Routine Histology After Hemorrhoidectomy: Uncovering the Hidden Risk of Malignancy?

Area of Science:

• Colorectal Surgery
• Surgical Pathology
• Oncology

Background:

• Histological examination of hemorrhoidectomy specimens is often omitted, relying on macroscopic assessment.
• This omission may lead to the underdiagnosis of incidental pathologies, including malignancy.
• Evaluating local histology submission rates and unexpected findings is crucial.

Purpose of the Study:

• To assess the rate of histology submission for hemorrhoidectomy specimens.
• To determine the incidence and nature of unexpected findings, including neoplastic pathology.
• To evaluate the implications of relying solely on macroscopic assessment.

Main Methods:

• Retrospective analysis of 548 adult hemorrhoidectomy cases from January 2017 to April 2025.
• Review of electronic operative and pathology records for demographics and diagnoses.
• Statistical analysis using IBM SPSS v29, including chi-square and Mann-Whitney U tests.

Main Results:

• Only 34.67% of hemorrhoidectomy specimens were submitted for histology; 65.33% were discarded.
• Unexpected benign pathology was found in 6.84% of examined specimens.
• Two specimens (1.05%) revealed significant neoplastic pathology: invasive squamous cell carcinoma and high-grade anal intraepithelial neoplasia.

Conclusions:

• A low rate of histology submission for hemorrhoidectomy specimens was observed.
• A small but significant proportion of submitted specimens showed unexpected neoplastic findings.
• Routine or selective histological submission may enhance diagnostic safety and quality assurance in colorectal surgery.