Surprise in hernia sacs: Malignant tumor metastasis



Hernia sac, Incidental, Malignant tumor, Metastasis, Pathological findings


Background/Aim: Malignant tumors are rare in the hernia sac, and there are very few studies on this subject in the literature. We aimed to investigate the malignancies in surgically resected hernia sacs and their clinicopathological features in the last ten years in our institution. Methods: The hernia sac specimens sent for pathological examination between 2010 and 2021 were included in this retrospective cohort study. The age and gender of the patient, the type of hernia and known malignancy history of all patients were recorded. Cases with malignancy in the hernia sac were selected and their slides were re-evaluated. The cases with and without malignancy in the hernia sac were compared in terms of age, gender and known cancer history. Results: There were 455 hernia sac specimens belonging to 448 patients which underwent pathological examination between 2011 and 2021. Malignancy was detected in ten (2.20%) hernia sacs. Eight were malignant tumor metastases (1.75%). The remaining two were secondary involvement of another malignancy. Five malignant tumors were ovarian serous carcinoma, one was vulvar squamous cell carcinoma, one was appendiceal mucinous cystadenocarcinoma, one was malignant melanoma metastasis, one was undifferentiated pleomorphic sarcoma, and one was non-Hodgkin lymphoma. The incidence of hernia sac malignancy was similar in male and female patients (3.5% and 1.4%, respectively; P=0.190). There was a known cancer history in 70% (n=7) of ten patients with malignancy in the hernia sac. The incidence of malignancy in the hernia sacs of patients with a known cancer history was significantly higher (P<0.001). Malignancies were present in 0.95% (n=2) of inguinal hernias, 1.67% (n=2) of abdominal hernias and 5.45 % (n=6) of incisional hernias. Gross pathology was detected in the macroscopic examination of all malignant inguinal hernias, but not in any of the abdominal hernias. Conclusion: We recommend the microscopic examination of hernia sacs, even if there is no macroscopic abnormality, especially in the elderly and/or patients with a history of malignancy, in order to detect incidental metastases.


Download data is not yet available.


Nicholson CP, Donohue JH, Thompson GB, Lewis JE. A study of metastatic cancer found during inguinal hernia repair. Cancer. 1992;69(12):3008-11. doi: 10.1002/1097-0142(19920615)69:12<3008::aid-cncr2820691224>;2-8

Val-Bernal JF, Mayorga M, Fernández FA, Val D, Sánchez R. Malignant epithelial tumors observed in hernia sacs. Hernia. 2014;18(6):831-5. doi: 10.1007/s10029-014-1283-z

Topal U, Gok M, Akyuz M, Oz AB, Arikan TB, Solak İ, et al. Is histopathological evaluation of hernia sacs necessary?. Arch Iran Med. 2020;23(6):403-8. doi: 10.34172/aim.2020.34

Zhang D, Yang Q, Katerji R, Drage MG, Huber A, Liao X. Malignant tumors in hernia sac: Clinicopathological and immunohistochemical studies of 21 cases at a single institution. Pathol Int. 2020;70(12):975-83. doi: 10.1111/pin.13018

Roslyn JJ, Stabile BE, Rangenath C. Cancer in inguinal and femoral hernias. Am Surg. 1980;46(6):358–62.

Miyake Y, Kato T, Katayama K, Doi T, Oshima K, Handa R, et al. A case of ascending colon carcinoma metastasized to an inguinal hernia sac. Gan To Kagaku Ryoho. 2007;34(12):2016-8.

Val-Bernal JF, Mayorga M, Val D, Garijo MF. Low-grade serous primary peritoneal carcinoma incidentally found in a hernia sac. Pathol Res Pract. 2015;211(7):550-5. doi: 10.1016/j.prp.2015.04.001

Sakano Y, Ohtsuka M, Saito T, Mikamori M, Furukawa K, Suzuki Y, et al. A case of endometrioid adenocarcinoma in the sac of a femoral hernia. Gan To Kagaku Ryoho. 2018;45(13):2021-3.

Roberts JA, Ho D, Ayala AG, Ro JY. A study of metastatic carcinoma found in hernia sacs between 2006 and 2012 at one institution. Ann Diagn Pathol. 2014;18(2):71-3. doi: 10.1016/j.anndiagpath.2013.10.008

Wang T, Vajpeyi R. Hernia sacs: is histological examination necessary?. J Clin Pathol. 2013;66(12):1084-6. doi: 10.1136/jclinpath-2013-201734

Esquivel J, Sugarbaker PH. Pseudomyxoma peritonei in a hernia sac: analysis of 20 patients in whom mucoid fluid was found during a hernia repair. Eur J Surg Oncol. 2001;27(1):54-8. doi: 10.1053/ejso.2000.1031

Reddi DM, Scherpelz KP, Lerma A, Shriki J, Virgin J. Rapidly growing pancreatic adenocarcinoma presenting as an irreducible umbilical hernia. Case Rep Pathol. 2018;2018:1784548. Published 2018 Jun 13. doi: 10.1155/2018/1784548

Qin R, Zhang Q, Weng J, Pu Y. Incidental finding of a malignant tumour in an inguinal hernia sac. Contemp Oncol (Pozn). 2014;18(2):130-3. doi: 10.5114/wo.2014.42728

Oruç MT, Kulah B, Saylam B, Moran M, Albayrak L, Coşkun F. An unusual presentation of metastatic gastric cancer found during inguinal hernia repair: case report and review of the literature. Hernia. 2002;6(2):88-90. doi: 10.1007/s10029-002-0063-3

Pischon T, Nimptsch K. Obesity and Risk of Cancer: An introductory overview. Recent Results Cancer Res. 2016;208:1-15. doi: 10.1007/978-3-319-42542-9_1

Allott EH, Hursting SD. Obesity and cancer: mechanistic insights from transdisciplinary studies. Endocr Relat Cancer. 2015;22(6):365-86. doi: 10.1530/ERC-15-0400

Kulacoglu H, Köckerling F. Hernia and cancer: The points where the roads intersect. Front Surg. 2019;6:19. Published 2019 Apr 5. doi: 10.3389/fsurg.2019.00019

Gallagher EJ, LeRoith D. Obesity and diabetes: The increased risk of cancer and cancer-related mortality. Physiol Rev. 2015;95(3):727-48. doi: 10.1152/physrev.00030.2014

Lau B, Kim H, Haigh PI, Tejirian T. Obesity increases the odds of acquiring and incarcerating noninguinal abdominal wall hernias. Am Surg. 2012;78(10):1118-21.

Sugarbaker PH. Management of an inguinal hernia in patients with pseudomyxoma peritonei. Eur J Surg Oncol. 2017;43(6):1083-7. doi: 10.1016/j.ejso.2016.12.005

Itatsu K, Yokoyama Y, Sugawara G, Kubota H, Tojima Y, Kurumiya Y,et al. Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg. 2014;101(11):1439-47. doi: 10.1002/bjs.9600

Best IM, McKinney G, Garg C, Scott A, McKinney S, Weaver WL, et al. Squamous cell carcinoma at herniorrhaphy and unilateral renal agenesis. Am J Clin Oncol. 2003;26(3):297-9. doi: 10.1097/00000421-200306000-00018

Katsourakis A, Noussios G, Svoronos C, Alatsakis M, Chatzitheoklitos E. Direct inguinal hernia containing bladder carcinoma: A case report and review of the literature. Int J Surg Case Rep. 2014;5(4):180-2. doi: 10.1016/j.ijscr.2014.01.007

Qaiyumi Z, Nepal P, Iannuzzi C, Sapire J. Primary squamous cell carcinoma of the urinary bladder presenting as an inguinal mass. SA J Radiol. 2021;25(1):2048. Published 2021 Mar 29. doi: 10.4102/sajr.v25i1.2048

Christofi T, Jonas-Obichere M, Amo-Takyi BK. An unusual finding in an umbilical hernia. J Obstet Gynaecol. 2007;27(7):740. doi: 10.1080/01443610701629106

Demetri GD, Antonia S, Benjamin RS, Bui MM, Casper ES, Conrad EU 3rd, et al. Soft tissue sarcoma. J Natl Compr Canc Netw. 2010;8(6):630-74. doi: 10.6004/jnccn.2010.0049

Al Nemer AM, Al-Buainain H. The necessity of routine histologic examination of hernia sac, revisited. Hernia. 2015;19(6):915-8.doi: 10.1007/s10029-014-1338-1






Research Article

How to Cite

Seçinti İlke E, Gürsoy D, Özgür T, Hakverdi S, Doğan E, Temiz M. Surprise in hernia sacs: Malignant tumor metastasis. J Surg Med [Internet]. 2022 Mar. 1 [cited 2024 May 25];6(3):331-5. Available from: