Difference between revisions of "Hemorrhoid"

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#redirect [[Anus#hemorrhoids]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Hemorrhoid -- low mag.jpg
| Width      =
| Caption    = Hemorrhoid. [[H&E stain]].
| Micro      = polypoid lesion (epithelium on three sides) with large dilated veins and thick-walled vessels +/- fibrin thrombi, +/-edema, covered by squamous epithelium +/- keratinization and/or columnar epithelium
| Subtypes  =
| LMDDx      = [[fibroepithelial polyp]], vascular lesions (e.g. [[Kaposi sarcoma]])
| Stains    =
| IHC        =
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  =
| Site      = [[rectum]]/[[anus]]
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      = +/-bright red blood per rectum
| Symptoms  = +/-itching, +/-pain
| Prevalence = very common
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = benign
| Other      =
| ClinDDx    = other causes of rectal bleeding (e.g. [[colorectal carcinoma]]), [[malignant melanoma]]
}}
'''Hemorrhoid''' is a benign pathology of the rectal venous plexus, that may mimic more serious pathology, i.e. [[cancer]].
 
==General==
*Benign.
 
Clinical features:<ref>{{Cite journal  | last1 = Cazemier | first1 = M. | last2 = Felt-Bersma | first2 = RJ. | last3 = Cuesta | first3 = MA. | last4 = Mulder | first4 = CJ. | title = Elastic band ligation of hemorrhoids: flexible gastroscope or rigid proctoscope? | journal = World J Gastroenterol | volume = 13 | issue = 4 | pages = 585-7 | month = Jan | year = 2007 | doi =  | PMID = 17278225 }}</ref>
*[[Bright red blood per rectum]] (BRBPR).
*Pain.
*Itching.
*Prolapse.
 
==Gross==
Features:<ref name=Ref_GLP401>{{Ref GLP|401}}</ref>
*Grey mucosa.
*Pale or purple stroma.
 
DDx - clinical:
*[[Malignant melanoma]].<ref name=pmid11592745>{{Cite journal  | last1 = Felz | first1 = MW. | last2 = Winburn | first2 = GB. | last3 = Kallab | first3 = AM. | last4 = Lee | first4 = JR. | title = Anal melanoma: an aggressive malignancy masquerading as hemorrhoids. | journal = South Med J | volume = 94 | issue = 9 | pages = 880-5 | month = Sep | year = 2001 | doi =  | PMID = 11592745 }}
</ref>
 
==Microscopic==
Features:<ref name=Ref_GLP401>{{Ref GLP|401}}</ref>
*Polypoid lesion - epithelium on three sides:
**Large dilated veins and thick-walled vessels +/- fibrin thrombi - '''key feature'''.
**Edema.
**Squamous epithelium +/- keratinization ''or'' columnar epithelium.
 
DDx:
*[[Fibroepithelial polyp]].
*Vascular lesions.
**[[Kaposi sarcoma]].
**[[Angiosarcoma]].
**[[Arteriovenous malformation]] - has large arteries.
*[[Mucosal prolapse]].
 
===Image===
<gallery>
Image: Hemorrhoid -- very low mag.jpg | Hemorrhoid - very low mag. (WC)
Image: Hemorrhoid -- low mag.jpg | Hemorrhoid - low mag. (WC)
Image: Hemorrhoid - alt -- low mag.jpg | Hemorrhoid - low mag. (WC)
Image: Hemorrhoid -- intermed mag.jpg | Hemorrhoid - intermed. mag. (WC)
</gallery>
www:
*[http://www.profimedia.si/picture/longitudinal-section-of-human-rectum-hemorrhoid-tissue/0039860546/ Hemorrhoids (profimedia.si)].
 
==Sign out==
<pre>
ANAL LESION, REMOVAL:
- HEMORRHOID.
</pre>
 
<pre>
HEMORRHOIDS, EXCISION:
- HEMORRHOIDS.
</pre>
 
===Alternate===
<pre>
"EXTERNAL HEMORRHOID", EXCISION:
- POLYPOID FRAGMENTS OF RECTAL-TYPE MUCOSA WITH REACTIVE CHANGES, ULCERATION, SMOOTH
  MUSCLE HYPERPLASIA, AND GRANULATION TISSUE WITH INTERMEDIATE SIZE BLOOD VESSELS.
- NEGATIVE FOR DYSPLASIA.
</pre>
 
===Micro===
The sections show rectal and anal mucosa, and a submucosa with prominent blood vessels in a fibrotic stroma.  The rectal mucosa has focal reactive nuclear changes and evidence of prior erosions. The anal mucosa is unremarkable.
 
====Anal mucosa only====
The sections show anal mucosa, and submucosa with prominent blood vessels in a
fibrotic stroma. The anal mucosa is unremarkable.
 
==See also==
*[[Anus]].
*[[Colon]].
 
==References==
{{Reflist|2}}
 
[[Category:Anus]]
[[Category:Gastrointestinal pathology]]
[[Category:Diagnosis]]

Latest revision as of 12:10, 26 June 2014

Hemorrhoid
Diagnosis in short

Hemorrhoid. H&E stain.
LM polypoid lesion (epithelium on three sides) with large dilated veins and thick-walled vessels +/- fibrin thrombi, +/-edema, covered by squamous epithelium +/- keratinization and/or columnar epithelium
LM DDx fibroepithelial polyp, vascular lesions (e.g. Kaposi sarcoma)
Site rectum/anus
Signs +/-bright red blood per rectum
Symptoms +/-itching, +/-pain
Prevalence very common
Prognosis benign
Clin. DDx other causes of rectal bleeding (e.g. colorectal carcinoma), malignant melanoma

Hemorrhoid is a benign pathology of the rectal venous plexus, that may mimic more serious pathology, i.e. cancer.

General

  • Benign.

Clinical features:[1]

Gross

Features:[2]

  • Grey mucosa.
  • Pale or purple stroma.

DDx - clinical:

Microscopic

Features:[2]

  • Polypoid lesion - epithelium on three sides:
    • Large dilated veins and thick-walled vessels +/- fibrin thrombi - key feature.
    • Edema.
    • Squamous epithelium +/- keratinization or columnar epithelium.

DDx:

Image

  • Hemorrhoid - very low mag. (WC)

  • Hemorrhoid - low mag. (WC)

  • Hemorrhoid - low mag. (WC)

  • Hemorrhoid - intermed. mag. (WC)

www:

Sign out

ANAL LESION, REMOVAL:
- HEMORRHOID.

HEMORRHOIDS, EXCISION: 
- HEMORRHOIDS.

Alternate

"EXTERNAL HEMORRHOID", EXCISION:
- POLYPOID FRAGMENTS OF RECTAL-TYPE MUCOSA WITH REACTIVE CHANGES, ULCERATION, SMOOTH
  MUSCLE HYPERPLASIA, AND GRANULATION TISSUE WITH INTERMEDIATE SIZE BLOOD VESSELS.
- NEGATIVE FOR DYSPLASIA.

Micro

The sections show rectal and anal mucosa, and a submucosa with prominent blood vessels in a fibrotic stroma. The rectal mucosa has focal reactive nuclear changes and evidence of prior erosions. The anal mucosa is unremarkable.

Anal mucosa only

The sections show anal mucosa, and submucosa with prominent blood vessels in a fibrotic stroma. The anal mucosa is unremarkable.

See also

References

  1. ↑ Cazemier, M.; Felt-Bersma, RJ.; Cuesta, MA.; Mulder, CJ. (Jan 2007). "Elastic band ligation of hemorrhoids: flexible gastroscope or rigid proctoscope?". World J Gastroenterol 13 (4): 585-7. PMID 17278225.
  2. ↑ 2.0 2.1 Iacobuzio-Donahue, Christine A.; Montgomery, Elizabeth A. (2005). Gastrointestinal and Liver Pathology: A Volume in the Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 401. ISBN 978-0443066573.
  3. ↑ Felz, MW.; Winburn, GB.; Kallab, AM.; Lee, JR. (Sep 2001). "Anal melanoma: an aggressive malignancy masquerading as hemorrhoids.". South Med J 94 (9): 880-5. PMID 11592745.
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