Necessity of Routine Histopathological Examination in Pilonidal Sinus Surgery: A Retrospective Analysis

Abstract

Objective: Pilonidal sinus disease (PSD) is a benign but recurrent disease of the sacrococcygeal region, occasionally associated with malignant transformation, most frequently squamous cell carcinoma. The increasing use of minimally invasive approaches without routine histopathological evaluation has raised concerns regarding the potential risk of missing rare malignancies. This study aimed to evaluate the necessity of routine histopathological examination of pilonidal sinus excision specimens.

Methods: This retrospective study analyzed 420 patients who underwent pilonidal sinus surgery at Gaziantep University between 2012 and 2025. Demographic characteristics (age, gender, comorbidities, smoking/alcohol use), the presence of additional malignancies, and histopathological findings (benign versus malignant and subtypes) were recorded and analyzed.

Results: The mean age of the patients was 25.8 ± 8.9 years, and 85.9% were male. All histopathological evaluations demonstrated benign pathology (100%), with no malignancy identified in any specimen. Active chronic inflammation (62.1%) and inflammatory granulation tissue (35.9%) were the most common findings. Rare histopathological findings included abscess formation (1.4%), dermatofibroma (0.2%), and fibrotic changes (0.2%).

Conclusion: Although no malignancies were detected in this large cohort, the potential risk of malignant transformation in long-standing, recurrent, or atypical pilonidal sinus lesions cannot be fully excluded. Routine histopathological evaluation remains a low-cost, safe diagnostic approach and should be particularly considered in patients aged >50 years, with recurrent disease or atypical presentations.