Hemorrhoids: Difference between revisions
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==Microscopic evaluation== | ==Microscopic evaluation== | ||
[[File:Histopathology of hemorrhoid.jpg|thumb|A hemorrhoid; a dilated vein with an organized thrombus, below anal epithelium.]] | [[File:Histopathology of hemorrhoid.jpg|thumb|A hemorrhoid; a dilated vein with an organized thrombus, below benign anal epithelium.]] | ||
*Have a brief scroll through the tissue to confirm the diagnosis of '''hemorrhoids'''. | *Have a brief scroll through the tissue to confirm the diagnosis of '''hemorrhoids''' (submucosal vessels with dilation, thick walls and congestion, often thrombosed)<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/anushemorrhoids.html|title=Anus & perianal area - Other nonneoplastic - Hemorrhoids|author=Elliot Weisenberg, M.D.|website=Pathology Outlines}} Topic Completed: 1 May 2014. Minor changes: 7 June 2021</ref> | ||
*Look at the '''epithelium''' for any [[anal intraepithelial neoplasia]]. | *Look at the '''epithelium''' for any [[anal intraepithelial neoplasia]]. | ||
:'''Example | |||
===Common findings=== | |||
<gallery mode=packed heights=170> | |||
File:Anorectal mucosa with hemorrhoid.jpg|'''Hyperplasia''' (anorectal mucosa shown) | |||
File:Histopathology of pagetoid dyskeratosis in epidermis of hemorrhoid.jpg|'''Pagetoid dyskeratosis''', with pale cells, occurs in most hemorrhoids. Look mainly for nuclear enlargement, which may indicate [[koilocyte]]s (having raisin-like dark nuclei), extramammary Paget's disease (having prominent nucleoli)<ref>{{cite web|url=https://plasticsurgerykey.com/mammary-and-extramammary-pagets-disease/#56061750|title=Mammary and Extramammary Paget’s Disease|website=Palstic Surgery Key|date=2016-06-11}}</ref> or superficial spread of carcinoma or [[melanoma]] (look at basal layer and surrounding epidermis.<ref name="pmid11473458">{{cite journal| author=Val-Bernal JF, Pinto J| title=Pagetoid dyskeratosis is a frequent incidental finding in hemorrhoidal disease. | journal=Arch Pathol Lab Med | year= 2001 | volume= 125 | issue= 8 | pages= 1058-62 | pmid=11473458 | doi=10.5858/2001-125-1058-PDIAFI | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11473458 }} </ref> | |||
</gallery> | |||
===Microscopic report=== | |||
*Diagnosis of '''hemorrhoids''' | |||
*{{Moderate-begin}}Description of thrombi.{{Moderate-end}} | |||
*{{Moderate-begin}}Even benign epithelium, with specification of types seen, that is, anoderm, rectal, or anorectal if both are seen.{{Moderate-end}} | |||
*{{Comprehensive-begin}}Any epidermal hyperplasia and/or Pagetoid dyskeratosis.{{Comprehensive-end}} | |||
:'''Example''': | |||
{|class=wikitable | {|class=wikitable | ||
| {{Moderate-begin}}Anal tissue, excision: | | {{Moderate-begin}}Anal/Rectal/Anorectal tissue, excision:{{Moderate-end}}<br>Hemorrhoids {{Moderate-begin}}with organizing thrombi, and benign anoderm/rectal mucosa/anorectal mucosa.{{Moderate-end}} | ||
|} | |} | ||
{{Bottom}} | {{Bottom}} | ||
Latest revision as of 13:29, 5 April 2022
Author:
Mikael Häggström [note 1]
Fixation
Generally 10% neutral buffered formalin.
Comprehensiveness
On this resource, the following formatting is used for comprehensiveness:
- Minimal depth
- (Moderate depth)
- ((Comprehensive))
Gross processing
Gross report
Example:
| ((A. Labeled - hemorrhoids. The specimen is received in formalin and consists of)) __ [[number of]] irregular fragment(s) of pink-tan tissue, partially covered by skin and mucosa, measuring __. On sectioning, engorged blood vessels are identified. ((Representative sections are submitted for microscopic examination in one cassette.)) |
Microscopic evaluation
- Have a brief scroll through the tissue to confirm the diagnosis of hemorrhoids (submucosal vessels with dilation, thick walls and congestion, often thrombosed)[1]
- Look at the epithelium for any anal intraepithelial neoplasia.
Common findings
-
Hyperplasia (anorectal mucosa shown) -
![Pagetoid dyskeratosis, with pale cells, occurs in most hemorrhoids. Look mainly for nuclear enlargement, which may indicate koilocytes (having raisin-like dark nuclei), extramammary Paget's disease (having prominent nucleoli)[2] or superficial spread of carcinoma or melanoma (look at basal layer and surrounding epidermis.[3]](https://upload.wikimedia.org/wikipedia/commons/thumb/8/82/Histopathology_of_pagetoid_dyskeratosis_in_epidermis_of_hemorrhoid.jpg/500px-Histopathology_of_pagetoid_dyskeratosis_in_epidermis_of_hemorrhoid.jpg?utm_source=commons.wikimedia.org&utm_campaign=imageinfo&utm_content=thumbnail)
Pagetoid dyskeratosis, with pale cells, occurs in most hemorrhoids. Look mainly for nuclear enlargement, which may indicate koilocytes (having raisin-like dark nuclei), extramammary Paget's disease (having prominent nucleoli)[2] or superficial spread of carcinoma or melanoma (look at basal layer and surrounding epidermis.[3]
![Pagetoid dyskeratosis, with pale cells, occurs in most hemorrhoids. Look mainly for nuclear enlargement, which may indicate koilocytes (having raisin-like dark nuclei), extramammary Paget's disease (having prominent nucleoli)[2] or superficial spread of carcinoma or melanoma (look at basal layer and surrounding epidermis.[3]](/File:Histopathology_of_pagetoid_dyskeratosis_in_epidermis_of_hemorrhoid.jpg)
Microscopic report
- Diagnosis of hemorrhoids
- (Description of thrombi.)
- (Even benign epithelium, with specification of types seen, that is, anoderm, rectal, or anorectal if both are seen.)
- ((Any epidermal hyperplasia and/or Pagetoid dyskeratosis.))
- Example:
| (Anal/Rectal/Anorectal tissue, excision:) Hemorrhoids (with organizing thrombi, and benign anoderm/rectal mucosa/anorectal mucosa.) |
Notes
- ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.
Main page
References
- ↑ Elliot Weisenberg, M.D.. Anus & perianal area - Other nonneoplastic - Hemorrhoids. Pathology Outlines. Topic Completed: 1 May 2014. Minor changes: 7 June 2021
- ↑ . Mammary and Extramammary Paget’s Disease. Palstic Surgery Key (2016-06-11).
- ↑ Val-Bernal JF, Pinto J (2001). "Pagetoid dyskeratosis is a frequent incidental finding in hemorrhoidal disease. ". Arch Pathol Lab Med 125 (8): 1058-62. doi:. PMID 11473458. Archived from the original. .
Image sources