Clinical Importance of Evaluating the Results of Excused Perianal Lesions

Abstract

BACKGROUND: Perianal and anal region lesions are mostly benign, typically polypoid formations seen adjacent and distal to the anal canal. Fibroepithelial anal polyps are benign lesions commonly found in the perianal region, composed of squamous epithelium and subepithelial connective tissue. Despite their benign nature, excision may be necessary in cases where they cause pain, progressively increase in size, or give rise to suspicion of an infectious or malignant disease, as well as during treatment for accompanying perianal conditions. Follow-up of the pathology results for all removed lesions is important, as the patient’s follow-up and treatment process may vary based on the pathology results. Based on this perspective, patients who underwent excision of perianal lesions during surgery for a preliminary diagnosis of benign anorectal diseases were retrospectively evaluated in our clinic. The importance of the excision and pathological examination of these lesions was discussed based on the results.

AIM: The study retrospectively evaluated patients who underwent surgery for anal fistula, anal fissure, or palpable lesions in the anal or perianal area and had accompanying lesions that were pre-diagnosed as sentinel tags excised.

MATERIALS AND METHODS: The patients who underwent surgery due to anal, perianal lesions, anal fistula, or anal fissures in the general surgery clinic were retrospectively evaluated between January 2017 and February 2022. Their medical history, surgical notes, and pathology results were reviewed. Patients who underwent excision of lesions from the perianal and anal regions were evaluated. The age, gender, pathology results, pre-operative diagnoses, number and size of polyps, and the presence of concomitant hemorrhoids, anal fissures, and fistulas were recorded. The Number Cruncher Statistical System (NCSS) 2020 Statistical Software (NCSS LLC, Kaysville, Utah, USA) program was used for statistical analysis for the evaluation of the findings obtained in the study.

RESULTS: A total of 49 patients were evaluated. Three patients were excluded from the study as their pathology results were not recorded, even though a lesion excision was mentioned in their surgical notes. One patient who underwent surgery for an incisional biopsy was also evaluated separately. Of the patients, 20 were female and 25 were male. The average age of the patients was 41 (ranging from 21 to 86 years old). The average diameter of the excised polypoid lesions was 1.29 cm. When the final pathology results of the cases were reviewed, it was found that 37.8% (n = 17) had anal condyloma, 35.6% (n = 16) had fibroepithelial polyp, 8.9% (n = 4) had pyogenic granuloma, 4.4% (n = 2) had hemorrhoid, 4.4% (n = 2) had inflammatory polyp, 2.2% (n = 1) had multiple squamous papilloma, 2.2% (n = 1) had basal cell carcinoma, 2.2% (n = 1) had hypertrophic anal papilla, and 2.2% (n = 1) had pilonidal sinus. One notable result was that, despite the pre-operative diagnosis not being malignant, one patient had a pathology result of basal cell carcinoma. In addition, it is important to note that low-grade dysplasia was also detected in a patient with anal condyloma.

CONCLUSION: While perianal and anal lesions are generally benign, it is noteworthy that malignant cases can still occur, although rarely. Therefore, it is important to subject every excised perianal and anal lesion to pathological evaluation, as it is crucial for the proper follow-up and treatment of patients.