Saccular and Intra-saccular Neoplasms of the Hernia Sac – A Case Series

Ambar Banerjee, MD, Randy Tashjian, MD, Robert D Danforth, MD, John E Boccaccio, MD. DEPARTMENT OF SURGERY, DEPARTMENT OF PATHOLOGY, ST JOHN HOSPITAL AND MEDICAL CENTER, DETROIT, MI

 

Introduction: The presence of a saccular or an intra-saccular neoplasm is a rare occurrence with a reported incidence of less than 0.5% in the literature. Despite numerous case reports, there is a dearth of case series on such lesions. We retrospectively reviewed the cases of inguinal, incisional and umbilical hernia repairs, performed at our institution, to present our experience with such unusual hernia contents.

Methods: After obtaining Institutional Review Board (IRB) approval, a search of the institutional pathology database was conducted for patients who were treated with inguinal, incisional or umbilical hernia repair along with excision of respective sacs from January 2007 through September 2011 at St. John Hospital and Medical Center (SJHMC). A retrospective evaluation of histopathology reports of the selected patients was performed. Patient demographics, forms of herniation and their concomitant repair procedures, types of malignancy in the hernia sacs and other associated features were noted. The pertinent patient variables were analyzed with descriptive statistics.

Results: Nine of 1801 patients (0.49%), with a mean age of 59.9 years (SD 19.9; range = 17, 83), were found to have neoplastic contents in their hernia sacs following inguinal (N=6), incisional (N=2) and umbilical (N=1) hernia repairs. Six of nine patients (66.7%) were male. 55.6% of the patients were not known to have intra-abdominal malignancies prior to herniorrhaphy. All patients were treated with open hernia surgeries. The attached table elaborates the various neoplasms encountered in the hernia sacs at our institution.

Conclusion: Peritoneal carcinomatosis is the most common cause of saccular neoplasms in our study population, with liposarcoma of the cord being most common in the intra-saccular subgroup. Our study highlights the importance of routine pathological evaluation of hernia sacs, which may aid in the diagnosis, and guide eventual management of unknown malignancies in the afflicted patients.

Table demonstrating the different types of neoplasms in the hernia sac
SubjectType of herniaType of neoplasm
1InguinalLiposarcoma of the cord
2InguinalMetastatic adenocarcinoma of recto-sigmoid junction
3InguinalSeminoma of right testicle
4IncisionalMetastatic mucinous adenocarcinoma of ascending colon
5UmbilicalMetastatic ovarian serous carcinoma
6InguinalMetastatic ovarian serous carcinoma
7InguinalLiposarcoma of the cord
8IncisionalMetastatic malignant mixed mullerian tumor of the ovary
9InguinalMetastatic prostatic adenocarcinoma

 


Session Number: Poster – Poster Presentations
Program Number: P292
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