Histopathological Examination Of Patients Research Articles

Sensitivity and Specificity of Pleural Fluid Cytology to Histopathology Examination in Lung Tumor Patients at Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia

Introduction. Lung tumors are pathological growths in the lung that are strongly associated with lung cancer. In 2018, lung cancer, a form of lung tumor, had the greatest occurrence among all types of cancer. It accounted for 2,093,876 new cases, which represented 11.6% of all cancer cases. The objective of this study was to assess the sensitivity and specificity of pleural effusion cytology testing compared to histopathological examination in patients with lung malignancies at Dr. Mohammad Hoesin General Hospital in Palembang, Indonesia.
 Methods. This study was a retrospective analytical-observational study. This study encompassed a cohort of 35 patients who fulfilled the specified inclusion criteria. We used the SPSS version 22.0 for Windows application to perform bivariate analysis in data processing and analysis.
 Results. The study yielded a sensitivity score of 13.63%, indicating the pleural fluid cytology method's accuracy in detecting lung cancer in individuals with low values. This study demonstrates a specificity value of 100%, indicating the frequency at which the pleural fluid cytology approach accurately identifies cancer.
 Conclusion. The use of cytology as a screening tool for identifying lung tumor illnesses is limited, although it demonstrates a high level of specificity in ruling out healthy individuals.

Imaging Features of Pediatric Sarcoidosis.

Sarcoidosis is a granulomatous inflammatory disease of uncertain cause. It occurs most commonly in young and middle-aged adults and less frequently in children; therefore, few data on pediatric sarcoidosis exist in the literature. The diagnosis and management of sarcoidosis remain challenging because of diverse and often nonspecific clinical and imaging findings. In addition, the clinical picture varies widely by age. Prepubertal and adolescent patients often present with adult-like pulmonary disease; however, early-onset sarcoidosis is typically characterized by the triad of arthritis, uveitis, and skin rash. Sarcoidosis is mostly a diagnosis of exclusion made by demonstrating noncaseating granulomas at histopathologic examination in patients with compatible clinical and radiologic findings. Although sarcoidosis often affects the lungs and thoracic lymph nodes, it can involve almost any organ in the body. The most common radiologic manifestation is pulmonary involvement, characterized by mediastinal and bilateral symmetric hilar lymphadenopathies with perilymphatic micronodules. Abdominal involvement is also common in children and often manifests as hepatomegaly, splenomegaly, and abdominal lymph node enlargement. Although neurosarcoidosis and cardiac sarcoidosis are rare, imaging is essential to the diagnosis of central nervous system and cardiac involvement because of the risky biopsy procedure and its low diagnostic yield due to focal involvement. Being familiar with the spectrum of imaging findings of sarcoidosis may aid in appropriate diagnosis and management. ©RSNA, 2023 Test Your Knowledge questions are available in the supplemental material.

Is Surgery in Autoimmune Pancreatitis Always a Failure?

Autoimmune pancreatitis is a rare form of chronic pancreatitis of presumed autoimmune etiology. Due to significant overlap in clinical and imaging characteristics, misdiagnosis as a pancreatic malignancy is common. As a result, a significant number of patients undergo a major pancreatic resection, associated with considerable morbidity, for a disease process that generally responds well to corticosteroid therapy. In the past ten years, important advances have been made in understanding the disease. Several diagnostic criteria have been developed to aid in diagnosis. Despite this, pancreatic resection may still be required in a subset of patients to reliably exclude pancreatic malignancy and establish a definite diagnosis of autoimmune pancreatitis. This article aimed to define the role of surgery in autoimmune pancreatitis, if any. For this purpose, published case series of patients with a diagnosis of autoimmune pancreatitis, based on the histopathological examination of surgical specimens, were reviewed and patients' clinical, radiological and serological details were assessed. At the end, histopathologic examinations of patients who underwent pancreatic resection at our department in the last 10 years were retrospectively reviewed in order to identify patients with autoimmune pancreatitis and assess their clinical characteristics.

HISTOPATHOLOGICAL EXAMINATIONS PROFILE OF BLADDER DISEASES IN DR. SOETOMO GENERAL ACADEMIC HOSPITAL FROM JANUARY 2015 TO DECEMBER 2019

Objective: This study aimed to analyze the profile of bladder disease in Soetomo General Hospital based on histopathological examination. Material & Methods: This study was using secondary data. Histopathological examination data of patients with bladder disease were evaluated based on age, gender, and histopathological types. Results: There were 419 patients with bladder abnormalities. Non-neoplasm bladder diseases were found in 62 patients consisted of 56 patients (90.32%) with cystitis and 6 patients (9.67%) with glandular cystitis. Neoplastic bladder diseases were found in 357 patients and were divided into benign and malignant neoplasm. Benign neoplasms were found in 11 patients consisted of 5 patients (45.45%) with UP and 6 patients (54.54%) with IUP. Malignant neoplasms were found in 340 patients consisted of 300 patients (88.23%) with urothelial carcinoma, 26 patients (7.64%) with adenocarcinoma, 14 patients (4.12%) with SCC. Moreover, six male patients with PUNLMP were also reported. Conclusion: Histopathological examination in patients with bladder abnormalities shows that neoplastic bladder diseases (357/419, 85.20%) were more common than non-neoplastic bladder disease (62/419, 14.80%).

Evaluation of Tumour Volume as a Prognostic Factor in Carcinoma Buccal Mucosa.

(1) To determine tumor volume by clinical measurement, imaging and histopathological examination in patients with squamouscarcinoma of buccal mucosa. (2) To correlate tumor volume with lymph-node metastasis and loco-regional control. Retrospective Observational Study. Rural tertiary care hospital. 75 Patients undergoing surgery for T2 (68%) and T3 (32%) Oral squamous carcinomas were included in this observational study. Tumor volume-a product of maximum length, breadth and thickness, was determined clinically and by imaging. Tumor volume on histopathology was documented and correlated with lymph-node metastasis. After 13months minimum follow-up, tumor volume was correlated with loco-regional control. Recurrences were analysed with regard to tumor volume, depth of invasion, lymph-node metastasis and resection margins. Average tumor volume was 7.1cm3among T2 and 14.4cm3among T3. 25% of T2 tumors had metastatic lymph-nodes compared to 33.3% in T3. There was positive correlation between tumor volume and lymph-node metastasis. Lymph-node metastasis was absent when tumor volume was < 8cm3. There were 4 local and 2 regional recurrences in this study. Average histopathological tumor volume among patients who had local recurrence was 12.95cm3. Regional recurrences occurred in tumors staged N2b and N3b on histopathology. Average depth of invasion in patients with recurrence was 10.33mm.. Tumor volume represents actual tumor load and correlates with lymph node metastasis and prognosis in oral cancers. Depth of invasion and tumor thicknessinfluence staging and prognosis. Large volume tumors have poor oncological outcome.

Association of single nucleotide polymorphisms rs63751445 of the MSH2 gene and rs863224614 of the MSH6 gene with susceptibility to breast cancer in samples from Northeast Brazil

Breast cancer (BC) is the cancer with the greatest epidemiological impact on the female population worldwide. The disease has a multifactorial etiology, with genetic implications that are not fully understood. In this context, genetic changes in the mismatch repair mechanism are notable for their potential relationship with BC, especially the single nucleotide polymorphisms (SNPs), which are the most common type of genetic variation. The aim of this study was to evaluate for the first time the influence of the SNPs rs63751445 (A&gt;G) of the MSH2 gene and rs863224614 (T&gt;G) of the MSH6 gene for susceptibility to CM. For that, 100 samples obtained by histopathological examination of patients from the Northeast region of Brazil were used. The methodology used was the Didesoxy Single Allele Specific PCR (DSASP) method. Statistical analysis was performed by comparison with the control population (population in Hardy-Weinberg equilibrium) using Pearson's Chi-square and Fischer's exact tests. It was concluded that these two SNPs may be associated with susceptibility to BC in the studied population.

Clinical, ultrasound and histopathological correlation of clinically N0 neck nodes in patients with cancers of the pharynx and larynx.

Background: The presence of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymphadenopathy (N0) remains controversial. Neck palpation, as the method used in tumor, node, metastasis (TNM) staging, has limitations and can provide false negative results in some cases. Lymph node metastases are associated with a reduced survival rate but at the same time, neck dissection for the patient with N0 neck is not without risks or complications. Objectives: In prospective study, we compared palpation, ultrasonography (US) examination of the neck and histopathological examination in patients with cancers of the pharynx and larynx. Patients, Materials and Methods: Forty-six patients with cancers of the pharynx and larynx that presented with a N0 neck were prospectively analyzed. They were divided in two groups: 23 patients operated with an external approach including the control of the lymph node areas, and a second group of 23 patients operated using endoscopy and carbon dioxide (CO2) laser, no neck dissection – “watchful waiting policy”. All patients have had a flexible endoscopy of the pharynx and larynx, US of the neck and all received surgical treatment for their primary tumor. Imaging was performed in selected cases. All the removed lymph nodes were sent for histopathology. US was also used as a follow-up method. The US features of the examined lymph nodes were: diameters [longitudinal (L) and transverse (T)]; the ratio of the two diameters (L/T); shape; lymph node area; central hypodensity; regular/irregular margins; aspect (homogeneous or not). Results: US has detected 25 lymph nodes in the open surgery group and intraoperatively, we excised 31 (sensitivity of 80.6%). Ten lymph nodes showed metastases, with 100% accuracy of US, which have been confirmed both pathologically and immunohistochemically. US in the second group – patients treated with CO2 laser – detected at four patients 10 cervical lymph nodes that did not presented any malignant features. At recurrence alone, the US confirmed 100% presence of nodes metastases. Conclusions: US was superior to palpation and this method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis (N0).

The assessment of the accuracy of clinical preoperative lymph node

Purpose:The aim of the present study is to assess the accuracy of clinical preoperative lymph node and to define the degree of relation between the clinical preoperative assessment and histopathological examination in patients with head and neck cancer and cN+.Methods:This retrospective study was performed on 125 patients (85 males and 40 females) at the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Zhengzhou University, between December 2012 and December 2014.Result:Of all the patients who underwent neck dissection, 37 were found with no neck metastasis. Positive or suspected lymph nodes were detected at computed tomography (CT) in 44 and detected at ultrasonogram diagnosis (USG) in 38 of 125 patients, and the necks were assessed as normal in 55 (44%) by both USG and CT.Conclusion:Further investigation is needed to evaluate the rates of overall survival and disease-free survival of these N0 patients with neck dissection.

Concomitant Gastric Metastases From Renal Cell Carcinoma Presenting as a Solitary Polyp: A Case Report

Background Gastric metastases are atypical and represent a late stage of malignant disease. Renal cell carcinoma metastases to the stomach have been discussed in the literature and usually presents as a large, solitary mass or ulcer resembling primary gastric cancer. We report a rare case of a metastatic renal call carcinoma preseting as a solitary gastric polyp Case Report A 62-year-old Caucasian women with history of COPD, PUD with prior partial gastrectomy presented for EGD and colonoscopy for evaluation of anemia. There was no prior history of gastrointestinal bleeding. The EGD showed, a single non-bleeding 6x8 mm sessil polyp in the fundus of stomach, which was completely removed via snare. A clip was placed at the polypectomy site for post polyepectomy bleeding. The colonoscopy at that time was poor prep without significant findings.2626_A Figure 1. CT Abd/Pelvis with renal mass2626_B Figure 2. Post Polypectomy SiteThe histopathologic examination of the excised gastric polyp showed metastatic clear cell renal carcinoma, with free margins of resection. Subsequently, the patient got a CT scan which showed a 5x4 cm renal mass. She had additional imaging studies which showed no other metastatic disease. She underwent repeat EGD which showed no residual polyp tissue, with repeat biopsies from the polypectomy site showing no evidence of malignancy. Patient is awaiting nephrectomy. Discussion Metastatic tumors to the stomach are rare. The reported incidence of metastatic gastric tumors is 0.2-0.7%. Reported primary tumors that spread to the stomach include breast (27%) lung (23%) renal cell (7%) and malignant melanoma (7%). Gastric metastasis from RCC usually presents as a large solitary mass or ulcer, but it can present as small benign-appearing polyps<./p> Presentation of RCC as a gastric polyp is usually a late occurance, happening on average 6.7 years after initial diagnosis of RCC. However, 25-30% of patients with RCC had distant metastases at the time of diagnosis. Typical manifestations in metastatic tumors in stomach include bleeding, anemia, abdominal pain, vomiting or even asymptomatic. The management modalities for gastric metastasis from RCC include gastrectomy, endoscopic resection, embolization, chemotherapy, and immunotherapy. The present case exemplifies that gastric metastases from RCC can be subtle and present as a solitray gastric polyp. This case also highlights the importance of a careful endoscopic examination as well as a thorough histopathologic examination in patients with a history of unexplained anemia.2626_C Figure 3. Pathology showing RCC with surrounding normal gastric tissue

A study of correlation of fine-needle aspiration cytology with postoperative histopathological examination in patients with either solitary thyroid nodule or multiple nodules

Background Fine-needle aspiration cytology (FNAC) of the thyroid gland is now a well-established, first-line diagnostic test for the evaluation of thyroid nodules with the main purpose of confirming benign lesions and thereby, reducing unnecessary surgery. Different imaging techniques are now used for diagnosis of thyroid nodules like radionucleotide scanning and ultrasonography. However, FNAC is still regarded as the single most accurate and cost-effective procedure, particularly if ultrasound is used as a guide for better sample collection, especially for cystic lesions. Aim The aim of the work is to evaluate the correlation of preoperative FNAC with postoperative histopathological examination in patients with either solitary thyroid nodule and multiple nodules. Patients and methods This prospective study was done between April 2016 and November 2017 on 100 patients presented to the General Surgical Department with either solitary or multiple thyroid nodule. This was done to assess the correlation between preoperative FNAC and postoperative histopathological examination. Results Statistical analysis of our study showed sensitivity, specificity, accuracy, false-positive fraction, false-negative fraction, positive predictive value, and negative predictive value of FNAC to be 92, 81, 84, 36, 3.3, 63, and 96%, respectively. Conclusion The FNAC is a sensitive, specific, and accurate initial diagnostic test for the preoperative evaluation of patients with thyroid swellings in our setting as well. The correlation of cytological and histopathological diagnoses is an important quality assurance method, as it allows cytopathologists to calculate their false-positive and false-negative results.

One-step nucleic acid amplification (OSNA) for the detection of sentinel lymph node metastasis in endometrial cancer

ObjectiveTo evaluate the efficacy of one-step nucleic acid amplification (OSNA) for the diagnosis of sentinel lymph node (SLN) metastasis compared with histopathological examination in patients with endometrial carcinoma. MethodsA total of 94 SLNs from 34 patients with endometrial carcinoma were enrolled. The central 1-mm portion of each node was subjected to semi-serial sectioning, sliced at 200-μm intervals and examined by hematoxylin and eosin and cytokeratin 19 (CK19) immunohistochemical staining, and the remaining tissue was analysed by OSNA using CK19 mRNA. The accuracy of the OSNA assay was evaluated based on histopathological diagnosis. ResultsHistologically, 89 SLNs were determined to be metastasis negative, and the remaining five SLNs were metastasis positive. Using the breast cancer cutoff value for detecting lymph node metastasis (OSNA criteria for breast cancer, >250copies/μl) the sensitivity of the OSNA assay was 100%; specificity was 87.6%; diagnostic accuracy was 88.3%. Discordant results were recorded for 11 of 94 SLNs. In all 11 cases, a positive result was given by the OSNA assay but not by histopathological examination. In two SLNs from the same patient, histopathological examination revealed the presence of benign epithelial inclusions that were CK19 positive; both SLNs yielded a positive result in the OSNA assay (true–false positive). All remaining nine histologically-negative/OSNA-positive SLNs were classified as micrometastasis (+) by the OSNA assay. ConclusionThe OSNA assay shows high sensitivity and specificity, which suggests its utility as a novel tool for the molecular detection of SLN metastasis in patients with endometrial carcinoma.

Is there any relationship between unrecognized Celiac disease and unexplained infertile couples?

Celiac Disease (CD) is a chronic autoimmune disease characterized by small intestinal malabsorbtion and diarrhea, triggered by the ingestion of food products containing gluten. There are studies reporting that some nutritional deficiencies and some factors related to immunity may cause a decrease in fertility as well as some problems in sperm parameters. The prevalence of CD in unexplained infertility (UEI) couples is not as high as that mentioned in some reports. There is no accurate knowledge about the prevalence of CD in a UEI couple. A total of 68 couples with UEI who were admitted at Türk Diyanet Vakfı 29 Mayıs Hospital Center of in vitro fertilization (IVF) between January and June 2014 were included in this prospective pilot study. The diagnosis of UEI was made with basic infertility tests. A history of CD was questioned in the initial evaluation. Anti-gliadin, anti-endomysial, and tissue transglutaminase antibodies as well as total IgA were tested. Gastroscopy was performed in patients with positive serologic tests. Histopathological CD diagnosis was made according to Marsh criteria. The mean age of the study population was 33.40±4.59 years. Out of the 65 couples who were included into the study group, one of the five couples was positive for the autoantibodies (7.69%). Out of these 65 couples, none of them had autoantibody positivity at the same time in both partners. Anti-gliadin antibodies were found to be positive for two females out of five couples and in three male partners of the same group. Out of these five couples, only one male partner had all the antibodies as positive (1.5%). In the histopathological examination of patients with positive autoantibodies, only the patient in whom all autoantibodies were positive had findings compatible with Marsh IIIa gluten enteropathy. Only one couple had a diagnosis of CD (1.5%). In many studies, CD was shown to affect the reproductive system of women. CD may also cause a decrease in fertility in men by affecting sperm motility and androgen levels. Our study is based on a limited sample size. Our data should be confirmed in a larger cohort of subjects. These results suggest that investigation of both couples with a diagnosis of UEI may be more beneficial in clarifying the etiology.

Diagnosis of deep cutaneous fungal infections: Correlation between skin tissue culture and histopathology

Deep cutaneous fungal infections (DCFIs) are responsible for significant morbidity and mortality, particularly in immunocompromised patients. Although a direct correlation between histopathologic examination and culture is expected, discordant findings may be seen, presenting a unique diagnostic and therapeutic challenge. We sought to determine the correlation between skin tissue cultures and histopathologic examination in patients with DCFI. This is a 10-year retrospective review (2003-2012) of patients with a diagnosis of DCFI seen at a single tertiary care institution. Tissue cultures and histopathologic findings were reviewed. In 8 of 33 cases, fungal elements were seen on routine histopathologic sections but skin cultures were negative. Three of 8 of the discordant cases had concurrent positive non-skin tissue cultures that correlated with the pathology interpretation, and 3 of 8 patients in the discordant group died of systemic fungal infection. This was a retrospective study design and a single tertiary care institution experience. The histopathologic interpretation of skin tissue specimens is critical for rapid and accurate diagnosis of DCFI. Despite the identification of fungal organisms on histopathologic assessment of skin tissue specimens, skin tissue culture may fail to show fungal growth. A diagnosis of a DCFI and initiation of appropriate treatment should always be considered in spite of discordant results.

Are histologic studies of adenotonsillectomy really necessary?

Introduction In most ear, nose, and throat services, it is routine to send the material extracted from tonsillectomy for histologic study to research malignancy, to analyze suspect material, or to provide medical-legal documentation. Recent studies have shown that this routine analysis is dispensable. Objective To evaluate the actual need and perform a cost–benefit analysis of routine histopathologic examination in tonsillectomy with no signs or symptoms of malignancy. Methods A retrospective observational study evaluated the charts of patients undergoing adenotonsillectomy, tonsillectomy, or adenoidectomy from January 2008 to September 2009 at the Institute of Otorhinolaryngology CEMA-SP. Costs of this test for the public health system were analyzed and the literature reviewed. Results We studied 281 patients between 2 and 22 years of age; 142 (50.5%) were male and 139 (49.5%) were female. Of the surgeries, 201 were adenotonsillectomies (71.5%), 41 were tonsillectomies (14.5%), and 39 were adenoidectomies (14%). The most common indication for surgery was recurrent infection (63.3%). None of study patients had clinical suspicion of malignancy. The tests showed a cost of R$20.03 per tonsil analyzed. Conclusion Routine histopathologic examination in patients undergoing adenotonsillectomy with no signs or symptoms of malignancy is dispensable and increases the cost of the surgeries.

Intraoperative Molecular Assessment for Lymph Node Metastasis in Head and Neck Squamous Cell Carcinoma Using One-Step Nucleic Acid Amplification (OSNA) Assay

Conventional intraoperative pathological examination for Sentinel node navigation surgery (SNNS) has been controversial. We evaluated the efficacy of one-step nucleic acid amplification (OSNA) assay for intraoperative diagnosis of cervical lymph node (CLN) metastasis compared with histopathological examination in patients with head and neck squamous cell carcinoma (HNSCC). A total of 175 CLNs dissected from 56 patients with HNSCC who underwent surgery at Aichi Cancer Center, Kyorin University, Gunma University or Fukushima Medical University, between April 2008 and December 2011 were enrolled. CLN samples were sectioned into four equal pieces, with two of each used for OSNA assay and other histopathological examinations. The diagnostic value of OSNA assay in HNSCC patients in predicting the results of histopathological diagnosis was evaluated using the area under the receiver operating characteristic (AUROC) curve. OSNA assay showed acceptable efficacy in the detection of pathological CLN metastasis (AUROC 0.918, 95% confidence interval [CI] 0.852-0.984). Regarding the CK19mRNA cutoff value, the optimum cutoff point in HNSCC patients was 131copies/μl (sensitivity: 82.4, 95% CI 65.5-93.2; specificity: 99.3, 95% CI 96.1-100.0; positive likelihood ratio 116.1; negative likelihood ratio 0.2]. We demonstrated that OSNA assay is useful in intraoperative diagnosis for CLN metastasis in patients with HNSCC. OSNA assay could be applied for SNNS in HNSCC patients.

Microvascular Invasion in Hepatocellular Carcinoma: Is It Predictable With Pretransplant MRI?

The purpose of this article is to correlate clinicopathologic and MRI parameters with the presence of microvascular invasion at histopathologic examination in patients with hepatocellular carcinoma (HCC) who are undergoing liver transplantation. In this retrospective single-center study, we assessed 60 patients (47 men and 13 women; mean age, 58 years) with HCC who underwent liver transplantation and pretransplant MRI (performed within 90 days before liver transplantation). Two observers analyzed the following tumor parameters in consensus: number, size, T1 and T2 signal intensity, margins, presence of capsule or pseudocapsule, distance to closest vessel, distance to liver capsule, and quantitative tumor enhancement. The size and number of HCCs, tumor differentiation, and the presence or absence of microvascular invasion were determined at histopathologic examination. Odds ratios (ORs) were calculated and logistic regression analysis was performed to assess the utility of these clinicopathologic and imaging parameters for predicting microvascular invasion. None of the clinical parameters or morphologic and enhancement MRI features of HCC was predictive of microvascular invasion. Tumor multifocality, on both MRI and pathologic examination, was the only variable that predicted microvascular invasion (OR = 2.43 and p = 0.013 for MRI; OR = 1.94 and p = 0.013 for pathologic examination). The presence of three or more tumors on MRI and four or more tumors at pathologic examination had high specificity (88.2% and 91.2%, respectively) for the prediction of microvascular invasion. Tumor multifocality on MRI was the only parameter that correlated significantly with microvascular invasion. All other MRI tumor characteristics failed to predict microvascular invasion.

Chronic idiopathic anal pain.

PURPOSE: This study was undertaken to analyze whether intra-anal ultrasound examination, anorectal physiologic evaluation, and histopathologic examination in patients with chronic idiopathic anal pain presented any common features and whether the results of different treatment modalities correlated with these findings. METHODS: Eighteen patients who met the criteria for chronic idiopathic anal pain were studied. All had an intra-anal ultrasound examination and a complete anorectal physiologic evaluation. In a selected group of patients, ultrasound-guided biopsy samples were taken from pathological areas in the internal and external sphincter. Treatment consisted of analgesics only in four patients, 0.2 percent nitroglycerin ointment in four, and ultrasound injection of botulin (botulinum toxin, Botox®) into the intersphincteric space in nine. Two patients, including one who was previously treated with botulin, ultimately had a colostomy. RESULTS: Four patients were managed satisfactorily on analgesic treatment under the guidance of the hospital's pain clinic. Nitroglycerin ointment resulted in temporary pain relief in one of four patients. Injection of botulin resulted in a permanent improvement in four patients, a temporary improvement in one patient, and no effect in four patients. Two patients had a colostomy, resulting in complete pain relief. The effect or lack of effect of nitroglycerin ointment and botulin was not related to changes in anal pressure. CONCLUSION: Chronic idiopathic anal pain is a condition of unknown origin for which no proven therapy exists. As in other syndromes based on muscular dystonia, some patients may benefit from injection of botulin.

Chronic idiopathic anal pain: analysis of ultrasonography, pathology, and treatment.

This study was undertaken to analyze whether intra-anal ultrasound examination, anorectal physiologic evaluation, and histopathologic examination in patients with chronic idiopathic anal pain presented any common features and whether the results of different treatment modalities correlated with these findings. Eighteen patients who met the criteria for chronic idiopathic anal pain were studied. All had an intra-anal ultrasound examination and a complete anorectal physiologic evaluation. In a selected group of patients, ultrasound-guided biopsy samples were taken from pathological areas in the internal and external sphincter. Treatment consisted of analgesics only in four patients, 0.2 percent nitroglycerin ointment in four, and ultrasound injection of botulin (botulinum toxin, Botox) into the intersphincteric space in nine. Two patients, including one who was previously treated with botulin, ultimately had a colostomy. Four patients were managed satisfactorily on analgesic treatment under the guidance of the hospital's pain clinic. Nitroglycerin ointment resulted in temporary pain relief in one of four patients. Injection of botulin resulted in a permanent improvement in four patients, a temporary improvement in one patient, and no effect in four patients. Two patients had a colostomy, resulting in complete pain relief. The effect or lack of effect of nitroglycerin ointment and botulin was not related to changes in anal pressure. Chronic idiopathic anal pain is a condition of unknown origin for which no proven therapy exists. As in other syndromes based on muscular dystonia, some patients may benefit from injection of botulin.