Difference between revisions of "Anus"
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The '''anus''' occasionally shows-up on the pathologists desk. It sometimes comes with the rectum and [[colon]], as an abdominoperoneal resection (APR). | The '''anus''' occasionally shows-up on the pathologists desk. It sometimes comes with the rectum and [[colon]], as an abdominoperoneal resection (APR). | ||
=Anal neoplasia= | |||
Immunosuppressed individuals and homosexuals have a higher risk of anal intraepithelial neoplasia (AIN) and anal cancer.<ref name=pmid20461117>{{cite journal |author=Park IU, Palefsky JM |title=Evaluation and Management of Anal Intraepithelial Neoplasia in HIV-Negative and HIV-Positive Men Who Have Sex with Men |journal=Curr Infect Dis Rep |volume=12 |issue=2 |pages=126–133 |year=2010 |month=March |pmid=20461117 |pmc=2860554 |doi=10.1007/s11908-010-0090-7 |url=}}</ref><ref name=pmid21083999>{{cite journal |author=Czoski-Murray C, Karnon J, Jones R, Smith K, Kinghorn G |title=Cost-effectiveness of screening high-risk HIV-positive men who have sex with men (MSM) and HIV-positive women for anal cancer |journal=Health Technol Assess |volume=14 |issue=53 |pages=1–131 |year=2010 |month=November |pmid=21083999 |doi=10.3310/hta14530 |url=}}</ref> | Immunosuppressed individuals and homosexuals have a higher risk of anal intraepithelial neoplasia (AIN) and anal cancer.<ref name=pmid20461117>{{cite journal |author=Park IU, Palefsky JM |title=Evaluation and Management of Anal Intraepithelial Neoplasia in HIV-Negative and HIV-Positive Men Who Have Sex with Men |journal=Curr Infect Dis Rep |volume=12 |issue=2 |pages=126–133 |year=2010 |month=March |pmid=20461117 |pmc=2860554 |doi=10.1007/s11908-010-0090-7 |url=}}</ref><ref name=pmid21083999>{{cite journal |author=Czoski-Murray C, Karnon J, Jones R, Smith K, Kinghorn G |title=Cost-effectiveness of screening high-risk HIV-positive men who have sex with men (MSM) and HIV-positive women for anal cancer |journal=Health Technol Assess |volume=14 |issue=53 |pages=1–131 |year=2010 |month=November |pmid=21083999 |doi=10.3310/hta14530 |url=}}</ref> | ||
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*Low-grade anal intraepithelial neoplasia (LGAIN). | *Low-grade anal intraepithelial neoplasia (LGAIN). | ||
=Anal cancer= | |||
*[[Squamous cell carcinoma]] - most common. | *[[Squamous cell carcinoma]] - most common. | ||
*[[Malignant melanoma]]. | *[[Malignant melanoma]]. | ||
*[[Adenocarcinoma]] from the [[rectum]]. | *[[Adenocarcinoma]] from the [[rectum]]. | ||
==Anal gland adenocarcinoma== | |||
*[[AKA]] ''anal adenocarcinoma''. | |||
===General=== | |||
*Rare. | |||
Risk factors:<ref name=pmid8085101>{{Cite journal | last1 = Tarazi | first1 = R. | last2 = Nelson | first2 = RL. | title = Anal adenocarcinoma: a comprehensive review. | journal = Semin Surg Oncol | volume = 10 | issue = 3 | pages = 235-40 | month = | year = | doi = | PMID = 8085101 }}</ref> | |||
*Anal [[Crohn's disease]]. | |||
*Chronic anal fistula. | |||
*Anal sexual intercourse. | |||
===Microscopic=== | |||
Features:<ref name=pmid22690260/> | |||
*Adenocarcinoma within the anal wall but not within the mucosa, i.e. extramucosal and intramural. | |||
**The Tumour lies beneath the squamous mucosa. | |||
DDx: | |||
*[[Rectal adenocarcinoma]]. | |||
Image: | |||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3369602/figure/F1/ Anal adenocarcinoma (nih.gov)].<ref name=pmid22690260>{{Cite journal | last1 = Warsch | first1 = S. | last2 = Bayraktar | first2 = UD. | last3 = Wen | first3 = BC. | last4 = Zeitouni | first4 = J. | last5 = Marchetti | first5 = F. | last6 = Rocha-Lima | first6 = CM. | last7 = Montero | first7 = AJ. | title = Successful treatment of anal gland adenocarcinoma with combined modality therapy. | journal = Gastrointest Cancer Res | volume = 5 | issue = 2 | pages = 64-6 | month = Mar | year = 2012 | doi = | PMID = 22690260 }}</ref> | |||
===IHC=== | |||
Features:<ref name=pmid22690260/> | |||
*CK7 +ve. | |||
*CK20 -ve. | |||
*CDX2 -ve. | |||
*p63 -ve. | |||
*PSA -ve. | |||
=Benign disease= | |||
==Hidradenoma papilliferum== | ==Hidradenoma papilliferum== | ||
:See ''[[Hidradenoma papilliferum]]''. | :See ''[[Hidradenoma papilliferum]]''. | ||
| Line 54: | Line 84: | ||
*[http://www.profimedia.si/picture/longitudinal-section-of-human-rectum-hemorrhoid-tissue/0039860546/ Hemorrhoids (profimedia.si)]. | *[http://www.profimedia.si/picture/longitudinal-section-of-human-rectum-hemorrhoid-tissue/0039860546/ Hemorrhoids (profimedia.si)]. | ||
=See also= | |||
*[[Colon]]. | *[[Colon]]. | ||
*[[Dermatopathology]]. | *[[Dermatopathology]]. | ||
=References= | |||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Gastrointestinal pathology]] | [[Category:Gastrointestinal pathology]] | ||
Revision as of 01:52, 31 August 2012
The anus occasionally shows-up on the pathologists desk. It sometimes comes with the rectum and colon, as an abdominoperoneal resection (APR).
Anal neoplasia
Immunosuppressed individuals and homosexuals have a higher risk of anal intraepithelial neoplasia (AIN) and anal cancer.[1][2]
Anal intraepithelial neoplasia
- Abbreviated AIN.
General
- Precursor lesion of anal cancer.
- Usually HPV associated.
Grading
AIN is graded much like cervical intraepithelial neoplasia:
- High-grade anal intraepithelial neoplasia (HGAIN).
- Low-grade anal intraepithelial neoplasia (LGAIN).
Anal cancer
- Squamous cell carcinoma - most common.
- Malignant melanoma.
- Adenocarcinoma from the rectum.
Anal gland adenocarcinoma
- AKA anal adenocarcinoma.
General
- Rare.
Risk factors:[3]
- Anal Crohn's disease.
- Chronic anal fistula.
- Anal sexual intercourse.
Microscopic
Features:[4]
- Adenocarcinoma within the anal wall but not within the mucosa, i.e. extramucosal and intramural.
- The Tumour lies beneath the squamous mucosa.
DDx:
Image:
IHC
Features:[4]
- CK7 +ve.
- CK20 -ve.
- CDX2 -ve.
- p63 -ve.
- PSA -ve.
Benign disease
Hidradenoma papilliferum
Hemorrhoids
General
- Benign.
Clinical features:[5]
- Bright red blood per rectum (BRBPR).
- Pain.
- Itching.
- Prolapse.
Gross
Features:[6]
- Grey mucosa.
- Pale or purple stroma.
Microscopic
Features:[6]
- 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.
Image:
See also
References
- ↑ Park IU, Palefsky JM (March 2010). "Evaluation and Management of Anal Intraepithelial Neoplasia in HIV-Negative and HIV-Positive Men Who Have Sex with Men". Curr Infect Dis Rep 12 (2): 126–133. doi:10.1007/s11908-010-0090-7. PMC 2860554. PMID 20461117. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860554/.
- ↑ Czoski-Murray C, Karnon J, Jones R, Smith K, Kinghorn G (November 2010). "Cost-effectiveness of screening high-risk HIV-positive men who have sex with men (MSM) and HIV-positive women for anal cancer". Health Technol Assess 14 (53): 1–131. doi:10.3310/hta14530. PMID 21083999.
- ↑ Tarazi, R.; Nelson, RL.. "Anal adenocarcinoma: a comprehensive review.". Semin Surg Oncol 10 (3): 235-40. PMID 8085101.
- ↑ 4.0 4.1 4.2 Warsch, S.; Bayraktar, UD.; Wen, BC.; Zeitouni, J.; Marchetti, F.; Rocha-Lima, CM.; Montero, AJ. (Mar 2012). "Successful treatment of anal gland adenocarcinoma with combined modality therapy.". Gastrointest Cancer Res 5 (2): 64-6. PMID 22690260.
- ↑ 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.
- ↑ 6.0 6.1 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.