آزمايشگاه رز - Ackerman Atlas(chaptr18)

Anus

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Figure 18.1 Diagrammatic representation of normal anal structures. (From Lamps LW, et al. Diagnostic Pathology: Normal Histology. Salt Lake City, UT: Amirsys; 2014)

Figure 18.2 Normal anal duct, lined by transitional epithelium, running longitudinally through the muscle wall

Figure 18.3 Normal transition zone mucosa of anal canal. The stratified epithelium somewhat resembles bladder epithelium or immature squamous epithelium histologically

Figure 18.4 Anal fissure in the posterior midline. (Courtesy of Dr. Jason Mizell.)

Figure 18.5 Multiple fistulous tracts (arrows) in a patient with Crohn disease. (Courtesy of Dr. Jason Mizell)

Figure 18.6 A, Fibroepithelial polyps, anal skin tags, and hypertrophic papillae are essentially identical and consist of a central core of edematous and inflamed fibrovascular stroma covered by squamous epithelium. (Courtesy of Dr. Sara Shalin.) B, These lesions can grow to an impressive size

Figure 18.7 Inflammatory cloacogenic polyp featuring perpendicular fibromuscular hyperplasia, prominent lamina propria capillaries, and a villiform appearance to the surface mucosa with overlying erosion and fibrinopurulent exudate. (Courtesy of Dr. Rhonda Yantiss)

Figure 18.8 Large external hemorrhoid protruding through the anal orifice. (Courtesy of Dr. Jason Mizell.) Engorged vessels are clearly visible

Figure 18.9 Hemorrhoid with markedly dilated submucosal vessels containing numerous thrombi. The overlying epithelium is both squamous and transitional

Figure 18.10 Perianal Crohn disease featuring noncaseating epithelioid granulomas with scattered multinucleated giant cells and associated chronic inflammation, fibrosis, and ulceration of the squamous epithelium

Figure 18.11 A, Granuloma inguinale clinically simulating carcinoma. B, Donovan bodies (arrow) within cyst in cytoplasm of macrophage in a patient with granuloma inguinale (Warthin-Starry stain)

Figure 18.12 Anorectal lymphogranuloma venereum featuring a dense lymphohistiocytic infiltrate with prominent plasma cells, mimicking chronic idiopathic inflammatory bowel disease (Courtesy of Dr. Rhonda Yantiss)

Figure 18.13 Lymphogranuloma venereum complicated by squamous cell carcinoma

Figure 18.14 A, This HIV+ patient has multiple condylomata complicated by SCC. B, The cut surface of this anal condyloma shows the typical papillary, cauliflower-like appearance. (A, Courtesy of Dr. Rhonda Yantiss; B, Courtesy of Dr. George F. Gray, Jr.)

Figure 18.15 A and B, Low-power views of anal condylomata. C and D, Characteristic features of koilocytes include wrinkled nuclear contours, sharply demarcated perinuclear clearing, and binucleation. E, Dyskeratotic keratinocytes are common

Figure 18.16 High-Grade SIL (AIN2/3) Features Full Thickness Nuclear Atypia. A, Increased nuclear density and loss of maturation are apparent, as seen here at the transition zone. B, Dysplastic cells are characterized by nuclear membrane irregularity, hyperchromasia, enlargement, and pleomorphism; increased mitoses are obvious as well, including atypical mitoses mitotic figures present well above the basal zone. C, Overlying atypical parakeratosis is common. (Courtesy of Dr. Keith Lai.)

Figure 18.17 A, Diffuse, 'block-like' staining with p16 in a case of anal HGSIL. B, In contrast, LGSIL and reactive processes usually show absent or weak, patchy staining. (A, Courtesy of Dr. Keith Lai.)

Figure 18.18 The differentiated (or simplex) type of SIL shows marked basal atypia with eosinophilic cytoplasm and preservation of squamous maturation, similar to vulvar SIL. (Courtesy of Drs. Keith Lai and Brad Fogel.)

Figure 18.19 A, This squamous cell carcinoma (SCC) of the anal canal has a verrucoid appearance and protrudes out through the anal orifice. Note the small adjacent condylomata (arrows). B, This ulcerated SCC with rolled edges extends out to involve the perianal skin. (A, Courtesy of Dr. Jason Mizell; B, Courtesy of Dr. Jason Mizell.)

Figure 18.20 A and B, Invasive conventional-type (keratinizing) anal squamous cell carcinoma undermining perianal skin. C, Keratinization, including keratin whorls or "pearls," may be prominent

Figure 18.21 A and B, Basaloid (nonkeratinizing) SCC features irregular nests of basophilic cells that

may have peripheral palisading of nuclei. C, Some have focal keratinization (arrow)

Figure 18.22 Squamous cell carcinoma (SCC) with mucinous microcysts has also been referred to as microcystic SCC or mucoepidermoid car- cinoma of the anus

Figure 18.23 Verrucous carcinoma of the anus has a pushing, rather than an infiltrative, border. Note the juxtaposition of the tumor with the muscle of the anal canal wall

Figure 18.24 A, This anal duct adenocarcinoma infiltrates the perianal soft tissues and forms a large mass that undermines the overlying epithelium. B and C, This anal duct adenocarcinoma features deeply infiltrating well differentiated glands associated with large pools of dissecting mucin. The glands are present deep within the anal musculature. This example (D) shows clusters of poorly differentiated cells (including signet ring cells) in pools of mucin. This tumor was CK7+ and CK20-, consistent with an anal primary

Figure 18.25 Gross Appearance of Paget Disease of the Anus. A, The lesion is erosive and hyperemic and has ill-defined borders. B, Paget cells are predominantly located along the basal layer, infiltrating the epithelium as individual cells or nests. The cells are large with atypical nuclei, abundant pale cytoplasm, and occasional mucin vacuoles

Figure 18.26 This basal cell carcinoma "buds" from the overlying perianal skin and shows a nodular tumor composed of basaloid cells with prominent peripheral palisading

Figure 18.27 A, Cross section from excision specimen of an anal melanoma demonstrates the polypoid configuration of the tumor as well as the pigmentation. Note the extension into the surrounding mucosa. B, This biopsy from an anal melanoma demonstrates involvement at the dermal/epidermal junction. C, High-power view shows large, epi- thelioid tumor cells with abundant pigment. D, This desmoplastic anal melanoma features a spindle cell proliferation with a prominent col- lagenous matrix and no pigment

Figure 18.28 Anogenital mammary analog glands give rise to a variety of tumors that resemble their breast counterparts, including fibroad- enoma (A) and hidradenoma papilliferum (B)

Figure 18.29 A, Embryonal rhabdomyosarcoma of perianal region. B, Electron microscopic appearance of embryonal rhabdomyosarcoma arising in perianal region. There is clear-cut evidence of skeletal muscle differentiation, including the formation of Z lines. (Courtesy of Dr. J. Magidson, Brookhaven, NY.)

Figure 18.30 A low rectal medullary carcinoma involving the anal canal

Figure 18.31 A and B, Lobular breast carcinoma metastatic to the anus