Leukoplakia of the anal verge with bleeding hemorrhoids: a case report

case report On 14th August 2002, a 46-yearold male, an office clerk, reported with bleeding and prolapse per rectum for since 6 months, however without any complaint of any pain, pruritus or discharge per anus.. Upon anal and intra anal examination a circumferential area of thickening and whitish discoloration of the anal verge, which was extending up to the dentate line, was found. Perianal skin was macerated, excoriated and thickened, suggestive of leukoplakia. (Figure 1) Anoscopy showed prolapsing hemorrhoids. The patient gave no history of previous anal surgery, homosexual contact or exposure to radiation. He had been using various hemorrhoids ointments in and around the anus for the last four months. The test for HIV virus was negative. The hemorrhoids were ablated using a Ellman radiowave generator [Ellman International Inc., Oceanside, NY, USA] under local anesthesia with the patient in a lithotomy position. A biopsy was taken from the anal verge and the patient was discharged after 2 hours. He was asked to return after 4 weeks. The microscopic picture of the biopsied anal skin showed pronounced cornification of the anoderm. Acanthosis was prominent, but rete cells were orderly and the basal layer was well defined. The dermis showed profuse chronic inflammation, with lymphocytes, plasma cells and large mononuclear cells in the papillary layer. At the 4 week follow-up, the patient was asymptomatic, the biopsy wound was healed and the hemorrhoids were not visible. The patient was asked to report each year or earlier if symptoms appeared. At the last follow-up in October 2007, the patient had no specific anal symptoms except occasional Dyschezia. The leukoplakic area remained unchanged.