INITIAL BIOPSY
CLINICAL NOTES: Ulcerated anal skin tag. 3/12 Hx of pain/PR bleeding -> biopsies.
MACROSCOPIC DESCRIPTION: "Unlabelled as to site": Multiple fragments of soft tan and cream tissue 1-4mm. A1.
MICROSCOPIC DESCRIPTION:
The section shows a polypoid epithelial lesion composed of tubular and villous structures lined by a stratified arrangement of pleomorphic columnar epithelial cells. These have enlarged round, oval and angulated hyperchromatic and vesicular nuclei and a small amount of eosinophilic cytoplasm. Occasional mitotic figures are identified. Irregularly shaped glandular structures are seen to extend into connective tissue at the base of the lesion. Similar irregularly shaped glandular structures are also present within the lamina propria of the larger accompanying fragment of squamous mucosa. No lymphovascular or perineurial invasion is seen. The features are of moderately differentiated adenocarcinoma arising in a severely dysplastic tubulovillous adenoma.
DIAGNOSIS:
Anal skin: Moderately differentiated adenocarcinoma arising in a severely dysplastic tubulovillous adenoma.