Is routine pathologic evaluation of hemorrhoidectomy specimens necessary?

AIM: To confirm that systematic histological study of hemorrhoidectomy specimens is useless, as is proposed by the French Society of Coloproctology (Société Nationale Française de Colo-Proctologie) under the sponsorship of the French National Health Accreditation and Evaluation Agency (Agence Nationale d'Accréditation et d'Evaluation en Santé). METHODS: Retrospective histological analysis of hemorrhoidectomy specimens obtained in a coloproctology unit between January 1, 1985 and December 31, 2001. RESULTS: We found 56 histological abnormalities (0.69%) among 8153 hemorrhoidectomy specimens considered normal at gross examination, with three cases of intraepithelial neoplasia of the anal canal (0.04%) and four cases of severe dysplasia (0.05%). Specimens associated with anal fissure (N = 906) or suppuration (N = 610) did not display more histological lesions. For all patients, the initial surgical resection prevented recurrence. CONCLUSION: Routine pathological evaluation of hemorrhoidectomy specimens is not useful and is expensive. All operating procedures in proctology should reflect this attitude. It is nevertheless advisable to select for gross and microscopic evaluation any suspicious areas noticed at the preoperative examination or during the procedure.

[Anal canal squamous-cell carcinomas in HIV positive patients: clinical features, treatments and prognosis]. / Caractéristiques cliniques, thérapeutiques et pronostiques des carcinomes épidermoïdes du canal anal chez les malades VIH positifs.

UNLABELLED: The prevalence of squamous-cell carcinoma of the anus seems to be increasing in HIV positive patients. Clinical features and prognosis in this population have not been well evaluated. AIMS: To assess the prognosis of anal squamous-cell carcinoma in HIV positive patients as well as clinical features and treatment procedures. METHODS: A series of 20 HIV positive patients presenting with invasive anal squamous-cell carcinoma was retrospectively analyzed. Data have been compared to those obtained from 24 randomly selected HIV negative patients who were followed during the same periods in the same centers for anal carcinoma with similar histopathological features. RESULTS: The follow-up ranged from 10 to 172 months. No difference was observed between the two groups concerning the clinical features leading to anal cancer diagnosis, although HIV positive patients were younger. Anal cancer was more frequently associated with lymph node metastasis in HIV positive (60%) than in HIV negative (17%) patients, although its size was similar in both groups. Radiotherapy was similarly performed in both groups, while chemotherapy was administered less frequently in HIV positive than in HIV negative patients (54% vs 25%). Immediate side effects and mortality at 1 year follow-up were similar in both groups, whereas the objective initial response to therapy (50% versus 88%), the remission rate with anal conservation at 1 year follow-up (45% versus 88%), and the mortality at 3 years were better in HIV negative patients. CONCLUSION: The prognosis of anal squamous-cell carcinoma is poor in HIV positive patients. This correlates with a more advanced tumor stage and an alteration of systemic immunity status at the time of diagnosis and less response rate to treatment. Detection of precancerous lesions and treatment procedures should be evaluated in HIV infected patients.