Elliptical incisional and excisional biopsies of the perineal skin and anal margin are handled similarly to skin biopsies. Anal canal biopsy fragments are processed as previously described -see Gastrointestinal Specimens - General Comments (page 6). Specific points of note are:
Haemorrhoids: typically nodular and 1-2 cm in diameter with a smooth covering mucosa and ectatic submucosal vessels. Bisect vertically down through the epithelial surface and process both halves. With larger or multiple specimens a mid-slice of each is taken.
Skin tags: count and measure, process intact, vertically bisect or take a representative mid-slice according to size.
Fissure-in-ano: not usually excised although biopsy fragments of granulation tissue from its edge may be submitted.
Anorectal abscess: usually heavily inflamed ellipses of tissue from the covering skin, lateral or deep aspects of the abscess wall. Measure, process intact, vertically bisect or take a representative mid-slice according to size.
Fistula-in-ano (Figure 7.3): rarely resected but typically a small skin ellipse often with a punctate opening on the surface, minimal subcutaneous tissue and a stringy attachment which may be up to several centimetres long - the fistulous tract. It may also be submitted in fragments if excision was difficult. Measure the skin ellipse, its opening and the tract. Take a block vertically through the skin to include the punctum and represent any subcutaneous abscess. Sample multiple transverse sections of the fistulous tract and label a transverse deep resection limit block.
Cloacogenic polyp: measure, vertically bisect or take representative slices. Prior to this paint the deep and lateral margins in case it turns out to be polypoid tumour.
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