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Cecilia M. Fenoglio, MD
Veterans Administration Medical Center Albuquerque

JAMA. 1985;253(16):2363.

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In Reply.—

I believe that Dr Barnett is wrong in saying that the clinician can judge what is present in hemorrhoids better than a pathologist.

When there is a large, grossly visible lesion, the surgeon is more capable of diagnosing it and determining the extent of the disease process. However, all pathologists can recount many instances in which a neoplastic lesion has been missed by the clinician, through either lack of experience or failure to take the time to examine the tissues. I wonder how many surgeons carefully examine each hemorrhoid that is removed for the possibility of gross abnormalities. This is something that the pathologist is trained to do as part of the gross description.

When I was at Columbia, we encountered an unexpected finding in hemorrhoids approximately once every 18 months. Sometimes these findings were of minimal importance to the patient. At other times they were of much . . . [Full Text PDF of this Article]

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