Difference between revisions of "Hemorrhoid"
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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> | 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). | *[[Bright red blood per rectum]] (BRBPR). | ||
*Pain. | *Pain. | ||
*Itching. | *Itching. | ||
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</ref> | </ref> | ||
==Microscopic== | |||
Features:<ref name=Ref_GLP401>{{Ref GLP|401}}</ref> | Features:<ref name=Ref_GLP401>{{Ref GLP|401}}</ref> | ||
*Polypoid lesion - epithelium on three sides: | *Polypoid lesion - epithelium on three sides: | ||
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**[[Angiosarcoma]]. | **[[Angiosarcoma]]. | ||
**[[Arteriovenous malformation]] - has large arteries. | **[[Arteriovenous malformation]] - has large arteries. | ||
*[[Mucosal prolapse]]. | |||
===Image=== | ===Image=== | ||
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HEMORRHOIDS, EXCISION: | HEMORRHOIDS, EXCISION: | ||
- HEMORRHOIDS. | - 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> | </pre> | ||
Latest revision as of 12:10, 26 June 2014
| 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:
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)
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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.
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.
- ↑ 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.