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Difference between revisions of "Hemorrhoid"
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{{ 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]] | |||