Re: Pilonidal sinus: is histological examination necessary? – the age of patients with pilonidal carcinoma is overestimated

Abstract

Otutaha et al. published a recommendation when to work up pilonidal sinus disease (PSD) specimens, relying on his database of 325 pilonidal specimens. We would like to disagree in one point: patient age is not a good criterion for the indication of PSD specimen analysis. Of course, it is known and was recently published that regional differences of PSD incidence do occur, which are associated with gender difference incidences as well. While the Australian–New Zealand region may be blessed with a lower PSD incidence and thus a lower PSD carcinoma incidence as well, it cannot be deduced from thereon that histology is not needed below the age of 50 years. We analysed a series of 129 PSD carcinomas. We found that the mean age of these patients was 54 years with an age range of 19–86 years (Fig. 1). As can be deduced from Figure 1, more than 20% of the PSD carcinoma patients are below the age of 50 years (mean ± SD 53.7 ± 12.6 years). These would be lost with the introduction of a 50-year age barrier. There are several reasons to omit histology in pilonidal sinus. But patient age is not a criterion, as PSD might arise in earlier or later age. Long-standing disease should raise our suspicion, as neoplasia nearly always arises in infection which is smouldering for decades. But as can be seen, there are exemptions. Interestingly, PSD carcinoma can also arise in so-called late recurrences that have been fully clinically silent over decades, as every asymptomatic pilonidal sinus tissue always contains infection of different intensity.