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Classification
of anal
adenocarcinoma
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Irregular mucosa and angioectasia
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Anal canal cancer
Contributed by Raul S. Gonzalez, M.D.
Infiltrating, gland forming
Infiltrating glands
Mucinous and signet ring
Fistula tract associated
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Coronal section of rectum and anal canal
Columns of Morgagni and the anal valves
Inner wall of the lower end of the rectum and anus
Median sagittal section of male pelvis
Median sagittal section of female pelvis
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Anal / rectal junction and sphincter
Contributed by Xiaoyan Liao, M.D., Ph.D.
Well circumscribed tumor located deep in perianal dermal tissue
Low high grade components, with comedo necrosis in high grade components
Cribriform architecture, tumor cells with abundant eosinophilic cytoplasm
GCDFP-15
Smooth muscle actin
Ki67
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Perianal basal cell carcinoma
Contributed by Raul S. Gonzalez, M.D.
Basal cell carcinoma
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Cell clusters
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Tumor invading the rectum
Extensive pelvic infiltration of tumor
Pelvic structures infiltrated by tumor
Tumor expands along the endopelvis
Tumor involves the inguinal area
Contributed by Philippe Simon, M.D. and Andrew L. Atkinson, M.D.
Bulky tumor of vulva and anus
Large exophytic tumor of vulva and perineum
Contributed by Lewis A. Hassell, M.D. (source: Juan Rosai Slide Collection)
Well formed papillae with fibrovascular cores
Hyperkeratosis with parakeratosis
Koilocytes and fungal elements
Koilocytes with perinuclear clearing
Chronic
inflammation and
vascular changes
in stroma
Giant condyloma
Contributed by Erna Forgó, M.D.
Single warty lesion
Multiple flat lesions
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Severe case
Contributed by Jian-Hua Qiao, M.D.
Vaginal condyloma
Contributed by Erna Forgó, M.D. and AFIP images
Koilocytosis
Papillary exophytic squamous epithelium
Hyperplastic squamous epithelium
Papillary exophytic squamous epithelium
Large papillary structures
Negative p16 expression (nonblock positivity)
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LSIL, Pap
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Large perianal skin tags
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Colon of 39 year old male
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Epithelioid cells, giant cells, lymphocytes
Fistula formation
Fistula opening onto perineum
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CT findings in a patient with CMV colitis
Contributed by Martha M. Yearsley, M.D.
Diffuse erythema
Pseudomembrane
formation
Irregular ulceration, loss of vascular pattern
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Diffuse inflammation
Ulcerating mass
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Ulceration and erythema
Ulceration secondary to CMV colitis
Terminal ileum
Cecum
Multiple, small punctate ulcers in the mucosa
Contributed by Martha M. Yearsley, M.D.
Enlarged cells in colonic lamina propria
Cytomegalic endothelial cells
Owl's eye and coarse red granules
Infected endothelial cells
Cytomegalic endothelial cells partially occluding vessel
Immunoreactivity with CMV immunostain
Scattered CMV positive cells
CMV positive endothelial cells
Contributed by @RaulSGonzalezMD on Twitter
Cytomegalovirus (CMV)
CMV colitis in ulcerative colitis and immunocompromised states
Contributed by Arvind Rishi, M.D., M.B.B.S.
Pathophysiology and progression of anal fissure
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Perianal abscesses
Fistulae and ischiorectal abscess
Fistula classification
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Endoanal USG
Inflammatory infiltrate
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Horseshoe fistula in ano
Multiple fistula tracts
Contributed by Fahire Goknur Akarca, M.D. and Kwun Wah Wen, M.D., Ph.D.
Epithelized anal fistula tract
Granulation tissue with inflammatory cells
Giant cells, in association with granulation tissue
Perianal fistula
Fistula in ano
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MRI of perianal mass
Ultrasound of perianal mass
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Anal polypoid mass
Perianal cutaneous nodule
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Excision of perianal tumor
Contributed by Raul S. Gonzalez, M.D.
Gastroesophageal junction lesion
Pseudoepitheliomatous
hyperplasia
Phagolysosomes
S100
CD68
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Ultrastructural view
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Diffuse ulceration
Auto-amputation
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Safety pin shaped structures
Epithelioid histiocytes
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Common sites of major anal and internal hemorrhoids
Prominent prolapsed true (internal) hemorrhoids
Hemorrhoids at anorectal junction
Contributed by James Mueller, M.D., Ph.D. and Vikram Deshpande, M.D.
Typical hemorrhoid
Transitional mucosa
Thrombosed hemorrhoid
Ulcerated hemorrhoid
AIN3
SCC presenting as hemorrhoids
Colorectal adenocarcinoma presenting as hemorrhoids
Papillary endothelial hyperplasia
Incidental AIN
p16 IHC stain
Histopathology of hemorrhoids
Overview of hemorrhoids
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Fistulous tract
Contributed by Qingqing Liu, M.D., Ph.D.
Typical features
Thin walled vessels
Chronic inflammation
Atypical stromal cells
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Cloacogenic polyps on rectal retroflexion
Contributed by Nikka Khorsandi M.D., M.P.H., Kwun Wah Wen, M.D., Ph.D. and Yvonne Bury, M.D.
Squamous and glandular epithelium
Surface erosion
Mucosal erosion
Regenerative epithelial changes
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Groove sign (squamous cell carcinoma, not LGV)
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C. trachomatis inclusion bodies (brown)
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Anorectal mass (CT of pelvis)
Anorectal mass (MRI)
Anorectal mass (MRI / PET)
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Anorectal mass
Prolapsed anal mass
Prolapsed anorectal mass
Polypoid lesion on colonoscopy
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Pigmented anal mass
Anorectal mass
Contributed by Aaron R. Huber, D.O. and @RaulSGonzalezMD on Twitter
Tumor underlying squamous epithelium
Epithelioid and spindled cells
Malignant cells with pigment
Ulcerated mucosa
Malignant cells with pigment
Large nuclei with prominent nucleoli
SOX10
MelanA
PRAME
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Primary anal melanoma
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Metastatic melanoma smears
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MRI
PET scan
Metastatic disease
Contributed by Raul S. Gonzalez, M.D.
Small cell carcinoma
Large cell carcinoma
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Extensive perianal Paget disease, perineum
Early response
Notable telangiectasia and fibrosis
Contributed by Raul S. Gonzalez, M.D.
Visible Paget cells
Prominent intracytoplasmic mucin
Contributed by Raul S. Gonzalez, M.D.
Anorectal tumor
Anal tumor
Large exophytic mass
Contributed by Raul S. Gonzalez, M.D.
Infiltrating anal mass
Prominent nuclear atypia
Necrosis
Contributed by Xiaoyan Liao, M.D., Ph.D.
Condyloma acuminatum
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Anoscopy
Contributed by Xiaoyan Liao, M.D., Ph.D. and @AnaPath10 on Twitter
Flat squamous proliferation
Papillary squamous proliferation
Papillary squamous proliferation, parakeratosis and koilocytosis
Condyloma with invasion
Invasive
squamous cell
carcinoma arising
in condyloma
HSIL
HSIL at the anal transitional zone
Involving a hemorrhoid
Squamous dysplasia
Squamous dysplasia
p16 immunohisto-
chemistry
HPV in situ hybridization
Squamous dysplasia
Contributed by Irene Y. Chen, M.D.
Anal Pap smear
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LSIL
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Multiple perianal lesions
Anorectal ulcerated mass
Exophytic perineal lesions
Condylomata lata
Contributed by Aaron R. Huber, D.O.
Epithelial hyperplasia and inflammation
Plasma cell infiltrate
Rectal biopsy with inflammation
Silver stain
T. pallidum IHC
Perianal condyloma lata
Syphilis stains and IHC
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Retrorectal space
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Retrorectal cystic mass
Malignant transformation
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Posterior approach view
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Intact resection
Mud-like contents
Tailgut cyst adenocarcinoma
Contributed by John D. Paulsen, M.D. and Alexandros D. Polydorides, M.D., Ph.D.
Dense fibroconnective tissue stroma
Disorganized smooth muscle
Epithelial linings
Multiple loculations
Mucinous columnar epithelium
Neoplastic transformation, neuroendocrine tumor
Contributed by Raul S. Gonzalez, M.D.
Verrucous carcinoma
Cohen: 2014
Greenson: 2019
IARC: 2019
Lamps: 2015
Montgomery: 2024
Odze: 2022
Srivastava: 2023
Voltaggio: 2024
Yantiss: 2021
Zutshi: 2016
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