Hemorrhoid
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| 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 |
| 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 |
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.
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:
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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.