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Anal fissures — is a pathomorphological study of excised fragments of the mucous membrane and skin of the anal canal, which were formed as a result of a chronic tissue defect. Code PG062 provides for the analysis of the edges of the fissure and underlying tissues. This is necessary to confirm the diagnosis of "chronic anal fissure", assess the degree of cicatricial changes and, most importantly, exclude specific diseases or cancer that can mask a normal fissure.

Research objective: The main task is to verify the pathological process. Since the long-term existence of the fissure leads to the formation of «sentinel tubercles» and deep scars, the pathologist must make sure that these changes do not hide squamous cell carcinoma of the anal canal, Crohn's disease, or specific infections (for example, tuberculosis or syphilis).

What does the pathologist evaluate:

Depth of defect: assessment of the spread of the ulcer process within the mucous membrane or with the involvement of the sphincter muscle fibers.
Degree of fibrosis: analysis of the replacement of normal tissues with coarse connective tissue, which explains the lack of self-healing.
Presence of inflammation: description of the nature of the infiltrate (acute, chronic or granulomatous inflammation).
Cellular atypia: careful search for signs of dysplasia or malignant degeneration of the epithelium at the edges of the crack.
Morphology of the "guardian mound": assessment of hypertrophied tissues for the presence of inflammatory hyperplasia or signs of malignancy.

Clinical significance: The conclusion with the code PG062 allows the proctologist to establish a final diagnosis. If histology confirms a banal chronic fissure, surgical treatment is considered complete. If signs of Crohn's disease or neoplasia are detected, the patient is referred for specific treatment to a gastroenterologist or oncologist.

When is it prescribed:

after surgical excision of a chronic anal fissure;
if malignant transformation of a long-existing mucosal defect is suspected;
in case of an atypical appearance of the crack (too wide edges, uneven bottom);
for differential diagnosis with infectious and autoimmune lesions of the rectum.