Hemorrhoidal disease III and IV: histopathological assessment in women of different age groups

Hemorroids are normal vascular structures found in submucosa of anal canal, while hemorrhoidal disease (HD) is characterised by its sympthomatic enlargement and distal dislocation. Besides, nowadays it increasingly occures in younger individuals. Morphologically HD is mainly described by varicous veins, however, other histopathological changes contributing to its pathogenesis remain obscure.  The HD III and IV tissue samples were obtained from 39 patients during closed and open excisional hemorrhoidectomy (Longo, MilLīgan-Morgan, Ferguson) subdivided into two groups stated by age – women ≤45 years of age (group A) and >45 years of age (group B), respectively. The tissues were processed conventionally, sectioned, and stained with hematoxylin and eosin. Histopathological changes evaluated using light microscope ×100 – 400 magnification. Statistical data analysis performed using SPSS 22.0. Overall 39 patients were identified, 51% in group A and 49% in group B with the median age of 35.45 (IQR=33–38) and 65.26 (IQR=51–70), respectively. In both groups, varicous veins were found in 50% (group A) and 52.7% (group B), respectively. Thrombosed veins were observed almost half more (30%) in group A when compared to group B (15.8%).Sclerosis of varicous veins was identified more often in group A (60%) than in group B (42.1%). Mucosa of the anal cushions was found hyperplastic in 4 (20%) subjects of the younger age exclusively, whereas odematous submucosa – in 2 (10%) and 1 (1.3%) of women in group A and B, respectively. Finally, chronic inflammation was observed in 25 and 1.3% of samples in group A and B, respectively. Histopathological assessment confirmed the presence of structural differences in the anal cushions of women aged younger and older than forty-five. Younger patients presented with thrombosis and sclerosis of veins significantly more often than older women. Hyperplastic mucosa of the anal cushion was demonstrated in the younger women’s group exclusively.