Myofibrotic malformation vessels: unique angiodysplasia toward the progression of hemorrhoidal disease
Sheng-Long Li,1,* Fang-Yan Jing,1–3,* Li-Li Ma,2,3 Li-Li Guo,2,3 Feng Na,2,3 Sheng-Li An,4 Yan Ye,5 Jun-Ming Yang,1 Ming Bao,1 Dong Kang,1 Xiao-Lan Sun,1 Yong-Jian Deng2,3 1Department of Anorectal Surgery, 2Department of Pathology, Nanfang Hospital, 3Department of Pathology, Scho...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2015-08-01
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| Series: | Drug Design, Development and Therapy |
| Online Access: | http://www.dovepress.com/myofibrotic-malformation-vessels-unique-angiodysplasia-toward-the-prog-peer-reviewed-article-DDDT |
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| author | Li SL Jing FY Ma LL Guo LL Na F An SL Ye Y Yang JM Bao M Kang D Sun XL Deng YJ |
| author_facet | Li SL Jing FY Ma LL Guo LL Na F An SL Ye Y Yang JM Bao M Kang D Sun XL Deng YJ |
| author_sort | Li SL |
| collection | DOAJ |
| description | Sheng-Long Li,1,* Fang-Yan Jing,1–3,* Li-Li Ma,2,3 Li-Li Guo,2,3 Feng Na,2,3 Sheng-Li An,4 Yan Ye,5 Jun-Ming Yang,1 Ming Bao,1 Dong Kang,1 Xiao-Lan Sun,1 Yong-Jian Deng2,3 1Department of Anorectal Surgery, 2Department of Pathology, Nanfang Hospital, 3Department of Pathology, School of Basic Medical Sciences, 4Department of Biostatistics, Southern Medical University, 5Department of General Surgery, Xintang Hospital, Zengcheng, Guangzhou, People’s Republic of China *These authors contributed equally to this work Background: The etiology and pathogenesis of hemorrhoids is unclear, although hemorrhoids are a worldwide disease in men and women, with peak prevalence at 45–65 years of age. Hemorrhoidal cushions as the anal venous plexi are normal anatomical structures from infancy. This study attempts to reveal the angiodysplasia and other pathological changes in association with different degrees of symptomatic hemorrhoids.Materials and methods: A total of 281 patients with internal hemorrhoids from degree I to IV underwent hemorrhoidectomy. The vascular changes were analyzed by microscopic assessment and software analysis, with Masson’s trichrome, CD34, and smooth muscle actin.Results: The hemorrhoidal tissues exhibited abnormal vessels in the mucosae and submucosae that we termed them as myofibrotic malformation vessels (MMVs). MMVs are not ascribed to arteries or veins because they exhibit enlarged and tortuous lumens with smooth muscle dysplasia and fibrotic deposition in the walls without overlying mucosal ulceration. The muscularis mucosae also showed smooth muscle dysplasia and fibrosis, even if it were interrupted by the intruding MMVs. The statistical data indicated that the severity of all the changes correlate positively with the progression of hemorrhoids (P<0.001). Hemorrhoidal patients are prone for reoccurrence even with prolapsing hemorrhoid when compared with the conventional hemorrhoidectomy. Multiple logistic regression analysis showed that MMVs in mucosal propria, mean thickness of mucosal muscularis layer, and fibrotic changes in MMV were independent risk factors for MMVs in hemorrhoidal disease.Conclusion: MMVs and muscularis mucosae dysplasia reciprocally contribute to hemorrhoidal exacerbation. The novel findings of this study propose that the characteristic features of MMVs and muscularis mucosae dysplasia of the anorectal tube ultimately cause symptomatic hemorrhoids, which could affect the clinical management of hemorrhoidal disease through the use of surgery to target the malformed vessels. Keywords: internal hemorrhoids, hemorrhoidal progression, myofibrotic malformation vessels, muscularis mucosae dysplasia, anorectal disease |
| first_indexed | 2024-12-12T13:44:52Z |
| format | Article |
| id | doaj.art-aed4905ba7e6439795989fca8c4ecfd8 |
| institution | Directory Open Access Journal |
| issn | 1177-8881 |
| language | English |
| last_indexed | 2024-12-12T13:44:52Z |
| publishDate | 2015-08-01 |
| publisher | Dove Medical Press |
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| series | Drug Design, Development and Therapy |
| spelling | doaj.art-aed4905ba7e6439795989fca8c4ecfd82022-12-22T00:22:42ZengDove Medical PressDrug Design, Development and Therapy1177-88812015-08-012015default4649465623132Myofibrotic malformation vessels: unique angiodysplasia toward the progression of hemorrhoidal diseaseLi SLJing FYMa LLGuo LLNa FAn SLYe YYang JMBao MKang DSun XLDeng YJSheng-Long Li,1,* Fang-Yan Jing,1–3,* Li-Li Ma,2,3 Li-Li Guo,2,3 Feng Na,2,3 Sheng-Li An,4 Yan Ye,5 Jun-Ming Yang,1 Ming Bao,1 Dong Kang,1 Xiao-Lan Sun,1 Yong-Jian Deng2,3 1Department of Anorectal Surgery, 2Department of Pathology, Nanfang Hospital, 3Department of Pathology, School of Basic Medical Sciences, 4Department of Biostatistics, Southern Medical University, 5Department of General Surgery, Xintang Hospital, Zengcheng, Guangzhou, People’s Republic of China *These authors contributed equally to this work Background: The etiology and pathogenesis of hemorrhoids is unclear, although hemorrhoids are a worldwide disease in men and women, with peak prevalence at 45–65 years of age. Hemorrhoidal cushions as the anal venous plexi are normal anatomical structures from infancy. This study attempts to reveal the angiodysplasia and other pathological changes in association with different degrees of symptomatic hemorrhoids.Materials and methods: A total of 281 patients with internal hemorrhoids from degree I to IV underwent hemorrhoidectomy. The vascular changes were analyzed by microscopic assessment and software analysis, with Masson’s trichrome, CD34, and smooth muscle actin.Results: The hemorrhoidal tissues exhibited abnormal vessels in the mucosae and submucosae that we termed them as myofibrotic malformation vessels (MMVs). MMVs are not ascribed to arteries or veins because they exhibit enlarged and tortuous lumens with smooth muscle dysplasia and fibrotic deposition in the walls without overlying mucosal ulceration. The muscularis mucosae also showed smooth muscle dysplasia and fibrosis, even if it were interrupted by the intruding MMVs. The statistical data indicated that the severity of all the changes correlate positively with the progression of hemorrhoids (P<0.001). Hemorrhoidal patients are prone for reoccurrence even with prolapsing hemorrhoid when compared with the conventional hemorrhoidectomy. Multiple logistic regression analysis showed that MMVs in mucosal propria, mean thickness of mucosal muscularis layer, and fibrotic changes in MMV were independent risk factors for MMVs in hemorrhoidal disease.Conclusion: MMVs and muscularis mucosae dysplasia reciprocally contribute to hemorrhoidal exacerbation. The novel findings of this study propose that the characteristic features of MMVs and muscularis mucosae dysplasia of the anorectal tube ultimately cause symptomatic hemorrhoids, which could affect the clinical management of hemorrhoidal disease through the use of surgery to target the malformed vessels. Keywords: internal hemorrhoids, hemorrhoidal progression, myofibrotic malformation vessels, muscularis mucosae dysplasia, anorectal disease http://www.dovepress.com/myofibrotic-malformation-vessels-unique-angiodysplasia-toward-the-prog-peer-reviewed-article-DDDT |
| spellingShingle | Li SL Jing FY Ma LL Guo LL Na F An SL Ye Y Yang JM Bao M Kang D Sun XL Deng YJ Myofibrotic malformation vessels: unique angiodysplasia toward the progression of hemorrhoidal disease Drug Design, Development and Therapy |
| title | Myofibrotic malformation vessels: unique angiodysplasia toward the progression of hemorrhoidal disease |
| title_full | Myofibrotic malformation vessels: unique angiodysplasia toward the progression of hemorrhoidal disease |
| title_fullStr | Myofibrotic malformation vessels: unique angiodysplasia toward the progression of hemorrhoidal disease |
| title_full_unstemmed | Myofibrotic malformation vessels: unique angiodysplasia toward the progression of hemorrhoidal disease |
| title_short | Myofibrotic malformation vessels: unique angiodysplasia toward the progression of hemorrhoidal disease |
| title_sort | myofibrotic malformation vessels unique angiodysplasia toward the progression of hemorrhoidal disease |
| url | http://www.dovepress.com/myofibrotic-malformation-vessels-unique-angiodysplasia-toward-the-prog-peer-reviewed-article-DDDT |
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