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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). |
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| | =Normal= |
| | *The dentate line (also known as the ''pectinate line'') divides the anal canal into upper two thirds and lower one third. |
| | *Typically, the squamocolumnar junction is just above the dentate line. |
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| | Note: |
| | *Squamous epithelium 1 cm proximal to the dentate line is considered abnormal.<ref name=pmid11174313>{{Cite journal | last1 = Bujanda | first1 = L. | last2 = Iriondo | first2 = C. | last3 = Muñoz | first3 = C. | last4 = Etxezarraga | first4 = C. | last5 = Ramírez | first5 = MM. | last6 = Ramos | first6 = F. | last7 = Sánchez | first7 = A. | title = Squamous metaplasia of the rectum and sigmoid colon. | journal = Gastrointest Endosc | volume = 53 | issue = 2 | pages = 255-6 | month = Feb | year = 2001 | doi = | PMID = 11174313 }}</ref> |
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| | ==Squamous metaplasia of the anus== |
| | {{Main|Squamous metaplasia of the anus}} |
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| =Benign disease= | | =Benign disease= |
| ==Anal wart== | | ==Anal wart== |
| *See ''[[condyloma acuminatum]]''. | | *See ''[[condyloma acuminatum]]''. |
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| | ==Pilonidal cyst== |
| | :Also ''pilonidal sinus'' and ''pilonidal disease''. |
| | {{Main|Pilonidal cyst}} |
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| ==Perianal abscess== | | ==Perianal abscess== |
| ===General=== | | ===General=== |
| *Common - often young men.<ref name=pmid22362468>{{Cite journal | last1 = Ommer | first1 = A. | last2 = Herold | first2 = A. | last3 = Berg | first3 = E. | last4 = Fürst | first4 = A. | last5 = Sailer | first5 = M. | last6 = Schiedeck | first6 = T. | title = German S3 guideline: anal abscess. | journal = Int J Colorectal Dis | volume = 27 | issue = 6 | pages = 831-7 | month = Jun | year = 2012 | doi = 10.1007/s00384-012-1430-x | PMID = 22362468 }}</ref> | | *Common [[ditzel]] - often young men.<ref name=pmid22362468>{{Cite journal | last1 = Ommer | first1 = A. | last2 = Herold | first2 = A. | last3 = Berg | first3 = E. | last4 = Fürst | first4 = A. | last5 = Sailer | first5 = M. | last6 = Schiedeck | first6 = T. | title = German S3 guideline: anal abscess. | journal = Int J Colorectal Dis | volume = 27 | issue = 6 | pages = 831-7 | month = Jun | year = 2012 | doi = 10.1007/s00384-012-1430-x | PMID = 22362468 }}</ref> |
| *May be due to [[Crohn's disease]].<ref name=pmid21088749>{{Cite journal | last1 = Lewis | first1 = RT. | last2 = Maron | first2 = DJ. | title = Efficacy and complications of surgery for Crohn's disease. | journal = Gastroenterol Hepatol (N Y) | volume = 6 | issue = 9 | pages = 587-96 | month = Sep | year = 2010 | doi = | PMID = 21088749 }}</ref> | | *May be due to [[Crohn's disease]].<ref name=pmid21088749>{{Cite journal | last1 = Lewis | first1 = RT. | last2 = Maron | first2 = DJ. | title = Efficacy and complications of surgery for Crohn's disease. | journal = Gastroenterol Hepatol (N Y) | volume = 6 | issue = 9 | pages = 587-96 | month = Sep | year = 2010 | doi = | PMID = 21088749 }}</ref> |
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| ===Sign out=== | | ===Sign out=== |
| | <pre> |
| | Submitted as "Perineal Fistula Tract", Excision: |
| | - Consistent with fistula tract (acutely and chronically inflamed |
| | squamous mucosa with subepithelial inflamed tract, skeletal muscle |
| | and fibrosed tissue). |
| | - NEGATIVE for dysplasia and NEGATIVE for malignancy. |
| | </pre> |
| | |
| | ====Block letters==== |
| <pre> | | <pre> |
| PERIANAL TISSUE ("OPENING OF FISTULA"), EXCISION: | | PERIANAL TISSUE ("OPENING OF FISTULA"), EXCISION: |
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| ==Hemorrhoids== | | ==Hemorrhoids== |
| ===General===
| | {{Main|Hemorrhoid}} |
| *Benign.
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| 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>
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| *Bright red blood per rectum (BRBPR).
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| *Pain.
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| *Itching.
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| *Prolapse.
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| ===Gross===
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| Features:<ref name=Ref_GLP401>{{Ref GLP|401}}</ref>
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| *Grey mucosa.
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| *Pale or purple stroma.
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| ===Microscopic===
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| Features:<ref name=Ref_GLP401>{{Ref GLP|401}}</ref>
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| *Polypoid lesion - epithelium on three sides:
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| **Large dilated veins and thick-walled vessels +/- fibrin thrombi - '''key feature'''.
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| **Edema.
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| **Squamous epithelium +/- keratinization ''or'' columnar epithelium.
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| DDx:
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| *[[Fibroepithelial polyp]].
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| *Vascular lesions.
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| **[[Kaposi sarcoma]].
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| **[[Angiosarcoma]].
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| **[[Arteriovenous malformation]] - has large arteries.
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| Image:
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| *[http://www.profimedia.si/picture/longitudinal-section-of-human-rectum-hemorrhoid-tissue/0039860546/ Hemorrhoids (profimedia.si)].
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| ===Sign out===
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| <pre>
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| ANAL LESION, REMOVAL:
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| - HEMORRHOID.
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| </pre>
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| <pre>
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| HEMORRHOIDS, EXCISION:
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| - HEMORRHOIDS.
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| </pre>
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| ====Micro====
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| 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.
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| =====Anal mucosa only=====
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| The sections show anal mucosa, and submucosa with prominent blood vessels in a
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| fibrotic stroma. The anal mucosa is unremarkable.
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| =Anal neoplasia= | | =Anal neoplasia= |
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| ==Anal intraepithelial neoplasia== | | ==Anal intraepithelial neoplasia== |
| *Abbreviated ''AIN''. | | *Abbreviated ''AIN''. |
| ===General===
| | {{Main|Anal intraepithelial lesions}} |
| *Precursor lesion of anal [[squamous cell carcinoma]].
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| *Usually [[HPV]] associated.
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| **May be prevented by HPV vaccine.
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| ===Grading===
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| AIN is graded much like [[cervix|cervical intraepithelial neoplasia]]:
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| *High-grade anal intraepithelial neoplasia (HGAIN).
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| *Low-grade anal intraepithelial neoplasia (LGAIN).
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| ===Sign out===
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| <pre>
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| ANAL CANAL, RIGHT UPPER QUADRANT, BIOPSY:
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| - LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESION (CONDYLOMA ACUMINATUM-LIKE).
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| </pre>
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| <pre>
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| ANAL CANAL, LEFT UPPER QUADRANT, BIOPSY:
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| - LOW-GRADE SQUAMOUS INTRAEPITHELIAL LESION.
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| - RECTAL MUCOSA WITHIN NORMAL LIMITS.
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| </pre>
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| <pre>
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| SKIN LESION, PERIANAL, BIOPSY:
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| - ANAL INTRAEPITHELIAL NEOPLASIA 3 (SEVERE DYSPLASIA), WARTY-TYPE.
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| - MARGIN POSITIVE FOR ANAL INTRAEPITHELIAL NEOPLASIA 3.
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| </pre>
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| ====Micro====
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| There is dysplastic squamous epithelium with coarse chromatin, nuclear hyperchromasia,
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| nuclear enlargement, irregular nuclear membranes, and an increase nuclear-to-cytoplasmic
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| ratio. Mitotic activity is abundant. Several atypical mitoses are identified.
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| The dysplastic squamous epithelium shows minimal maturation toward the surface (AIN 3). A
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| sizable portion of the lesion show some maturation to the surface (AIN 2).
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| Inflammation at the dermal-epidermal interface is minimal and the dermal-epidermal
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| interface is well-demarcated. Focal ulceration is present.
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| The margin of the biopsy has severely dysplastic epithelium (AIN 3). | | Note: |
| | *The terminology changing to match the one now widely used for the [[uterine cervix]]. |
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| =Anal cancer= | | =Anal cancer= |
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| *[[AKA]] ''anal squamous carcinoma''. | | *[[AKA]] ''anal squamous carcinoma''. |
| *[[AKA]] ''squamous cell carcinoma of the anus''. | | *[[AKA]] ''squamous cell carcinoma of the anus''. |
| ===General===
| | {{Main|Anal squamous cell carcinoma}} |
| *Most common form of anal cancer.
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| Risk factors:<ref name=pmid23806153>{{Cite journal | last1 = Kutlubay | first1 = Z. | last2 = Engin | first2 = B. | last3 = Zara | first3 = T. | last4 = Tüzün | first4 = Y. | title = Anogenital malignancies and premalignancies: Facts and controversies. | journal = Clin Dermatol | volume = 31 | issue = 4 | pages = 362-73 | month = | year = | doi = 10.1016/j.clindermatol.2013.01.003 | PMID = 23806153 }}</ref>
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| *Men who have sex with men.
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| *Immunosuppressed.
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| *[[HIV]] infection.
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| ===Microscopic===
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| Features:
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| *See ''[[squamous cell carcinoma]]''.
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| DDx:
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| *[[Anal gland adenocarcinoma]].
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| *Poorly differentiated [[rectal adenocarcinoma]].
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| ===IHC===
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| *p16 +ve.<ref name=pmid23105122/>
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| *CDX2 -ve/+ve.
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| **May be useful to differentiate from vulva and penis.<ref name=pmid23105122>{{Cite journal | last1 = Gunia | first1 = S. | last2 = Koch | first2 = S. | last3 = May | first3 = M. | title = Is CDX2 immunostaining useful for delineating anorectal from penile/vulvar squamous cancer in the setting of squamous cell carcinoma with clinically unknown primary site presenting with histologically confirmed inguinal lymph node metastasis? | journal = J Clin Pathol | volume = 66 | issue = 2 | pages = 109-12 | month = Feb | year = 2013 | doi = 10.1136/jclinpath-2012-201138 | PMID = 23105122 }}</ref>
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| ===Sign out===
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| <pre>
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| RECTUM, DISTAL, BIOPSY:
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| - INVASIVE SQUAMOUS CELL CARCINOMA.
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| </pre>
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| ==Anal gland adenocarcinoma== | | ==Anal gland adenocarcinoma== |