Hemorrhoid

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]

Bright red blood per rectum (BRBPR).
Pain.
Itching.
Prolapse.

Gross

Features:^[2]

Grey mucosa.
Pale or purple stroma.

DDx - clinical:

Malignant melanoma.^[3]

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.
Mucosal prolapse.

Image

Hemorrhoid - very low mag. (WC)
Hemorrhoid - low mag. (WC)
Hemorrhoid - low mag. (WC)
Hemorrhoid - intermed. mag. (WC)

www:

Hemorrhoids (profimedia.si).

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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.

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.

[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.

[Ref_GLP401-2] 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.

[pmid11592745-3] 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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