Histopathological surprises in inguinal hernial sac

Among all age groups, inguinal hernia repair is one of the most frequently performed surgical procedures. The histopathological examination of the hernial sac specimen is usually unexciting. Occasionally, the findings might surprise the surgeon with an unexpected diagnosis. The literature reveals that hernial sac has not only shown the presence of well differentiated tissues, ranging from urological and gynecological origin, but also sometimes could be the initial revelation of cancers like malignant mesothelioma, liposarcoma, pseudomyxoma peritonei or a deposit from a distant intra- abdominal malignancy. It has been well recognized that lymph nodes positive for metastasis can be found in the hernial sac as well. The routine microscopic evaluation of hernial sac remains a worthwhile procedure especially when there is a suspicion for an occult malignancy or there is a concern regarding injury to the reproductive organs. Additionally, intra-operative consultation should be utilized for identifying any unknown pathologic process or ectopic tissue in the inguinal sac to guide management and to prevent a possible second surgery. In such special conditions, involving a pathologist for both physical examinations of the tissue with the naked eye as well as examining processed tissue under a microscope may lead to better clinical outcomes and overall better patient care. This chapter provides an overview of the different findings that can be encountered in the hernial sac specimen, in both pediatric as well as the adult age groups.