Hemorrhoids

Author: Mikael Häggström

Gross pathology of hemorrhoids, showing engorged blood vessels.

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

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 (submucosal vessels with dilation, thick walls and congestion, often thrombosed)
• 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) or superficial spread of carcinoma or melanoma (look at basal layer and surrounding epidermis.

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.)

Main page

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