversible suppression of ovarian function can be achieved in female rabbits by the use of GnRH slow-release implants administered before or after puberty. The findings of endometrial hyperplasia and endometritis in seven out of 13 rabbits treated once or twice with the implant may indicate that the development of age-related pathologies of the uterus cannot be prevented by the suppression of ovarian function with a long-acting GnRH implant.

Processing of the explanted heart.

Analysis of the explanted hearts from heart transplant recipients provides valuable clinical samples, which can be used to study the anatomy and pathology of the heart. PubMed database was employed as the article source of this review. This article summarized the processing methods of the explanted heart, including dissection, histopathologic examination, cryopreservation, and genetic testing. A standard processing of explanted hearts ensures the quality and reliability of samples. Analysis of explanted hearts facilitates the diagnostic assessment and therapy strategy of heart diseases.

A case report: primary melanoma of the nasal cavity / Un reporte de caso: melanoma primario de la cavidad nasal

We report a rare case of sinonasal mucosal malignant melanoma in the nasal cavity. The patient had respiratory difficulty, continuous epistaxis and nasal pain. We identified a malignant tumour which is a rare pathology with detailed physical examination, anterior rhinoscopy, computed tomography (CT) scan, magnetic resonance imaging (MRI) and histopathologic examination. The patient did not accept surgical procedures and was referred for chemotherapy or immunotherapy. Continued follow-up of this is necessary.

Reportamos un caso raro de melanoma maligno de la mucosa del tracto nasosinusal. El paciente tenía dificultad respiratoria, epistaxis continua, y dolor nasal. Identificamos un tumor maligno que es una patología, con examen físico detallado, rinoscopia anterior, tomografía computarizada (TC), resonancia magnética (MRI) y examen histopatológico. El paciente no aceptaba los procedimientos quirúrgicos y fue remitido para quimioterapia o inmunoterapia. Es necesario realizar un seguimiento continuo.

Isolated axillary lymph node tuberculosis in ultrasonography. A case report.

We present a rare case of isolated axillary lymph node tuberculosis. A 66-year-old patient was admitted in order to perform the diagnostics of a painless tumor of the left armpit. Blood biochemistry tests and chest X-ray did not show any abnormalities. In the ultrasound examination a solid structure of the dimensions of 1.8×1 cm of irregular outline with adjacent hypoechogenic lymph nodes was visualized. The diagnosis of tuberculosis was based on histopathologic examination of the excised tumor. In the latter years an increase in extrapulmonary type of tuberculosis has been observed. Extrapulmonary tuberculosis may appear in practically each organ, nevertheless it affects pleura most often. Lymph node tuberculosis is the second, when it comes to the prevalence rate, type of extrapulmonary tuberculosis. In the majority of cases of lymph node tuberculosis it affects superficial lymph nodes. In the ultrasound examination a packet of pathological, enlarged and hypoechogenic lymph nodes is stated. In 1/3 of cases the central part of the nodes is hyperechogenic which indicates its caseation necrosis. Lymph nodes have a tendency to be matted and they have blurred outline. We observed this type of lymph node image in the presented patient. This image may be a diagnostic hint. Nevertheless, in the differentiation diagnostics one should take many other disease entities into consideration, inter alia: sarcoidosis, lymphomas, fungal infections, neoplastic metastases; the latter ones have an image most similar to tuberculosis lymph nodes. Tuberculosis ought to be considered in differential diagnosis of atypical masses.

É o exame anatomopatológico de rotina indispensável em cirurgias orificiais / Is the histopathologic examination essential in orificial sugeries

Introdução: O exame anatomopatológico é feito rotineiramente em cirurgias orificiais e é importante para diagnosticar doenças anais concomitantes, lesões malignas e doenças sexualmente transmissíveis não previstas anteriormente no exame clínico. O gasto com estes exames é bastante significativo para o serviço público o que evidencia a necessidade de avaliar o custo/benefício da sua utilização rotineira. Objetivos: Avaliar o tempo decorrido entre a entrega do material e a emissão do laudo, o nível de concordância entre a impressão diagnóstica e a conclusão do anatomopatológico, a importância clínica das patologias diagnosticadas secundariamente, o custo de realização dos exames e a relação custo/benefício dos mesmos. Metodologia: Estudo descritivo e retrospectivo de 173 exames anatomopatológicos de pacientes do Hospital Universitário de Aracaju realizados de 2005 a 2007, que foram submetidos à cirurgias orificiais. Resultados: O nível de concordância entre a impressão diagnóstica e a conclusão do anatomopatológico foi elevada e, dos laudos discordantes, poucos apresentaram relevância clínica, havendo somente um caso de neoplasia anorretal. Houve um atraso significativo na emissão dos laudos, sugerindo sobrecarga do serviço e o custo/benefício para realização dos exames foi desfavorável. Conclusão: Sugerimos triagem para um uso racional e criterioso do exame anatomopatológico em cirurgias orificiais baseada na história clínica e fatores de risco do paciente.

Introduction: The histopathologic examination is repeatedly done in orificial surgeries and it's important to diagnose anal diseases associated, malign lesions and sexually transmitted diseases that weren't previously predicted on the clinic examination. The cost of the histopathologic examinations is very significant to the public health service, which shows the need to do a cost-benefit analysis of their routine use. Objectives: Evaluate the time between the surgical specimen's delivery and the emission of the histopathologic examination's report, the concordance level between the clinic impression and the histopathologic examination's report, the clinical relevance of the diseases secondarily diagnosed, the cost of the histopathologic examinations and the cost-benefit analysis of them. Methods: Descriptive and retrospective study of 173 histopathologic examinations from patients of the Hospital Universitário de Aracaju made from 2005 to 2007, that were submitted to orificial surgeries. Results: High concordance level between the clinic impression and the histopathologic examination's report; from the discordants reports, a few had clinical relevance and was only one case of anal cancer. There was a significant delay on the reports' emission, which suggests that the pathology service is overloaded; and the cost-benefit analysis was unfavorable. Conclusions: We suggest screening to a rational and judicious use of the histopathologic examination in orificial surgeries based on the patient's clinical history and risk factors.