Pilonidal sinus: is histological examination necessary?

Abstract

Background Pilonidal sinus is a common pathology occurring in a number of sites including the gluteal cleft between the buttocks. Surgery is the principal mode of treatment with a variety of techniques proposed to cure the disease and prevent recurrence. The rate of malignant degeneration is estimated at 0.1% in patients with chronic pilonidal disease. A case series study of pilonidal sinus found that most patients with malignancy were over the age of 50 years and had had chronic pilonidal disease for several years. This study aimed to review the value of histological analysis of pilonidal sinus specimens. Methods A retrospective observational study was conducted of all patients who have undergone pilonidal sinus excision by the Department of General Surgery at Counties Manukau District Health Board in the past 10 years. Results This study reviewed 1324 admissions with a pilonidal disease requiring surgical management. There were 325 pilonidal resections with 320 histological specimens analysed. Pilonidal sinus was detected in 312 specimens, eight others were benign and there were no specimens with malignancy. Conclusion No cases of malignancy were found in all pilonidal specimens that were sent for histological review. Routine histological examination of pilonidal sinus specimens appears to be unnecessary; however, it should be considered in patients over the age of 50 years.

Is It Necessary to Perform a Histopathological Examination of Pilonidal Sinus Excision Material?

“…14,15 In a recent study, Bacil ‘Otutaha et al reported that a routine histopathological examination of the pilonidal sinus material was unnecessary, but such an examination should be performed over the age of 50 years. 16 In our study, only 133 (5.3) of the 2486 patients were 50 years or older. The most common malignancy (90%) that develops on the basis of this disease is squamocolumnar carcinoma, but albeit rarely, basal cell carcinoma, sweat gland adenocarcinoma, and verrucous carcinoma have also been reported in the literature, mostly in the form of case reports.…”

Treatment of a Chronic Open Wound Related to Sacrococcygeal Pilonidal Cyst and Squamous Cell Carcinoma: A Case Report

“…Underlying clinical conditions, including diabetes mellitus or autoimmune disease, and patient factors, such as alcohol or tobacco usage and excessive pressure, are common causes of delayed wound healing. In our patient, bacterial wound infection and residual malignant lesion contributed to the chronic open wound [7,8]. Incomplete resection of the pilonidal disease could have added another causality.…”

“…In summary, a pilonidal sinus appeared after traumatic contusions, and the lesion progressed to malignant SCC. The short period for malignant transformation is notable, and mechanical and chemical injuries could have contributed to tissue alteration [7]. Imaging studies before the primary excision seemed to display a benign pilonidal cyst.…”

Histopathological Examination and Endoscopic Sinusectomy: Is It Possible?

“…Since the first case of malignant degeneration of pilonidal cyst described by Wolff in 1900 ( 24 ), the total number of reported cases in lituerature is fewer than 100. The most common histological type is squamous cell carcinoma, occurring in ~90% of cases ( 25 ).…”