Hemorrhoid
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Hemorrhoid is a benign pathology of the rectal venous plexus, that may mimic more serious pathology, i.e. cancer.
| 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 |
General
- Benign.
Clinical features:[1]
- Bright red blood per rectum (BRBPR).
- Pain.
- Itching.
- Prolapse.
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:
- Fibroepithelial polyp.
- Vascular lesions.
- Kaposi sarcoma.
- Angiosarcoma.
- Arteriovenous malformation - has large arteries.
Image
Hemorrhoid - very low mag. (WC)
Hemorrhoid - low mag. (WC)
Hemorrhoid - low mag. (WC)
Hemorrhoid - intermed. mag. (WC)
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ANAL LESION, REMOVAL: - HEMORRHOID.
HEMORRHOIDS, EXCISION: - HEMORRHOIDS.
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
- ↑ 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.
- ↑ 2.0 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.
- ↑ 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.